Article Text
Abstract
Introduction A clinical prediction rule (CPR) using psychosocial questions was previously derived to target sexual healthcare in general practice by identifying women at risk of unintended pregnancy (UIP) and sexually transmitted infections (STIs). This psychosocial CPR may help target resources within contraception and sexual health (CASH) services. This study investigated how well it predicted recent self-reported risk of UIP and STI acquisition among women attending a CASH clinic.
Methods Female patients aged 16–44 years attending a CASH clinic in South-East England were offered a questionnaire on arrival. This comprised psychosocial questions, and others addressing three sexual risks: (1) two or more male sexual partners in the last year (2+P), (2) risk of STI acquisition through most recent partner and (3) risk of UIP in the last 6 months. A CPR score was calculated for each participant and cross-tabulated against self-report of each sexual risk to estimate CPR sensitivity and specificity.
Results The psychosocial questions predicting 2+P had sensitivity 83.2% (95% CI 79.3% to 86.5%) and specificity 56.1% (95% CI 51.3%−60.6%). Those predicting combined 2+P and/or risk of STI acquisition through most recent partner had a sensitivity of 89.1% (95% CI 85.7%−91.8%) and specificity of 43.7% (95% CI 39.0%−48.5%). Questions predicting risk of UIP in the last 6 months had a sensitivity of 82.5% (95% CI 78.6%−86.0%) and specificity of 48.3% (95% CI 43.4%−53.1%).
Conclusions The CPR demonstrated good sensitivity but low specificity, so may be suited to triaging or stratifying which interventions to offer CASH patients and by which mode (eg, online vs face-to-face). Further investigation of causal links between psychosocial factors and sexual risk is warranted to support development of psychosocial interventions for this patient group.
- family planning service provision
- genitourinary medicine
- needs assessment
- service delivery
- surveys
- sexually transmitted infections
Data availability statement
Data are available upon request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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- family planning service provision
- genitourinary medicine
- needs assessment
- service delivery
- surveys
- sexually transmitted infections
Data availability statement
Data are available upon request.
Footnotes
Twitter @natalieedelman
Contributors NE led the study conception, design, implementation, analysis and publication. JC, RV and CM contributed to conception, design and publication. JW and AG acted as Principal Investigators at study sites, contributing also to study planning and data acquisition, and consulting on the publication and cut-off score choices. CJ and SB advised on the sample size, plan of analysis and interpretation of findings, as well as this publication, and SB oversaw the analysis itself.
Funding This is a summary of independent research funded by the National Institute for Health Research (NIHR)’s Doctoral Research Fellowship programme (DRF-2013-06-004).
Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. The Methods section contains further details.
Provenance and peer review Not commissioned; externally peer reviewed.