title: Community-Based Assessment to Inform a Chlamydia Screening Program for Women in a Rural American Indian Community.
abstract: Rates of chlamydial infection in American Indian/Alaska Native women in the United States are approximately 4-fold those in non-Hispanic white women. We conducted a community-based survey of self-identified American Indian/Alaska Native women 14 to 25 years of age on a reservation in the Northwestern United States to inform a chlamydia screening strategy.
  
  
  
  The anonymous survey assessed respondents' knowledge, perceptions, and preferences related to chlamydia screening, results receipt, and partner notification. We recruited women using respondent-driven sampling, school-based sampling, and direct recruitment through social media and fliers. Participants in schools completed the survey as a paper-based, self-administered survey. Other participants could complete the survey in person, by phone as an interviewer-administered survey, or online.
  
  
  
  We recruited 162 participants, most in schools (n = 83; 51%) or by peer referral (n = 55; 34%). Only 1 woman completed the survey online. Thirty-one respondents (19%) reported a history of an unplanned first pregnancy, and 19 (12%) reported a history of a diagnosed sexually transmitted disease. Most women (n = 98; 63%) recognized the potential impact of Chlamydia trachomatis on fertility. The preferred site for chlamydia screening was the Indian Health Service Clinic (n = 114; 70%), but 79 women (41%) would accept a C. trachomatis test at a nonclinical testing site. Of the 56 women (35%) who would accept home testing, most preferred to get the test kit from a clinic.
  
  
  
  Our results suggest that Indian Health Service efforts to increase chlamydia screening in the clinic and through outreach may be more successful than promotion of home testing in this population.
authors.affiliation: From the *Awatam Consulting, Yakima, WA; †Indigenous Wellness Research Center, University of Washington, Seattle, WA; ‡Toppenish School District, Toppenish, WA; §Indian Health Services, Yakama Nation, Toppenish, WA; ¶Center for AIDS and STD, University of Washington, Seattle, WA; ∥Public Health-Seattle & King County HIV/STD Program, Seattle, WA.
authors.forename: Lucy
authors.initials: L
authors.lastname: Smartlowit-Briggs
authors.forename: Cynthia
authors.initials: C
authors.lastname: Pearson
authors.forename: Patricia
authors.initials: P
authors.lastname: Whitefoot
authors.forename: Bianca N
authors.initials: BN
authors.lastname: Altamirano
authors.forename: Michelle
authors.initials: M
authors.lastname: Womack
authors.forename: Marie
authors.initials: M
authors.lastname: Bastin
authors.forename: Julia C
authors.initials: JC
authors.lastname: Dombrowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000072957:Alaska Natives; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D016358:Contact Tracing; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007198:Indians, North American; D008403:Mass Screening; D011247:Pregnancy; D012424:Rural Population; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult