Theunissen Kevin A T M, Hoebe Christian J P A, Crutzen Rik, Kara-Zaïtri Chakib, de Vries Nanne K, van Bergen Jan E A M, van der Sande Marianne A B, Dukers-Muijrers Nicole H T M
Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Services South Limburg, Geleen, The Netherlands.
BMC Public Health. 2013 Oct 22;13:996. doi: 10.1186/1471-2458-13-996.
Many young people at high risk for Chlamydia trachomatis (Ct) are not reached by current sexual health care systems, such as general practitioners and public sexual health care centres (sexually transmitted infection clinics).Ct is the most frequently diagnosed bacterial sexually transmitted infection (STI) among sexually active people and in particular young heterosexuals. Innovative screening strategies are needed to interrupt the transmission of Ct among young people and connect the hidden cases to care.
Intervention Mapping (IM), a systematic approach to develop theory- and evidence-based interventions, was used to develop a strategy to target Ct testing towards young people who are currently hidden to care in The Netherlands. Both clinical users (i.e. sexual health care nurses) and public users (i.e., young people at risk for Ct) were closely involved in the IM process. A needs assessment study was carried out using semi-structured interviews among users (N = 21), a literature search and by taking lessons learned from existing screening programmes. Theoretical methods and practical applications to reach high risk young people and influence testing were selected and translated into specific programme components.
The IM approach resulted in the development of a secure and web-based outreach Ct screening strategy, named SafeFriend. It is developed to target groups of high-risk young people who are currently hidden to care. Key methods include web-based Respondent Driven Sampling, starting from young Ct positive sexual health care centre clients, to reach and motivate peers (i.e., sex partners and friends) to get tested for Ct. Testing and the motivation of peers were proposed as the desired behavioural outcomes and the Precaution Adoption Process Model was chosen as theoretical framework. End users, i.e., young people and sexual health care nurses were interviewed and included in the development process to increase the success of implementation.
IM proved useful to develop an intervention for targeted Ct testing among young people. We believe this to be the first web-based outreach screening strategy which combines chain referral sampling with the delivery of targeted Ct testing to high risk young people within their sexual and social networks.
许多沙眼衣原体（Ct）感染高危的年轻人未被当前的性健康保健系统覆盖，如全科医生和公共性健康保健中心（性传播感染诊所）。Ct是性活跃人群尤其是年轻异性恋者中最常被诊断出的细菌性性传播感染（STI）。需要创新的筛查策略来阻断Ct在年轻人中的传播，并使隐匿病例获得治疗。
干预映射法（IM）是一种用于制定基于理论和证据的干预措施的系统方法，被用于制定一项针对荷兰目前未获治疗的年轻人群进行Ct检测的策略。临床使用者（即性健康保健护士）和公众使用者（即Ct感染高危的年轻人）都密切参与了IM过程。通过对使用者进行半结构式访谈（N = 21）、文献检索以及借鉴现有筛查项目的经验教训开展了一项需求评估研究。选择了针对高危年轻人并影响检测的理论方法和实际应用，并将其转化为具体的项目组成部分。
IM方法促成了一种名为SafeFriend的安全且基于网络的外展Ct筛查策略的制定。该策略旨在针对目前未获治疗的高危年轻人群体。关键方法包括基于网络的应答驱动抽样，从Ct检测呈阳性的年轻性健康保健中心客户入手，以接触并激励同龄人（即性伴侣和朋友）进行Ct检测。将检测和激励同龄人作为期望的行为结果，并选择预防采用过程模型作为理论框架。对最终用户，即年轻人和性健康保健护士进行了访谈并将其纳入开发过程，以提高实施的成功率。
事实证明，IM对于制定针对年轻人的有针对性的Ct检测干预措施很有用。我们认为这是首个将链式推荐抽样与在性和社交网络内向高危年轻人提供有针对性的Ct检测相结合的基于网络的外展筛查策略。
