Stacey Griner, PhD, MPH, CPH, on STI Screening on College Campuses

Although rates of sexually transmitted infections (STIs) are increasing on college campuses, screening rates among college-age women are low. A new study,¹ led by Stacey Griner, PhD, MPH, CPH, investigated the preferred screening methods of women on a college campus.

After conducting interviews with 24 women aged 18 to 24 years, Griner and colleagues found an emergent theme that mental health providers and the counseling center were described as a source of information about STI screening. Women reported the counseling center as feeling “private” and “confidential,” and viewed mental health providers as trusted emotional support.

To gain more insight into these findings, Infectious Diseases Consultant reached out to lead author Dr Griner, who is an assistant professor in the Department of Health Behavior and Health Systems at the School of Public Health in the University of North Texas Health Science Center in Fort Worth, Texas.

ID CON: Your study found that college-age women feel comfortable speaking with mental health providers about STI screening. But what about college campuses that do not have mental health providers? What are some other methods of delivering STI-related information to these women?

Stacey Griner: For college and university campuses without mental health providers, an alternative approach to explore for partnerships may include emerging counseling approaches (ie, TalkSpace, BetterHelp, Breakthrough) that utilize video chat appointments or asynchronous discussion with a counselor. The focus of this study was self-sampling methods for STI screening, which are often accessed outside of the traditional clinic visit. Given this, these alternative mental health service delivery platforms may be a novel solution.

Health care providers are viewed as the most preferred source of STI-related information among young adults, closely followed by internet and college resources. As an alternative to health care providers, most college women in this study reported that informational emails from the college would be an acceptable approach. However, the women specified that the emails should be sent only to those who identify as women to reduce the stigma.

It is important to note that this study focused on undergraduate women at a large, public, 4-year university in the Southeast United States. Currently, we are unable to generalize these results to young adult women in the general population or those on smaller campuses who may not have the unique access to resources that these particular women had. Studies are currently in progress to generalize these findings with a larger, more representative population of young adult women.

ID CON: Mental health providers were also viewed as “trusted sources of information.” How can public health providers off-campus be seen as trusted sources of information as well? What are your tips for building patient-provider trust?

SG: Off-campus providers play a large role in providing information, as many college women reported they wanted to receive sexual health care off-campus to avoid the stigma associated with receiving care at the campus health clinic. This is further complicated because women feel they can trust the information health care providers provide; however, they do not feel comfortable discussing their sex lives or sexual health with them. In most of the conversations in this study, ensuring privacy and confidentiality during sexual health visits were of utmost importance. Off-campus providers may benefit from sharing with their patients the ways in which their patients’ information will be kept private and confidential. Particularly among young adults, there are concerns regarding insurance billing and the possibility of their parents receiving an explanation of benefits or a bill disclosing the services received. Therefore, off-campus providers may offer low-cost, cash-payment STI screening options to mitigate this risk.

While these are practical changes to improve patient-provider trust, many of the women in this study viewed mental health providers as more accepting and less judgmental than physicians in the context of STI screening. This may indicate that college women are looking to their providers as not only an informational source, but also for emotional support when seeking STI screening and information. One of the goals of Healthy Campus 2020 is to increase the proportion of students who report that their health care providers have satisfactory communication skills. Physicians and public health providers are viewed as trustworthy for the STI-related information they provide but improve their communication with this specific population by engaging in empathetic and open communication about sexual health.

ID CON: Another finding of your interviews highlighted the fact that mental health providers may be underutilized on college campuses. What do these results mean for other public health providers who manage college-age patients off-campus?

SG: For public health providers who interact with college women off-campus, it may be beneficial to consider the social context of young adults in this setting. College women are at a transition point in their lives and may be learning to make health-related decisions for themselves. College women have expressed that they value when providers are knowledgeable, warm, friendly, understanding, and nonjudgemental. Meeting these needs, being willing to start the conversation about sexual health and STI screening, and recognizing that college women may be in transition from pediatric care to adult care may be important considerations in becoming a “young-adult-friendly” provider.

The results of this study also indicate a need to close systems-level gaps by connecting mental health providers, physicians, and OB/GYNs, both on- and off-campus, to ensure patients have access to STI screening and related information. The results further underscore the need for multilevel interventions to meet the needs of college women and highlight a further need for systems-level connections between a variety of specialties serving young adults, both on- and off-campus.

ID CON: In your opinion, what interventions or events have to happen to reduce the burden of STIs/STDs among young adults?

SG: Because STIs are currently at an all-time high, there have been many suggestions to reduce the burden among young adults. These include re-establishing specialty STI clinics, leveraging HIV funding to benefit STIs, reducing the stigma associated with STIs, and providing evidence-based sexual health education for young adults. On a large scale, these approaches will be effective, but take time.

College women have identified scheduling issues and a need for convenience as key issues for not receiving STI screening.² To address scheduling concerns and reduce the burden of STIs among young adults, approaches could include the implementation of alternative approaches to STI screening, like self-sampling methods collected at home or walk-in screening without scheduling appointments. Additionally, point-of-care testing is rapidly developing and will change the process of STI screening, diagnosis, and treatment for the better.

As the results of this study suggest, another alternative approach to STI screening may be exploring alternative health care providers to provide screening recommendations and referrals, including mental health providers.

Reference:

1. Griner S, Vamos CA, Puccio J, et al. Sexually transmitted infection screening information: Are mental health providers a resource for college students? Paper presented at: The American Public Health Association 2019; November 2-6, 2019; Philadelphia, PA. https://apha.confex.com/apha/2019/meetingapp.cgi/Paper/446217. Accessed November 19, 2019.
2. Griner SB, Vamos CA, Puccio JA, Perrin K, Beckstead J, Daley EM. “I’ll just pick it up…” Women’s acceptability of self-sampling methods for STI screening [published online October 30, 2019]. Sex Transm Dis. https://doi.org/10.1097/OLQ.0000000000001077.