Chlamydia screening in at-risk adolescent females: An evaluation of screening practices and modifiable screening correlates

Abstract

Purpose To identify modifiable correlates of chlamydia screening that could offer intervention targets to enhance screening. Methods We surveyed a representative sample of primary care providers (n = 186) at an integrated healthcare delivery system to document their self-reported adherence to annual screening of sexually-active adolescents and to identify specific, modifiable constructs that were correlated with annual chlamydia screening. To cross-validate providers’ self-report, we also used automated data to examine adolescent screening in an anonymous sample of primary care providers (n = 143). Results Forty-two percent of providers reported annual chlamydia screening of sexually-active adolescents. Univariate correlates of annual screening were: provider type (non-physician) ( p = .01), female gender ( p = .001), fewer years of clinical experience ( p = .001), greater perceived knowledge about chlamydia ( p = .001), greater confidence across a range of screening-related activities ( p ≤ .01), greater comfort recommending screening for sexually transmitted diseases ( p = .001), and greater perceived patient comfort discussing sexual issues ( p < .01). In multivariate analyses, providers’ perceived knowledge, confidence, comfort, and perceived patient comfort continued to be significantly associated with annual chlamydia screening after controlling for other relevant provider characteristics. Self-reported screening practices were consistent with observed screening rates in the anonymous provider sample. Conclusions Routine chlamydia screening among asymptomatic, at-risk adolescent females could be enhanced through additional intervention targeting specific provider attitudes and beliefs about chlamydia screening.