Background A systematic and selective screening programme for CT was set up in the Netherlands, in which adolescents were invited by a personal letter to request a home collection kit online (http://www.chlamydiatest.nl). After collection, the kit could be returned to the laboratory by mail. In the first screening round (2008/2009), 20% (52 346/261 053) of the adolescents requested a kit. Of those, 22% (11 317/52 346) did not return the kit (non-testers). Here, we describe a qualitative study examining motives of non-testers for requesting a home collection kit, and their barriers for using it.
Methods Semistructured telephone interviews were conducted with non-testers from the second screening round (2009/2010) until data saturation was reached (n=25). They were invited for participation by email. Transcribed interviews were analysed qualitatively using Flexible Content Analysis, and interpreted using health behavioural theories that is, the Health Action Process Approach (HAPA).
Results Motives of participants to request a kit related to perceived risk for CT were: for certainty/reassurance, having complaints, or to take responsibility for one's own health. Motives related to specific features of the screening procedures were: it avoids invasive screening at STI-clinic or GP, procedures are simple, or because the screening is anonymous. Barriers for using a kit related to perceived risk for CT were: recently being tested, worries about the consequences of a positive test-result on the relationship, having no time, giving testing no priority, or laziness. Barriers related to specific features of the screening were: making wrong assumptions about the term of preservability of an unused test kit or about the term of the screening round, the user manual is unclear, being afraid to make mistakes during the collection procedures, the method of collection is unpleasant, or worries about privacy.
Conclusions Motives to request the CT home collection kit were related to the participants perceived risk of acquiring CT, and to advantages of the screening procedures compared to conventional testing. Barriers for using the test kit were related to low personal risk perception, unclear procedures of the screening, and fear for a positive test result. To overcome these barriers, the ease of contracting CT, and consequences of an untreated infection, should be emphasised. Furthermore, screening procedures should be optimised according to the users experiences.