Over the two study days 51 eligible women were seen by the GPs, 45 were asked to participate, and 36 agreed. Of these, interviews were undertaken with 24 (66%). Reasons for failure to be interviewed included: unable to contact the woman (1), unable to find a suitable time for the interview (1), refusal to be interviewed once contacted (1) and the decision on the part of the research team not to arrange interviews due to data saturation (9). The women were evenly distributed between urban, regional and rural areas. They were primarily recruited by female GPs.
How women thought screening could work
The women felt how they were approached about having a chlamydia test was important and that comprehensive information about chlamydia should be provided when the test was offered. There was strong agreement that age-based screening, for instance, of young women between 16 and 24 years, would be acceptable and non-discriminatory:
So I think you have to make it known, just even if they come out and say 'look, we screen everybody in this age and you're in that category...and we'd basically like to do that on you just to make sure.' And I wouldn't even go into detail or ask them how many people they've slept with.
Introducing the issue of chlamydia screening during a sexual health-related consultation was seen as appropriate as it was directly related to the consultation:
I think it depends on the circumstances of why I'm there. Like I said, if I was just purely going for a Pap smear, well then, you know, you're showing everything anyway.
Need to normalise chlamydia
Normalising chlamydia was seen as important to minimise stigma associated with chlamydia infection:
Well, Pap smears have been normalised. Community awareness, um, screening programs for everyone.
The women felt that chlamydia should be framed as a public health issue that is openly discussed rather than an issue that relates to the behaviour of an individual:
If there was something in the waiting-room that said your doctor may ask you about having the test, then you're a little bit more prepared for it, and if you saw in the paper that it was becoming a big issue and they'd probably ask you about it next time you go in...So it's much more a public health issue than a individual, yeah, hush-hush kind of....
A widespread community education campaign was seen as a crucial factor in normalising chlamydia testing and diagnosis.
Sexual history taking before a chlamydia test
These young women emphasised there should be no pressure put on women to provide a sexual history. Some felt that questions relating to number of partners would be a barrier to accepting a chlamydia test and that they would not answer them truthfully in any case:
Yeah. I wouldn't, I think I would lie about it if I got asked.
Young women were concerned about being judged and may not disclose sexual activity because of this:
No, that's something that would shock me, like, that's something that you
shouldn't be asking.
Psychosocial implications of chlamydia screening
Concerns were raised about the confronting nature of being tested for chlamydia and about fear of the infection:
..cause it's, like, you know, a scary word, and especially young girls it would probably just...I know it would scare the crap out of me.
There was particular concern that young women diagnosed with chlamydia would be judged and seen as sexually promiscuous:
There's a big stigma if you get something and that makes it really hard for people to get tested 'cause you feel like you're dirty or you're worthless or you've done something wrong.
However, although some young women felt that they would be 'embarrassed and ashamed' if they were diagnosed with chlamydia, others commented that the initial shock would turn to relief that the infection had been detected and could be treated:
...like, it's not anything that anyone likes to hear, but I think it's good because it does give you peace of mind and you're, like, 'oh, at least now I know. I can do something about it.'
Management of chlamydia infection
Women were asked about how they would want to receive their chlamydia test results. When asked, the young women were clear that they did not want to be contacted by SMS (mobile text messaging):
... some people might go through your phone and read the message or whatever.
Some women felt being contacted by email would be acceptable but a number did not have access to a computer and many had privacy concerns about email (although not as much as for SMS):
I don't like the Internet so much because, you know, anyone could view that, anyone could get in. You know it could be your little brother gets in and finds your results.
Many women felt receiving a letter to their home address would be acceptable, both for results and for recalls, as long as it was in an unmarked envelope. A phone-call was acceptable (particularly to mobile phones) but face-to-face with their GP was definitely preferred for receiving results, especially if positive.
A phone call would be best to say to come in, um, 'we need to talk to you about your test results,' and definitely one on one.
Partner notification
Interestingly more than half of the women interviewed thought that they probably would not tell their partners, particularly if it was a more casual sexual contact, or if they had subsequently broken up with that person:
I don't think I would tell somebody I wasn't with um, for a long period, that I didn't, wasn't in an official relationship with, because you'd think, you'd probably think, 'that's my business, not theirs.'
Some of the reasons given for not telling partners included being fearful of negative gossip and worrying about what would be the reactions of partners if they were told they might have been exposed to chlamydia:
...you could be, you know, down at the footy club or wherever and blah, blah, blah and there you go, you're known as the town bike...you see, I initially came from a small town, so I know gossip travels very quickly, so that kind of sticks in the back of my mind.
Most women thought they would feel very uncomfortable about telling partners that they may have been exposed to chlamydia. Those women who thought they would notify partners were more likely to be older and to be in a stable relationship. A feeling of responsibility toward their partners and thinking chlamydia is a serious disease was associated with being more likely to tell partners.
Almost all the women interviewed thought that anonymous contact tracing would be useful and would make it easier to notify partners who would otherwise not be contacted. However, some women saw the idea of anonymous notification as cowardly and disrespectful.