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What is the Effectiveness of Different Community-based Health Promotion Campaign Methods on Chlamydia Screening Uptake in Young People and What Barriers and Facilitators Have Been Identified? A Mixed-Methods Systematic Review and Time-Series Analysis

Leads: Prof Kate Jolly (Public Health), Dr Laura Quinn (Meths)

Rapid response research.

Dates: October 2019 - February 2021

Background:

Unlike screening for cervical, breast and bowel cancer, which typically have formalised population-based approach using registries for screening, chlamydia (CT) screening programmes rely on an opportunistic approach triggered by health-care encounters. To supplement this many CT programmes use public campaigns to raise awareness of chlamydia screening in young people and ultimately encourage the visits that trigger screening. These campaigns may be targeted to groups at highest risk of CT infection, or more universally aimed at young people. Services are expected to achieve an annual diagnosis rate of 2300/100,000 15-24 year olds per year.

Policy Partners:

University Hospitals Birmingham NHS Foundation Trust (Umbrella Service) and Public Health England.

Co-Funding Partners:

University Hospitals Birmingham NHS Foundation Trust, Public Health England.

Aims and Objectives:

It is not at all clear whether these campaigns work and we sought to synthesise what is known about their efficacy and examine the impact of local CT campaigns in the Midlands on screening uptake with the ultimate goal of increasing access to chlamydia screening (and the efficiency of the screening programmes).

Methods:

A mixed-methods systematic review assessing the outcomes of community-based health-promotion campaigns to increase chlamydia screening in young people, their experiences of the campaigns and other facilitators and barriers to the conduct of the campaigns was completed. Studies of promotional campaigns, either quantitative (with comparison to a pre-campaign period, a different campaign or no-campaign) or qualitative design published in any language were selected from searches (MEDLINE, EMBASE, CINAHL, Open Grey) undertaken in April 2020. Standard study appraisal and synthesis methods were used.

Time-series analysis of weekly aggregate data on CT tests performed and positive CT tests in young people aged 15-24 living in Birmingham and Solihull, and four other UK cities, 2012-2018.

Main Results:

From screening 10,329 records, 100 full text articles were assessed in detail leading to 20 papers representing 19 studies included in the review; 14 quantitative, 2 qualitative and 3 mixed-methods. All studies with quantitative outcomes were before-after study designs or interrupted time series. Relative change (RC) in test counts increased (RC 1.22; 95% CI 1.14 to 1.30) after campaigns, but no significant increase was seen for number of positive tests (RC 1.10; 95% CI 0.93 to 1.30) nor for test positivity rate (RC 0.93; 95% CI 0.81 to 1.07). Heterogeneity between studies was very high for all analyses so it was not possible to explore outcomes by type of campaign components. Seven major qualitative themes were identified: negative views around targeting of campaigns; need for high quality materials and messaging; the positive impact of materials in multiple languages; preference for anonymity; use of technology to support campaign reach; relevance of messaging content to the young people; and promotion of variety of testing options.

Time-series analysis is still underway.

Conclusions:

Promotional campaigns to increase CT testing in those aged 15-24 may show some effectiveness in increasing overall numbers of tests, however numbers of positive tests do not follow the same trend. This highlights a tension between screening numbers to achieve the target diagnostic rate and efficiency of screening programmes.

Implications for Implementation:

We have identified components of campaigns that are valued by young people, and chlamydia programmes need to assess the extent to which they meet these. General community chlamydia campaigns may not be cost-effective and targeting is likely to be necessary. These findings will be used to inform delivery of chlamydia screening campaigns by the Umbrella Service.