title: How social representations of sexually transmitted infections influence experiences of genito-urinary symptoms and care-seeking in Britain: mixed methods study protocol.
abstract: Social understandings of sexually transmitted infections and associated symptoms and care-seeking behaviour continue to lag behind advancements in biomedical diagnostics and treatment, perpetuating the burden of disease. There is a lack of research linking perceptions, experiences and care-seeking for sexual health issues, especially research conducted outside of medical settings. We aim to explore lay perceptions of STIs and how these influence experiences of genito-urinary symptoms and associated care-seeking behaviour, in women and men in Britain.
  
  
  
  This study adopts a participant-selection variant of the explanatory sequential mixed methods design to incorporate quantitative and qualitative strands. We use data from Britain's third National Survey of Sexual Attitudes and Lifestyles (n = 15,162) to analyse national patterns of symptom experience and care-seeking, and to identify a purposive qualitative sample. Semi-structured interviews (n = 27) following up with survey participants include a novel flash card activity providing qualitative data about infection perceptions, symptom experiences and decisions about healthcare. Quantitative and qualitative data are analysed separately using complex survey analyses and principles of Interpretative Phenomenological Analysis respectively. Data are then integrated in a subsequent phase of analysis using matrices to compare, contrast and identify silences from each method.
  
  
  
  This is an ongoing mixed methods study collecting, analysing and synthesising linked data from a national survey and follow-up semi-structured interviews. It adds explanatory potential to existing national survey data and is likely to inform future surveys about sexual health. Given the current uncertainty around service provision in Britain, this study provides timely data about symptom experiences and care-seeking behaviour which may inform future commissioning of sexual healthcare.
authors.affiliation: Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK. Fiona.Mapp@lshtm.ac.uk.
authors.forename: Fiona
authors.identifier: 0000-0003-0733-6036
authors.initials: F
authors.lastname: Mapp
authors.affiliation: Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Ford
authors.initials: F
authors.lastname: Hickson
authors.affiliation: Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, London, UK.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Mercer
authors.affiliation: Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Kaye
authors.initials: K
authors.lastname: Wellings
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D057545:Social Stigma; D006113:United Kingdom; D055815:Young Adult
keywords: Care-seeking behaviour; Genito-urinary symptoms; Mixed methods research; Natsal-3; Non-attendance; Semi-structured interviews; Sexually transmitted disease; Sexually transmitted infections; Survey