The aim of this study was to assess whether women requesting contraception only find attendance at an integrated sexual health clinic ISHC more stigmatizing than attendance at a family planning FP —only clinic.
Women requesting contraception only were asked to complete a stigma assessment questionnaire in the waiting room of the clinic they attended. Ease of understanding was assessed for each item of the questionnaire prior to commencement of the survey.
One hundred questionnaires that fulfilled the inclusion criteria were returned. The results of this research indicate that among women who request contraception perceived stigma is higher when they attend an ISHC than when they attend a FP-only clinic. As this survey only enrolled clinic users, the authors were unable to assess whether integration generates sufficient stigma to deter some women from accessing contraception from integrated services.
Of all stigma-related issues, disclosure concerns are likely to be the most important to the service user. Stigma is not an issue of overriding concern for most service users. Sexual and reproductive health is a public health priority in the United Kingdom UK. Current UK health policy as set out in the National Sexual Health and HIV Strategy in 3 continues to endorse the concept of integrated sexual health services where patients can access the complete range of sexual health care from one center and
Sexual health clinic london contraception journal one visit.
By Julyintegration had advanced to a level that all Enfield services operated within the OSS model, with the exception of two FP clinics, the community gynecology clinic, and the specialist clinics for termination of pregnancy assessment. Enfield RASH has served as a research site for an evaluation of integrated sexual health care. Enfield is an outer London borough with a young and ethnically diverse population ofIt has one of the highest rates of teenage pregnancy and of the human immunodeficiency virus HIV being first diagnosed during pregnancy in the country.
"Sexual health clinic london contraception journal" four sites are in the general community, and they are either in a building that contains GP offices or in a shopping area. Privacy from outside visibility is ensured when clients are in the clinics. Patients can access all components of comprehensive sexual and reproductive health care at a single visit.
This is because there are no facilities in these clinics for microscopy or incubation or refrigeration of specimens. Service users can access either of the integrated clinics on a walk-in basis or by appointment. An all-day service is run from "Sexual health clinic london contraception journal" or other of the integrated clinics Sexual health clinic london contraception journal day, Monday to Friday, from 9 am to 8 pm.
Both of the FP-only clinics are walk-in clinics, and these two clinics provide only three half-day sessions per week between them. Only a few men attend the FP clinics, to obtain condoms, but these service users do not need to see the clinical staff. Recommendations have been Sexual health clinic london contraception journal to Sexual health clinic london contraception journal the stigma of sexual health services. Qualitative work undertaken as a part of research has found that the ISHC model may reduce for patients requiring GUM care but that it may also increase the stigma for others.
As a reduction in stigma does not create a disadvantage to the patient or the service, the present authors focused on the group of patients most likely to be affected by the increased stigma that might be associated with an ISHC — that is, women attending a clinic to request contraception only.
The authors developed a stigma assessment questionnaire in collaboration with Dr Ellen Mulholland, using the key themes identified in the literature on stigma for conditions such as HIV or epilepsy.
The stigma assessment questionnaire Figure S1 consisted of a brief demographic, a reason for attendance section, and 15 individual statements describing the presence or absence of stigma in the service. Participants were asked to indicate on a five-point Likert scale how much they agreed or disagreed with the statements.
The statements addressed the positive aspects of the service Statements 2, 7, 8, and 14disclosure concerns Statements 1, 3—6, and 10public attitudes Statements 5, 12, 13, and 15 and negative self-image Statements 9 and The ease with which each item of the stigma assessment questionnaire was understood and assessed prior to the survey, in a further education ie, continuing education college, a community gynecology clinic, an ISHC, and a conventional FP Participation was voluntary but it was restricted to people over the age of 15 who were literate.
The 55 participants were required to complete the stigma assessment questionnaire unaided and to answer five questions regarding the ease of using the stigma assessment questionnaire. The participants were allowed to give verbatim information on any aspects of the stigma tool that was relevant to them.
A survey of women attending sexual health services was performed at three of the four different medical sites of Enfield RASH: A formal sample size calculation was not possible, as the authors knew nothing about the distribution of answers prior to the study. Also, there are no published quantitative studies assessing stigma in sexual health services.
The authors looked at studies "Sexual health clinic london contraception journal" stigma of diseases and found that some studies had used a similar sample size. For example, Emlet 16 had a sample size of 88, Wright et al 12 had a sample size of 48, and Franke et al 14 had a sample size of when investigating the stigma of HIV in Sexual health clinic london contraception journal. All patients attending the ISHCs and the FP-only clinic were asked to participate in the study to assess how patients felt about coming to each Sexual health clinic london contraception journal. Those patients who gave verbal consent to participate received the stigma assessment questionnaire in the waiting room of the clinic they were attending and were asked to complete it while waiting to be seen.
A total of participants visiting the FP-only clinic and the ISHCs were eligible to participate in the study; of these, 41 were male, were female, and 6 did not reveal their gender.
Of the 50 women who attended the FP-only clinic and the women who attended the ISHCs, 44 and 56 women, respectively, were included in this study. This article is part of a larger study to assess stigma in sexual health services within Enfield RASH.
No errors were detected. Of those who were asked to assess the questionnaire prior to the survey, 51 of the 55 respondents Furthermore, 48 respondents Finally, 42 respondents The test—retest reliability of the stigma assessment questionnaire was assessed using the data obtained from completed stigma assessment questionnaires. This was done by comparing all stigma-positive responses of the first half of the participants with those of the second half in all clinics.
Significant associations were verified using a multiple regression controlling for any confounding factors age, ethnicity, and social deprivation. An answer was classified as stigma positive if a patient either agreed or strongly agreed with a statement describing the presence of stigma Statements 1, 3—6, 9—13, and 15 or if a patient
Sexual health clinic london contraception journal disagreed or strongly disagreed with a statement describing the absence of stigma Statements 2, 7, 8, and In the next part of this study, the authors tested the hypothesis that women requesting contraception only find attendance at an ISHC more stigmatizing than attendance at a FP-only clinic.
For this the authors used the answers given by women attending for contraception only. The demographic characteristics of the study participants are given in Table 1.
These data show that the mean average age was younger in the women attending the ISHCs than in those attending the FP-only clinic. The authors used Sexual health clinic london contraception journal indicators to highlight possible confounders.
Odds ratios ORs and age-adjusted ORs for perceived stigma at integrated sexual health clinics compared with perceived stigma at family planning—only clinics. Ethnicity and levels of social deprivation were also examined Sexual health clinic london contraception journal the authors found no significant differences between clinics ethnicity: As age may prove a confounder within the analysis, significant differences in responses between the clinics were investigated with a multiple regression to control for the influence of age.
All analyses showed that respondents in the FP-only clinic were "Sexual health clinic london contraception journal" less likely than those attending the ISHCs to report concerns about the service, independent of age. It has been demonstrated that STIs are stigmatizing conditions. Both points are significant, as stigma could deter those in real need from attending 21 and it could induce higher anxiety levels among those who do attend. To avoid measuring the stigma of a perceived STI risk, the authors focused the analysis on women who attended the ISHCs or the FP-only clinic for contraceptive needs only.
This analysis demonstrated that attendance at an ISHC was perceived as more stigmatizing than attendance at a FP-only clinic. It was reassuring that, overall, the majority of ISHC users did not perceive the service as stigmatized. However, there was a stigma-indicative response for Statements 1, 10, and According to Darzi, 23 a high quality of care is safe and effective leads to a good patient experience.
Therefore, it is possible that integration could reduce the quality of care for women who only require contraceptive services. However, the authors believe that this will be counteracted by the fact that many women who request contraceptive services only will benefit from the extended menu of sexual health care options available within the ISHC environment.
It is also clear that further efforts need to be made to reduce the stigma of ISHCs. The results confirm the finding of qualitative research that ISHCs can be perceived as more stigmatizing than FP-only clinics.
Two domains are particularly affected by stigma: This study also has some significant limitations, as outlined in the following points. Notwithstanding these limitations, the authors firmly believe that this study supports the following statements. The results of this study indicate that not only conditions but also services can be stigmatized. These findings are supported by qualitative research from this and other units.
The authors were reassured that the majority of women who attended the ISHCs for contraception expressed no or only minimal stigma concerns. However, even a limited effect could reduce access for those who are highly sensitive toward stigma.
Until it is certain that ISHCs are not perceived as more stigmatized than FP-only clinics, the authors believe that sexual health services should continue to provide a limited number of nonintegrated clinics, to cater for the contraception needs of the stigma-sensitive part of the population.
The authors thank Ms Ellen Mulholland, senior lecturer in psychology, School of Social Sciences and Law, Teesside University, Middlesbrough, UK, for her invaluable help with the development of the first draft of the stigma assessment questionnaire. National Center for Biotechnology InformationU. Int J Womens Health. Published online Feb 9.
Author information Copyright
Sexual health clinic london contraception journal License information Disclaimer.
This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. Patients and methods Women
Sexual health clinic london contraception journal contraception only were asked to complete a stigma assessment questionnaire in the waiting room of the clinic they attended. Results One hundred questionnaires that fulfilled the inclusion criteria were returned.
Conclusion The results of this research indicate that among women who request contraception only, perceived stigma is higher when they attend an ISHC than when they attend a FP-only clinic. Methods Development of the stigma assessment questionnaire The authors developed a stigma assessment questionnaire in collaboration with Dr Ellen Mulholland, using the key themes identified in the literature on stigma for conditions such as HIV or epilepsy.
Application of the stigma assessment questionnaire A survey of women attending sexual health services was performed at three of the four different medical sites of Enfield RASH: Results An answer was classified as stigma positive if a patient either agreed or strongly agreed with a statement describing the presence of stigma Statements 1, 3—6, 9—13, and 15 or if a patient either disagreed or strongly disagreed with a statement describing the absence of stigma Statements 2, 7, 8, and Table 1 Demographic characteristics of study participants.
Open in a separate window. Table 2 Odds ratios ORs and age-adjusted ORs for perceived stigma at integrated sexual health clinics compared with perceived stigma at family planning—only clinics.
Discussion It has been demonstrated that STIs are stigmatizing conditions. While a formal sample size calculation was not undertaken, the authors hoped to enroll about twice as many women in the study than the figure finally achieved.
Enrolling higher numbers proved to be difficult, as the majority of women attending Enfield RASH services came with a request for integrated or GUM care. The stigma assessment questionnaire is likely to be biased towards the detection of stigma, as it contains more statements describing the presence of stigma than statements describing the absence
Sexual health clinic london contraception journal stigma. The authors consider this is justified, as a questionnaire sensitive toward the detection of stigma was needed.
Burrell Street sexual health clinic is London's first NHS clinic which is open 7 days Advice and information; Contraception (including emergency contraception). Enfield is an outer London borough with a young and ethnically diverse These clinics are advertised to service users as “family planning clinics.” . Articles from International Journal of Women's Health are provided here. "Sexual health clinic london contraception journal" of Public Health, Volume 34, Issue 3, 1 AugustPages –.
Duringthere were 13 community Sexual health clinic london contraception journal health clinics within the study area ; two of . Service location is imperative when trying to improve access to contraception and sexual health advice; it is a distinct.
The aim of this examine was to assess whether women requesting contraception single find crowd at an integrated procreative health clinic ISHC more stigmatizing than attendance at a derivation planning FP —only clinic. Women requesting contraception on the other hand were asked to rank a smirch assessment questionnaire in the waiting flat of the clinic they attended. Nonchalance of grasp was assessed for each item of the questionnaire prior to commencement of the take the measure of.
One hundred questionnaires that fulfilled the inclusion criteria were returned. The results of that research imply that mass women who request contraception only, perceived stigma is higher when they occupy oneself with an ISHC than when they pay attention to a FP-only clinic. As this contemplate only enrolled clinic final users, the authors were unfit to assess whether integration generates enough stigma to deter some women from accessing contraception from integrated services.
Of all stigma-related issues, disclosure concerns are likely to be the most eminent to the service alcohol.
That clinic is based at the Streatham Hill Centre in south London. We no longer take walk-ins for asymptomatic no concerns or no symptoms check-ups. Please order an online self-testing accouterments. We offer an online booking employ where you can book an post to be seen for any of the services provided by the clinic. Call us on Patients Around your care Impel, cancel or swap an appointment Staying in hospital Your outpatient appointment Fail your feedback.
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We no longer accept walk-ins for asymptomatic no concerns or no symptoms check-ups. Please disposition an on the net self-testing implements. Saturday and Sunday are our busiest days.
If you are planning to visit Burrell Street on a weekend, it is advisable that you punch in early to avoid mortification. Patients can self-refer to most of our clinics. GPs and other robustness professionals can also refer a unfaltering. We essay an on the web booking serving where you can manual an date to be seen in behalf of any of the services provided by way of the clinic.
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This article is part of a larger study to assess stigma in sexual health services within Enfield RASH. However, the increase in stigma may not be detrimental when balanced against the likely decrease in stigma among STI service users. Of those who were asked to assess the questionnaire prior to the survey, 51 of the 55 respondents One of the main shortcomings of this study is the inability to control for other confounding factors. Of all stigma-related issues, disclosure concerns are likely to be the most important to the service user.
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