Increasing uptake of chlamydia screening – A peer-led approach

PictureThese kits enable young people to take a urine or vaginal swab sample, post it to a screening service and receive the results within two weeks.

By Jo Crichton

A key challenge for the National Chlamydia Screening Programme is increasing uptake of screening, particularly among high risk groups. The idea of peer-led screening was developed by staff at Bristol University and draws on aspects of other successful peer education interventions, such as DECIPHer’s ASSIST smoking reduction intervention.

Peer-led screening works through inviting young people to have informal conversations with their friends about a health issue, and to encourage their friends to engage in a health-promoting behaviour. ASSIST showed that informal peer conversations are a successful way to reduce smoking among secondary school pupils.

One of my PhD research questions examines whether a peer-led approach would be effective for increasing uptake of chlamydia screening among young people. I’m conducting research to build on a small study piloting the intervention, published in the Journal of Family Planning and Reproductive Health Care.


During the pilot, six men and six women aged 16 – 21 were invited to give chlamydia testing kits to their friends. Eleven of the men and women took a total of 45 kits. Three quarters of the kits were taken by women.

During the pilot, peer-led screening was found to be effective with women as peer communicators but not men. All six women gave out kits. Ten (38%) of the 26 kits given out by women were returned to the laboratory. Only two men gave out a total of three kits to their peers but none were returned. However, men returned kits offered by their female peers, so peer-led screening may be a way to encourage uptake by men.

In the pilot, young people were offered kits during interviews or group discussions. The next step is to work out how best to introduce peer-led screening in everyday situations. We are investigating the potential of a very brief intervention with peer communicators, lasting a few minutes (unlike other peer approaches that often involve two or more days of training).

Addressing inequalities

One interesting question is whether peer-led screening can help to reach young people who are at higher risk or are not being reached through existing screening services. Could we see a ‘snowballing’ effect where hard-to-reach individuals are reached through social networks? Such an approach has worked in the past with young Roma men in high risk sexual networks.

In our study, female participants were effective in reaching their social networks. One or more kits were returned from five out of the six participating women’s social networks.

Other qualitative research shows that there is a need to ‘normalise’ chlamydia testing to increase uptake. During interviews for this study, some participants said they found it embarrassing to offer their friends a kit, whereas others felt comfortable about it. My research will look at what kinds of resources and promotional activities might help to support peer-led conversations.

Jo Crichton is a DECIPHer PhD student based at the University of Bristol.


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