23-03-23 - Screening and prevention of STI Flashcards
Learning outcomes
- Illustrate the application of behavioural science to screening
- Evaluate the various methods of encouraging screening levels
- Explain the psychological basis of society not following the recommendations of a screening programme
What is the UK National Screening Committee definition of screening?
- UK National Screening Committee definition of screening:
- “A process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition”
What are the 10 parts of the Wilson & Jungner Screening criteria (WHO 1968)?
- 10 parts of the Wilson & Jungner Screening criteria (WHO 1968):
1) The condition being screened for should be an important health problem
2) The natural history of the condition should be well understood
3) There should be a detectable early stage
4) Treatment at an early stage should be of more benefit than at a later stage
5) A suitable test should be devised for the early stage
6) The test should be acceptable
7) Intervals for repeating the test should be determined
8) Adequate health service provision should be made for the extra clinical workload resulting from screening
9) The risks, both physical and psychological, should be less than the benefits
10) The costs should be balanced against the benefits
What are the 9 parts of the WHO revised Screening criteria (2008)?
- 9 parts of the WHO revised Screening criteria (2008):
1) Response to a recognised need
2) Objectives defined and evaluation planned at outset
3) Defined target population
4) Scientific evidence of effectiveness
5) Programme should be comprehensive and integrated
6) Quality assured, with systematic mitigation of risks
7) Informed choice, confidentiality, and respect for autonomy
8) Programme should promote equity and access to screening
9) The overall benefits of screening should outweigh the harm
What are the 2 outcomes of a screening programme?
- 2 outcomes of a screening programme:
1) Not screened – refused/did not get the opportunity
2) Screened
* True positive
* True negative
* False positive
* False negative
Who are the policy makers in screening?
What are 5 questions asked for every screening programme?
- The policy makers in screening are practitioners or the public
- 5 questions asked for every screening programme:
1) What do we offer screening for?
2) When and where is screening offered?
3) Who is offered screening?
4) Do you take up the screening offered?
5) What do you do after the results?
What are 4 models/theories that contribute to the decision to take up a screening opportunity?
- 4 models/theories that contribute to the decision to take up a screening opportunity:
1) Stages of change model (Prochaska & DiClemente, 1984)
* Contemplating or planning behaviour
2) Health belief model (Becker, 1974)
* Perceptions of the disease (susceptibility, risk, threat)
3) Theory of reasoned action (Ajzen & Fishbein, 1980)
* Perceptions and subjective norms related to the behaviour
4) Theory of planned behaviour (Ajzen, 1991)
* Locus of control
What are 3 parts of the COM-B model?
What do all of these factors affect?
- 3 parts of the COM-B model:
1) Capability
* An individual’s psychological and physical capacity to engage in the activity concerned.
2) Motivation
* All those brain processes that energize and direct behaviour, not just goals and conscious decision-making.
3) Opportunity
* All the factors that lie outside the individual that make the behaviour possible or prompt it.
- All of these factors contribute to behaviour
What are the 3 parts of the Social Cognitive Theory?
- 3 parts of the Social Cognitive Theory:
1) Behavioural Factors
* Skills, self-efficacy, practice
2) Environmental Factors
* Social norms, access in the community, influence on others and environment
3) Cognitive Factors
* Knowledge, expectations and attitudes
- These factors all exist in a triangle
STI screening Fishbone/Ishikawa diagram
What are the 5 individual consequences of STIs?
- 5 Individual consequences of STIs:
1) No sex
2) Infertility
3) Drugs e.g lifelong medication for HIV
4) Cervical cancer
5) Social media and stigma
Where can there be stigma in regards to STU screening?
What is a potential solution to this?
What is a downside to screening?
How can we increase the likelihood of screening?
- Stigma in regards to STI screening:
- From having an STI?
- From getting screened?
- A potential solution to this is anonymous and postal tests, which can be done for Chlamydia, Gonorrhoea and HIV
- A negative side to screening is that negative tests can be associated with reduced perception of risk (Shepherd & Smith, 2017, Thompson, et al. 2021)
- Individual sense of risk increases likelihood of screening Mevissen, et al. (2011)
- It’s been shown that providing tailored information on risk increased uptake of screening and condom use
Are males or females more likely to be screened?
Which groups were less likely to get cervical cancer screening?
- Females more likely to get screened than males
- Women who smoked, were obese and had poor perception of own health less likely to get cervical cancer screening (Harder, et al. 2021, Sassenou, et al. 2021)
What 3 factors inform sense of risk?
What do perceptions of the screening impact?
What 4 factors affect perceptions of the screening?
- 3 factors inform sense of risk:
1) Personal acceptable level of risk
2) Sense (locus) of control
3) Type of sexual contact - Perceptions of the screening impact on likelihood to be screened as well as attitudes to STIs (Shepherd & Harwood, 2017)
- 4 factors that affect perceptions of the screening:
1) Gender differences
2) Previous experiences of screening
3) Peers – social norms
4) Making Every Contact Count –
What 3 factors affect opportunity for STI screening?
What screening programmes have shown to be effective?
How can doctors bias effectiveness of STI screening?
- 3 factors affect opportunity for STI screening:
1) Ease of access
2) Opening hours
3) Privacy - Universal screening through school health services in New York, found to be effective, with more cases being identified and treated (Yussman & Urbach, 2020)
- How doctors can bias effectiveness of STI screening:
- ‘An unacceptably large percentage of people diagnosed with STI are not being tested for HIV because healthcare providers frequently fail to offer the test.’
- Not receiving an HIV test after the last STI diagnosis was independently associated with not being a man who has sex with men (MSM), having had fewer sexual partners, being diagnosed in general medical settings and having received a diagnosis other than syphilis.’
