'A circuit breaker' - Interrupting the alcohol autopilot: A qualitative exploration of participants' experiences of a personalised mHealth approach bias modification intervention for alcohol use.

Objective: There is a need for low-cost, wide-reaching interventions to enhance accessibility of support for people with hazardous alcohol consumption. We assessed participant experiences of using a novel, personalised mHealth intervention offering approach bias modification (ApBM) for alcohol use in a community sample drinking at harmful levels to enable a deeper understanding of the end user and engagement. Methods: Eighteen semi-structured telephone interviews were conducted with adults in the community drinking at harmful/hazardous levels. A reflexive thematic analysis approach was used and data analysis followed iterative categorisation. Results: Engagement/Motivation and Clinical Value were overarching themes. The useable, accessible, customisable design described by participants enabled training to be readily integrated into routines, enhancing autonomy and self-efficacy beliefs, and facilitating engagement/motivation. Where autonomy or perceived self-efficacy were threatened by a rigid training schedule or lack of clarity/reminders, engagement was reduced. Training increased awareness of drinking behaviours, and encouraged participants to consider alternate goal-directed behaviours with feedback suggesting training may function as a 'circuit breaker', increasing time between alcohol craving and seeking, and enabling reflective processing, at least in the short term. Conclusions: This novel smartphone intervention for alcohol use may be a useful, accessible, 'just in time' adjunctive support tool for non-treatment seekers, meeting an important gap in the field. Findings have implications for the implementation of subsequent digital interventions, suggesting participants may stand to gain more from an intervention which enables autonomy and improves self-efficacy beliefs. Theoretically, findings speak to the role of inferential processing in behaviour change, but further research is needed to clearly elucidate ApBM training mechanisms. Practical recommendations for subsequent app iterations are suggested, along with additional opportunities worthy of consideration for future initiatives.

"It feels good to be told that I'm all clear": patients' accounts of retesting following genital chlamydial infection.

OBJECTIVE: To examine the meaning that people with genital chlamydial infection attribute to retesting as part of their treatment management. METHODS: Unstructured interviews with 50 heterosexual patients (40 female and 10 male) who had or had had genital chlamydia infection. Recruitment was via a genitourinary medicine clinic and a contraceptive clinic. RESULTS: The return visit was understood in terms of the retest. The retest occupied a pivotal position in the infection experience and was invested with symbolic significance because it provided a means by which to deal with feelings of bodily pollution. It marked the end of dirtiness that was important for the restoration of identity. It also marked the beginning of cleanness that was important in relation to sexual relationships. CONCLUSION: The sociocultural construction of sexually transmitted infections shapes the individual experience of having chlamydial infection. This perspective sheds light on the meaning that individuals invest in aspects of infection management. It is important for some people to know rather than assume that their infection has been eliminated, a function that is fulfilled by the retest. When retesting is not available, individuals may use increasingly available opportunistic chlamydia testing for this purpose with consequent cost and resource implications.

Knowledge of genital Chlamydia trachomatis infection in family planning clinic attenders.

The purpose of this study was to determine the level of awareness of genital Chlamydia infection and level of knowledge related to this infection in family planning (FP) clinic attenders. Clients attending FP clinics during a 3 month study period were invited to complete an anonymous self-administered questionnaire. Five hundred and sixteen questionnaires from female attenders were analysed. Results showed that 54% of respondents had heard of Chlamydia. Subjective knowledge assessment for Chlamydia was low compared to that for other infections. Mean knowledge scores relating to genital chlamydial infection were low. There was no significant age-related trend in knowledge scores. The implications of these findings are discussed in relation to increased Chlamydia screening activity in FP clinics.

Knowledge of Chlamydia trachomatis infection in genitourinary medicine clinic attenders.

OBJECTIVES: To determine the level of awareness of genital chlamydial infection, and level of knowledge related to this infection, in genitourinary medicine (GUM) clinic attenders. METHODS: 500 consecutive patients attending a GUM clinic for the first time during a 3 month study period were invited to complete an anonymous self administered questionnaire on aspects of chlamydial infection. RESULTS: 482 (96.4%) questionnaires were available for analysis (57% female). 289 (60%) respondents had heard of Chlamydia trachomatis compared with 472 (98%) for thrush, 467 (97%) for HIV/AIDS, and 434 (90%) for gonorrhoea. Subjective knowledge of chlamydia, relative to the other infections, was poor. Overall, the mean chlamydial knowledge score was 0.38 (range 0.0-1.0). Females scored significantly higher than males (0.45 v 0.26; p < 0.00001) and younger females scored significantly higher than older females (p = 0.001). More females had experienced genital chlamydial infection than males (22.4% v 12.1%, p = 0.004). Those with prior exposure to C trachomatis had higher mean knowledge scores than those without (males 0.55 v 0.25, p < 0.00001; females 0.68 v 0.37, p < 0.00001). CONCLUSION: Even for a population considered as "high risk" by their attendance at a GUM clinic, there was poor awareness of genital chlamydial infection, and mean knowledge scores were low. Whether increased knowledge was due to successful health education at the time of diagnosis in those with previous infection remains to be determined. In the future, one would hope for increased knowledge scores in those at risk before the acquisition of infection, which may be achieved by national health education programmes for C trachomatis.