Two urine-based sexually transmitted infection screening interventions targeting young men in football club settings (SPORTSMART): a pilot randomised controlled trial

Abstract

BackgroundYoung people remain at highest risk for sexually transmitted infections (STIs), and engaging men in the UK in effective STI screening is challenging. England's national chlamydia screening programme has failed to reach the desired coverage in men. Sports venues might appeal to men as sites of STI screening, although the use of such venues has not been widely explored in the UK. Our recent random probability survey of men's attitudes to STI screening in Britain showed that in men who regularly participate in sport, just over half were willing to access self-completed screening kits at sporting venues. Other work suggests that sporting role models (popular opinion leaders [POLs]) offer potential for successful promotion of health behaviours. Because football is the highest participation team sport in England, we designed the SPORTSMART trial to develop and assess two models for promotion of STI screening in men in football clubs in London. We aimed to develop two replicable interventions for delivering STI screening in football clubs, including screening promoted by POLs; and to assess feasibility and acceptability of these interventions. MethodsWe undertook a cluster pilot randomised controlled trial with three groups in men aged 18–35 years within six amateur football clubs (clusters) in London recruited between October and December, 2012. Interventions were POL (team captain) and poster-promoted screening; sexual health adviser and poster-promoted screening; and poster-promoted screening only (control). Men were invited to use urine-based self-sampling kits for chlamydia and gonorrhoea, returning their sample to an on-site collection container or mailing it to the study sexual health clinic for routine testing and clinical management. The target was to recruit 200 men to estimate the overall acceptance rate with adequate precision. Six football clubs with two teams each of men aged at least 18 years were grouped by similar characteristics into three pairs and then randomly allocated to the study groups. Participants were unmasked after allocation. Masking of investigators during implementation or assessment was not feasible. A detailed process investigation assessed the extent and quality of intervention delivery and the mechanism, context, and responses of the participants. Robust standard errors acknowledging clustering of participants by team were used for analyses. Ethics approval was granted by the National Research Ethics Service, study 13/SC/0029. Club managers gave consent during the recruitment period. Signed informed consent was provided by team captains (POLs) before the intervention. Football team members opted in to testing by completing the kit offered but could opt out of the intervention at any time. FindingsAcross the three groups, 153 men received the intervention and 90 accepted the offer of screening (59%, 95% CI 35–79). Although acceptance rates varied substantially by club, they were broadly similar across groups: POL led 28 of 56 (50%); health adviser led 31 of 46 (67%); and control 31 of 51 (61%). Process assessment confirmed that the interventions were delivered in a standardised way across the arms. However, the control group was unintentionally enhanced by some team captains, who actively publicised the screening events. There were no adverse effects reported. InterpretationThese findings suggest that young men in football settings find both POL-led and health adviser-led STI screening interventions acceptable and uptake is high compared with existing community testing models. Although the poster-promoted screening control group was intended to be uninfluenced by football club POLs, this intention was not practically possible; many captains were enthusiastic and encouraged their players to participate in screening. This factor resulted in POL influence regardless of group allocation. A health economics assessment is in process. A full-scale randomised controlled trial is needed to examine the broader implications of this approach to men's STI screening in the UK. FundingThis research is funded by a National Institute for Health Research programme grant for applied research.