Table 1 Summary of the studies that included a qualitative component. Describes the settings, subjects and findings of the 11 studies that included a qualitative component.

[14]

USA, non-clinical and non-medical setting

32 men (aged 15–20 years) and 23 women (aged 16–24 years). Participants were sourced half from a job program and half from the juvenile justice system. All were out of school and were deemed "high risk" for STI acquisition.

Qualitative: 8 focus group interviews

Barriers to screening: confidentiality and privacy concerns; fear of a positive diagnosis and the negative consequences of chlamydia infection; ignorance of the significance of a chlamydia diagnosis

Facilitators of screening: the option of home testing, improved information about chlamydia; support for dealing with a diagnosis of chlamydia; promotion of chlamydia screening as "exhibiting responsible behaviour"

[35]

Sweden, urban, youth clinic

5 women and 4 men aged 18–22 years. All had a positive chlamydia test and were patients of the interviewer. All the men were contacted through partner notification.

Qualitative: In depth interviews

Attitude to being diagnosed with chlamydia: shame/guilt (worse for women); satisfaction (more for men). Support: Women told mothers, sisters and friends; men told no one. Beliefs: having sex with someone "known" protects against catching an STI; using condoms with someone you like is an expression of distrust; men felt women should be "condom-promoters"

[15]

UK, urban, sexual health clinic (London)

12 men (16–44), 12 women (16–34), heterosexual and a chlamydia diagnosis (82% participation)

Qualitative: Semi structured interviews

Attitude to chlamydia diagnosis: worry about infertility; self-blame

Knowledge: some people thought chlamydia was a relatively minor infection and put off seeking treatment

[23]

UK, urban, 2 genitourinary medicine (GUM) clinics and 1 family planning (FP) clinic (East Midlands)

37 women (15–53) had been screened for chlamydia, 3=black, 34=white, socially diverse backgrounds. All women who agreed to participate were included.

Qualitative: Semi structured interviews

Reasons for STI screening: own symptoms; partner's symptoms; partner's behaviour; own behaviour and health maintenance Barriers to STI screening in General Practice: relationship with the GP; views of the quality of clinical care; need for confidentiality and accessibility

Facilitators to STI screening: raise concerns about STIs at the same time as Pap tests; help women feel "in control" of receiving their test results

[36]

UK, urban, genitourinary medicine (GUM) clinic, family planning (FP) clinic (Glasgow)

17 women (18–29) with a current or recent diagnosis of chlamydia. The first 17 who agreed to participate were included (10 from GUM and 7 from FP response rate = 62%)

Qualitative: Semi structured interviews

Attitude to chlamydia diagnosis: stigma attached to having an STI; stigma about attending a sexual health service; anxiety about partner notification; fears about future effects on reproductive health and fertility. Facilitators: normalise and destigmatise chlamydia diagnosis; provide support for partner notification; provide support for dealing with uncertainties regarding future infertility

[26]

USA; population based non-medical setting

120 men and women aged 18–25, 55% were female (n = 66) and 61% were aged 18–21, 41% were white, 22% black and 33% Latino.

Qualitative: Semi structured Computer-Assisted Telephone Interviews (CATI)

Attitude to chlamydia diagnosis: shock, anger, embarrassment, disappointment (50% of participants); relief (14%); negative effect on personal relationships; fear; depression; low self-esteem; health-related concerns (only 4 participants); would seek treatment for chlamydia (most participants). Knowledge: 25% of participants believed chlamydia is very difficult to treat. Barriers to chlamydia testing: cost/time involved in seeking treatment; stigma. Facilitators of chlamydia testing: home urine testing/urine self-test kits. Advantages to home testing: privacy, increased testing, convenience, lower cost (no need to see a doctor). Disadvantages to home testing: doubts about test accuracy, doubt whether people at risk would use home tests and whether people with a positive result would get treated. Advantages of being given results over the phone: privacy, convenience, learning STD status, having control over the process Disadvantages of being given results over the phone: risk of a positive test and no professional to talk to face-to-face, fear of a positive test or of being overheard might put people off calling.

[18]

Australia, urban, youth clinic (Melbourne)

25 homeless young people aged 16–26; 19 male and 6 female, level of schooling varied from Year 8 to Year 12

Qualitative: 6 focus groups with 4 to 6 participants.

Participants had limited knowledge about chlamydia. Suggested ways to disseminate information: school, free entertainment magazines, billboard advertising, TV ads and pamphlets distributed by community groups. Humour seen as a useful tool. Barriers to screening: embarrassment, cost, ignorance. Suggested facilitators: mobile health van, free medical care (bulk billing), improved advertising and awareness of chlamydia, incentives for testing, outreach health professionals, self-testing.

[21]

UK, urban, general practice (8 general practices) (Edinburgh)

20 women who had participated in a pilot of opportunistic chlamydia screening including both those with positive (4) and negative (14) results and those still waiting for results (2).

Qualitative: Semi-structured interviews

Perception of risk of chlamydia infection: most women said they were not worried whilst waiting for results as they did not perceive themselves as being "at risk". Most had not heard of chlamydia before and therefore thought it was uncommon. Women found it difficult to accept that chlamydia could be asymptomatic. Women based their assessment of the risk of chlamydia infection on its perceived prevalence, on their previous experience, on their own or their partner's sexual history and on the presence or absence of symptoms. Views about chlamydia screening: all women were glad to have been screened. Reasons included: awareness of the risk of infertility, the ease of testing and knowing it can be treated with antibiotics. Information: This was important both in deciding whether to accept a test and in dealing with results. Knowing that if they did have chlamydia it could be treated with antibiotics was important to several women. Knowing that chlamydia could be asymptomatic for some time was important for women in dealing with the implications of an infection. Choice: Many women felt that although routine screening was a good idea, choosing to participate or not was very important. Younger women however thought being offered screening directly was good as they might not have asked for it.

[34]

UK, urban, population based probability sample (London)

36 sexually experienced men and women aged 18–44 (equal numbers of men and women)

Qualitative: In depth face-to-face interviews

Factors influencing an individual's decision to participate in chlamydia screening by urine included: trust and rapport with the interviewer who was inviting them to have the test, understanding the aims of the test and what would happen to the urine sample, a sense of obligation, not feeling embarrassed, the perceived importance of the test and the opportunity to receive free testing.

[38]

UK, urban, family planning clinic (Nottingham-shire)

4 women aged <25 who had had a positive chlamydia result 6 months previously.

Qualitative: In depth face-to-face interviews

Feelings about a diagnosis of chlamydia included: shock, worry, unhappiness, embarrassment and surprise. Attitude to partner notification: 3 felt embarrassed about the need to trace contacts but all 4 women attempted to do so. Concern for the future: all were very concerned about the long term effects of chlamydia if left untreated.

[20]

UK, urban, general practice, family planning (FP), genitourinary medicine (GUM) clinics, adolescent sexual health clinics, termination of pregnancy clinics and women's services in hospitals (antenatal, colposcopy, gynaecology and infertility clinics).

25 sexually active women aged 16–24 attending a range of healthcare settings, who had been screened for chlamydia, completed a questionnaire on the acceptability of screening and volunteered to participate in an in depth interview on their views on chlamydia screening. (80 people gave their contact details but only 25 were available for interview)

Qualitative: In-depth interviews

Women were pleased to be offered screening. A minority were concerned that the offer of screening meant they had been singled out as being "at risk" of an STI. Participants attending GUM or FP clinics were most comfortable with being screened. Motivations for accepting screening included: awareness that chlamydia infection can be asymptomatic, (many reported that they would not have sought out screening if it had not been opportunistically offered to them), also exposure to "formal" information (health professionals, leaflets, publicity campaigns) and "informal" information (family and friends). Women felt able to refuse screening. The most important factors influencing the decision to accept screening were having the perception of being at risk of infection, awareness of the possible long-term effect on fertility and thinking that chlamydia was easily treated. All the women interviewed found giving a urine sample acceptable. The majority said they would have declined screening if it involved a clinician-collected swab.