Derivation of a psychosocial clinical prediction rule to target sexual healthcare among women of reproductive age attending British General Practices

Abstract

In Britain, contraception advice and supply was traditionally provided in Family Planning clinics while STI diagnosis, treatment and partner notification was largely restricted to specialist Genito-Urinary Medicine Clinics. One of the strategies employed in Britain since 2000 to address continuing high rates of unintended pregnancy and of STI acquisition, has been widened availability of STI testing and of contraception in General Practices (GPs). The majority of the British population are registered with a GP, so that GP populations are heterogeneous in terms of their need for these interventions. In the absence of any bespoke means of targeting these interventions, valuable opportunities to offer sexual healthcare to women attending GPs, may currently be missed, in particular because GP consultations are extremely limited in length and evidence suggests that female patients may find routine discussion of sexual behaviour unacceptable. Therefore, the aim of this thesis was to derive a Clinical Prediction Rule (CPR), comprised of psychosocial questions. The CPR’s purpose is to discriminate women who had experienced risk of unintended pregnancy in the last six months and/or risk of STI acquisition through multiple partnerships or partner behaviour in the last year. This derivation work involved: 1. A systematic review of population surveys of women in the Western world reporting psychosocial predictors of sexual risk behaviour and adverse sexual health outcomes 2. An analysis of psychosocial predictors of sexual risk behaviour and adverse sexual health outcomes using data from the National Survey of Sexual Attitudes and Lifestyles-3 3. A cross-sectional survey of women attending GP settings and a Contraception and Sexual Health clinic in Brighton & Hove. The findings indicate that psychosocial questions do predict sexual risk and adverse outcomes in women attending GPs, but that the sensitivity and specificity are insufficient to warrant further validation and evaluation to support its routine use in practice.

Date of Award	2018
Original language	English
Awarding Institution	University of Brighton
Supervisor	Jackie A. Cassell (Supervisor), Catherine Mercer (Supervisor) & Richard De-Visser (Supervisor)