scholarly journals Healthcare-seeking behaviour for sexually transmitted infection testing in New Zealand: A mixed methods study

2021 ◽  
Author(s):  
◽  
Hayley Denison
Keyword(s):  
Public Health ◽  
New Zealand ◽  
Reactive Arthritis ◽  
Quantitative Methods ◽  
Service Providers ◽  
Financial Burden ◽  
Health Clinic ◽  
Healthcare Seeking ◽  
Sexually Transmitted ◽  
Sti Testing

<p>Sexually transmitted infections (STIs) are a global public health problem. Sequelae for infected individuals can be serious and STIs impose a substantial financial burden on healthcare systems. Duration of infection is one factor influencing transmission rates, and is modifiable through secondary prevention methods, namely ‘test and treat’. For this approach to be effective, at-risk individuals must choose to present for testing. New Zealand provides a useful case-study to investigate healthcare-seeking behaviour for STI testing, as incidence rates of common STIs are especially high.  The aims of this thesis were to quantify healthcare-seeking behaviour for STI symptoms and assess the risk of transmission in this period, to identify the barriers to STI testing, to understand the personal drivers for getting an STI test, to examine how STI knowledge is associated with testing behaviour, and finally, to collate and critically evaluate the published evidence regarding the incidence of a lesser known sequela of STI, reactive arthritis. This thesis took a mixed method approach, employing both qualitative and quantitative methods to address the research aims.  The results showed that delays in healthcare-seeking for STI symptoms were common among patients attending an inner-city Sexual Health Clinic (SHC). Almost half of people with symptoms waited longer than seven days to seek healthcare, although there were no identified predictors of delayed healthcare-seeking. Around a third of people with symptoms continued to have sex after they first thought they may need to seek healthcare. Among these individuals, infrequent condom use was reported more by those who had sex with existing sexual partners than by those who had sex with new partners. Having sex while symptomatic was statistically significantly associated with delaying seeking healthcare for more than seven days (odds ratio (OR) = 3.25, 95% CI 1.225 – 8.623, p = 0.018).  Analysis of qualitative interview data revealed three types of barriers to testing. These were personal (underestimating risk, perceiving STIs as not serious, fear of invasive procedure, self-consciousness in genital examination and being too busy), structural (financial cost of test and clinician attributes and attitude) and social (concern of being stigmatised).  This work also revealed several drivers for testing including crisis, partners, clinicians, routines, and previous knowledge. Knowledge of the incidence, asymptomatic nature and sequelae of STIs featured prominently in the explanations of those who undertook routine testing. However, at the same time, many of the participants felt they did not have a good knowledge base and that their school-based sex education had been lacking.  STI knowledge was investigated further using quantitative methodology. Levels of STI knowledge were generally good and did not differ between a Student Health Service population and an SHC population. Individuals who had tested before had significantly better knowledge than those who were attending for testing for the first time (U = 10089.500, Z = -4.684, p < 0.001). In addition, total knowledge score was an independent predictor of having had a previous test (OR = 1.436, 95% CI 1.217-1.694, p < 0.001).  Reactive arthritis can be triggered by STI, thus STI screening patients who present with reactive arthritis has the potential to identify undiagnosed infection. This thesis provides the first assessment of the international literature regarding the incidence of reactive arthritis after STI. The systematic review found only three published studies which had prospectively examined the incidence of reactive arthritis after STI. The studies reported an incidence of reactive arthritis after STI of 3.0% to 8.1% and were found to be of low to moderate quality.  In conclusion, this thesis provides healthcare service providers, policy makers and clinicians with data to inform practice and public health interventions aimed at improving healthcare-seeking behaviour for STI testing. It illustrates that delayed healthcare-seeking for STI symptoms is a common behaviour in New Zealand and could potentially be contributing to STI transmission and downstream burden on the health system. This work provides evidence of the drivers of STI testing that can be promoted, and the barriers that need to be removed. Specifically, improving STI knowledge may positively impact on testing rates. Lastly, this research indicates that there is a need for more studies assessing the incidence of reactive arthritis after an STI.</p>

scholarly journals Healthcare-seeking behaviour for sexually transmitted infection testing in New Zealand: A mixed methods study

2021 ◽  
Author(s):  
◽  
Hayley Denison
Keyword(s):  
Public Health ◽  
New Zealand ◽  
Reactive Arthritis ◽  
Quantitative Methods ◽  
Service Providers ◽  
Financial Burden ◽  
Health Clinic ◽  
Healthcare Seeking ◽  
Sexually Transmitted ◽  
Sti Testing

<p>Sexually transmitted infections (STIs) are a global public health problem. Sequelae for infected individuals can be serious and STIs impose a substantial financial burden on healthcare systems. Duration of infection is one factor influencing transmission rates, and is modifiable through secondary prevention methods, namely ‘test and treat’. For this approach to be effective, at-risk individuals must choose to present for testing. New Zealand provides a useful case-study to investigate healthcare-seeking behaviour for STI testing, as incidence rates of common STIs are especially high.  The aims of this thesis were to quantify healthcare-seeking behaviour for STI symptoms and assess the risk of transmission in this period, to identify the barriers to STI testing, to understand the personal drivers for getting an STI test, to examine how STI knowledge is associated with testing behaviour, and finally, to collate and critically evaluate the published evidence regarding the incidence of a lesser known sequela of STI, reactive arthritis. This thesis took a mixed method approach, employing both qualitative and quantitative methods to address the research aims.  The results showed that delays in healthcare-seeking for STI symptoms were common among patients attending an inner-city Sexual Health Clinic (SHC). Almost half of people with symptoms waited longer than seven days to seek healthcare, although there were no identified predictors of delayed healthcare-seeking. Around a third of people with symptoms continued to have sex after they first thought they may need to seek healthcare. Among these individuals, infrequent condom use was reported more by those who had sex with existing sexual partners than by those who had sex with new partners. Having sex while symptomatic was statistically significantly associated with delaying seeking healthcare for more than seven days (odds ratio (OR) = 3.25, 95% CI 1.225 – 8.623, p = 0.018).  Analysis of qualitative interview data revealed three types of barriers to testing. These were personal (underestimating risk, perceiving STIs as not serious, fear of invasive procedure, self-consciousness in genital examination and being too busy), structural (financial cost of test and clinician attributes and attitude) and social (concern of being stigmatised).  This work also revealed several drivers for testing including crisis, partners, clinicians, routines, and previous knowledge. Knowledge of the incidence, asymptomatic nature and sequelae of STIs featured prominently in the explanations of those who undertook routine testing. However, at the same time, many of the participants felt they did not have a good knowledge base and that their school-based sex education had been lacking.  STI knowledge was investigated further using quantitative methodology. Levels of STI knowledge were generally good and did not differ between a Student Health Service population and an SHC population. Individuals who had tested before had significantly better knowledge than those who were attending for testing for the first time (U = 10089.500, Z = -4.684, p < 0.001). In addition, total knowledge score was an independent predictor of having had a previous test (OR = 1.436, 95% CI 1.217-1.694, p < 0.001).  Reactive arthritis can be triggered by STI, thus STI screening patients who present with reactive arthritis has the potential to identify undiagnosed infection. This thesis provides the first assessment of the international literature regarding the incidence of reactive arthritis after STI. The systematic review found only three published studies which had prospectively examined the incidence of reactive arthritis after STI. The studies reported an incidence of reactive arthritis after STI of 3.0% to 8.1% and were found to be of low to moderate quality.  In conclusion, this thesis provides healthcare service providers, policy makers and clinicians with data to inform practice and public health interventions aimed at improving healthcare-seeking behaviour for STI testing. It illustrates that delayed healthcare-seeking for STI symptoms is a common behaviour in New Zealand and could potentially be contributing to STI transmission and downstream burden on the health system. This work provides evidence of the drivers of STI testing that can be promoted, and the barriers that need to be removed. Specifically, improving STI knowledge may positively impact on testing rates. Lastly, this research indicates that there is a need for more studies assessing the incidence of reactive arthritis after an STI.</p>

Unlinked anonymous HIV prevalence among New Zealand sexual health clinic attenders: 2005–2006

2008 ◽  
Vol 19 (11) ◽  
pp. 752-757 ◽  
Author(s):  
S M McAllister ◽  
N P Dickson ◽  
K Sharples ◽  
M R Reid ◽  
J M Morgan ◽  
...  
Keyword(s):  
New Zealand ◽  
Sexual Health ◽  
Health Clinic ◽  
Bisexual Men ◽  
Sexually Transmitted ◽  
Health Clinics ◽  
Undiagnosed Hiv ◽  
And Bisexual ◽  
Sex With Men ◽  
Sexual Health Clinics

This unlinked anonymous study aimed at determining the prevalence of HIV among sexual health clinic attenders having blood samples taken for syphilis and/or hepatitis B serology in six major New Zealand cities over a 12-month period in 2005–2006. Overall, seroprevalence was five per 1000 (47/9439). Among men who have sex with men (MSM), the overall prevalence and that of previously undiagnosed HIV were 44.1 and 20.1 per 1000, respectively. In heterosexual men, the overall prevalence was 1.2 per 1000 and in women 1.4 per 1000. HIV remains to be concentrated among homosexual and bisexual men. Comparison with a previous survey in 1996–1997 suggests an increase in the prevalence of undiagnosed HIV among MSM and also an increase in the number of MSM attending sexual health clinics. The low prevalence of HIV among heterosexuals suggests no extensive spread into the groups identified at risk of other sexually transmitted infections.

scholarly journals Factors Predicting Uptake of Sexually Transmitted Infections Testing among Men Who Have Sex with Men Who Are “Pre-Exposure Prophylaxis Tourists”—An Observational Prospective Cohort Study

2021 ◽  
Vol 18 (7) ◽  
pp. 3582
Author(s):  
Zixin Wang ◽  
Yuan Fang ◽  
Natthakhet Yaemim ◽  
Kai J. Jonas ◽  
Andrew Chidgey ◽  
...  
Keyword(s):  
Cohort Study ◽  
Service Providers ◽  
Risky Behaviors ◽  
Service Planning ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Sti Testing ◽  
Sex With Men ◽  
Exposure Prophylaxis

The term “Pre-exposure prophylaxis (PrEP) tourists” refers to individuals who obtain PrEP in other countries and use it in their home countries. A prospective observational cohort study was conducted among a group of men who have sex with men (MSM) who obtained PrEP in private clinics in Thailand and used it in Hong Kong. Participants completed two web-based self-administered surveys when obtaining PrEP in Thailand and three months afterwards. Out of 110 participants at baseline, 67 completed the follow-up. The prevalence of sexually transmitted infection (STI) testing was 47.8% during the follow-up period. Eleven participants received an STI diagnosis, and seven of them were incident infections in the past three months. Participants who perceived a higher chance for STI infection (adjusted odds ratios (AOR): 1.90, 95% CI: 1.00, 3.75) and reported higher intention to take up STI testing at baseline (AOR: 1.62, 95% CI: 1.05, 2.50) were more likely to receive STI testing during the follow-up period. Baseline perceptions that service providers would think they were having risky behaviors because of PrEP use was negatively associated with the dependent variable (AOR: 0.51, 95% CI: 0.31, 0.86). Service planning and health promotion related to STI testing is needed for MSM “PrEP tourists”.

scholarly journals Febrile Illness Outbreak Investigation in Sundarharicha-5 Foklan Tapu, Morang District

2019 ◽  
Vol 17 (2) ◽  
pp. 148-152
Author(s):  
Ashok Pandey ◽  
Arun Kumar Sah ◽  
Pradeep Belbase ◽  
Anil Kumar Sah ◽  
Anjani Kumar Jha
Keyword(s):  
Public Health ◽  
Quantitative Methods ◽  
Service Providers ◽  
Medical Officer ◽  
Febrile Illness ◽  
Outbreak Investigation ◽  
Community Leader ◽  
Local Health ◽  
Microbiological Analysis ◽  
Local Health Service

Background: On the date of 24 July 2017, the major national daily newspaper reported that there were two death cases from an unknown disease in the Morang district, Sundarharicha Municipality 5, Foklan Tapu. A team of researcher and experts were mobilized in the affected area to investigate and identify the etiological and epidemiological causes.Methods: Both qualitative and quantitative methods was used to conduct the outbreak investigation. 83 blood samples were taken from the patients and microbiological analysis was done at National Public Health Laboratory, Kathmandu. Similarly, 2 verbal autopsies and 5 Key in-depth interviews were taken from a local community leader, local health service providers, medical officer of Koshi Zonal Hospital, district public health officer and medical director of WHO.Results: Out of 83 participants, 49% and 25% of the participants were positive to IgM and IgG antibodies of Leptospira species respectively. 87% of the participants were exposed to animal living in his/her home (including pets). Conclusions: An outbreak which was existing during this investigation turned out to be leptospirosis outbreak, whose exposure was consumption of unhealthy meat during social gathering.Keywords: Epidemiological; etiological; febrile illness; outbreak investigation.

News Media Coverage of Stakeholder Views on Suicide and Its Reporting in New Zealand

Crisis ◽  
2020 ◽  
Vol 41 (4) ◽  
pp. 248-254
Author(s):  
Gabrielle L. S. Jenkin ◽  
Ben E. Slim ◽  
Sunny Collings
Keyword(s):  
Public Health ◽  
New Zealand ◽  
News Media ◽  
Media Coverage ◽  
Service Providers ◽  
Public Health Issue ◽  
Health Service Providers ◽  
Key Stakeholders ◽  
Chief Coroner ◽  
The Media

Abstract. Background: Periodically, a debate around suicide reporting becomes prominent in the media. At one point, the Chief Coroner of New Zealand made a public call to the media to open up discussions around suicide and its reporting. Following this action, a high-profile debate emerged in the media. Aims: Our aim was to identify the key players in this debate and examine their perspectives. Method: From a Factiva search of news items from high-circulation newspapers, we identified key stakeholders and documented their perspectives using a framing matrix. Results: Seven stakeholder groups were identified with coroners and health service providers dominant in the news. Framing around the issues varied. There was consensus among the majority of stakeholders supporting continued public health type coverage of the issue of suicide, but a number of differences in levels of support for the reporting individual suicides. Limitations: Although specific to New Zealand, the findings will be of interest to countries considering reporting restrictions. Conclusion: The debate around suicide and its reporting appears to have been obfuscated by the conflating of two different types of media reporting on suicide: news media coverage of suicide as a public health issue and the reporting of individual suicide cases.

Pathways ahead for New Zealand hill country farming

2016 ◽  
Vol 78 ◽  
pp. 73-82 ◽  
Author(s):  
F.G. Scrimgeour
Keyword(s):  
New Zealand ◽  
Rural Communities ◽  
New Technologies ◽  
Service Providers ◽  
Farming Systems ◽  
Hill Country ◽  
The Status ◽  
And Performance ◽  
Hill Farming ◽  
The Hill

This paper provides a stocktake of the status of hill country farming in New Zealand and addresses the challenges which will determine its future state and performance. It arises out of the Hill Country Symposium, held in Rotorua, New Zealand, 12-13 April 2016. This paper surveys people, policy, business and change, farming systems for hill country, soil nutrients and the environment, plants for hill country, animals, animal feeding and productivity, and strategies for achieving sustainable outcomes in the hill country. This paper concludes by identifying approaches to: support current and future hill country farmers and service providers, to effectively and efficiently deal with change; link hill farming businesses to effective value chains and new markets to achieve sufficient and stable profitability; reward farmers for the careful management of natural resources on their farm; ensure that new technologies which improve the efficient use of input resources are developed; and strategies to achieve vibrant rural communities which strengthen hill country farming businesses and their service providers. Keywords: farming systems, hill country, people, policy, productivity, profitability, sustainability

Information-seeking to Support Personal and Community Wellbeing: Report of a study of New Zealand Men Using Focus Groups

2016 ◽  
Author(s):  
Peta Wellstead
Keyword(s):  
New Zealand ◽  
Focus Groups ◽  
Support Services ◽  
Information Seeking ◽  
Service Providers ◽  
Structural Constraints ◽  
Health And Wellbeing ◽  
Study Results ◽  
Groupes De Discussion

This paper reports part of an ongoing study exploring the information behaviour of New Zealand men during periods of diminished health and wellbeing. Focus groups were used for this iteration of the study. Results indicate that New Zealand men face both personal and structural constraints to their information-seeking during periods when their health and wellbeing may be compromised. This study highlights that service providers need to develop more effective information delivery mechanisms and support services for men. These services need to be appealing to men and reflect men’s information seeking preferences. The role of LIS professionals in supporting this endeavour is discussed. Cet article présente une étude en cours explorant le comportement informationnel d’ hommes néo-zélandais durant des périodes où leur état de santé et de bien-être est amoindri. Des groupes de discussion ont été utilisés pour cette itération de l'étude. Les résultats indiquent que les hommes en Nouvelle-Zélande font face à des contraintes à la fois  personnelles et structurelles dans leur recherche d'information pendant les périodes où leur santé et leur bien-être peuvent être affaiblis. Cette étude met en évidence le besoin pour les fournisseurs de services de développer des mécanismes de diffusion de l'information plus efficaces et des services de soutien pour les hommes. Ces services doivent être attrayants et refléter les préférences des hommes dans leurs recherches d’information. Le rôle des professionnels de l'information dans le soutien à cette entreprise est discuté.

scholarly journals COVID-19: Intensifying the Existential Threat to the Caribbean

2021 ◽  
Vol 10 (1) ◽  
pp. 155-172
Author(s):  
Michael Witter
Keyword(s):  
Public Health ◽  
Public Policy ◽  
Service Providers ◽  
Oil Production ◽  
Neoliberal Globalization ◽  
Agricultural Exports ◽  
Existential Crisis ◽  
Tourism Sector ◽  
The Caribbean

The Caribbean has experienced an overlapping and interconnected series of challenges, including economic, social, and environmental, which pose an existential threat to the region. This article focuses on the nature of this threat as it evolved before and during the pandemic crisis. Under neoliberal globalization, Caribbean economies transformed themselves rapidly into service providers, most having resorted to developing a tourism sector, while some moved into oil production. In all cases, traditional agricultural exports declined with the loss of protected markets where they earned preferential prices. The COVID-19 pandemic has intensified the Caribbean’s existential crisis and revealed the inextricable links among the environment, economy, and public health. This article focuses on these links and suggests a way forward for public policy in the short, medium, and long term.

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