Health Care Service for the Upper Class? Equity in Utilization of an Internet-based Chlamydia trachomatis Infection Testing Service, Sweden: a Cross-Sectional Study

Masuma Novak^1, , Avneet Dayal¹ and Daniel Novak²

¹Institute for Health and Care Science, Sahlgrenska Academy, University of Gothenburg, SE-416 85, Gothenburg, Sweden

²2Department of Paediatrics, Queen Silvia Children’s Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Cite this paper:
Masuma Novak, Avneet Dayal and Daniel Novak. Health Care Service for the Upper Class? Equity in Utilization of an Internet-based Chlamydia trachomatis Infection Testing Service, Sweden: a Cross-Sectional Study. World Journal of Preventive Medicine. 2015; 3(2):40-43. doi: 10.12691/jpm-3-2-4

Abstract

The utilization rate between social groups of a free Internet based Chlamydia trachomatis (C. trachomatis) testing service in Sweden is unknown. This study examined variations in use of this service according to the participants’ age, gender, educational levels and their parents’ educational levels. In 2004, Sweden introduced the first free Internet-based C. trachomatis testing service for both men and women of all ages. During three consecutive years (2005-2007), the questionnaire that accompanied the ordered test contained questions regarding participants’ level of education and other socio-demographic information. A total of 6025 participants completed the questionnaires and provided urine samples. The response rate was 77% (2256/2923) for men and 93% (3769/4055) for women. In both gender, about 46% tests were accessed by those with high education (≥ 14 years) as compared to only 2% by those with low education (≤ 9 years) (p <0.001). With one exception, a similar trend was seen when parental educational levels were used where 35% to 40% of the tests were taken by participants whose parents had a high level of education and 18% to 26% of the tests were taken by participants whose parents had a low level of education. No significant trend was seen in terms of proportion of men accessing the service according to their mothers’ education. This study demonstrates an existence of inequality in utilization of an Internet-based C. trachomatis infection testing service as more men and women with a high level of education utilized this service than men and women with a low level of education. Future studies should aim to find a reason for this discrepancy which will help researchers and policy makers to find ways to promote the equal utilization of Internet-based health service between different socio-economic groups.

Keywords:
C. trachomatis health care service utilization equality Sweden

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Novak DP, Edman AC, Jonsson M, Karlsson RB. The internet, a simple and convenient tool in Chlamydia trachomatis screening of young people. Euro Surveill. 2003; 8 (9): 171-6.
[2]	Novak DP, Karlsson RB. Simplifying chlamydia testing: an innovative Chlamydia trachomatis testing approach using the internet and a home sampling strategy: population based study. Sex Transm Infect. 2006; 82 (2): 142-7; discussion 52-3.
[3]	Hanratty B, Zhang T, Whitehead M. How Close Have Universal Health Systems Come to Achieving Equity in use of CuraItive Services? A Systematic Review. International Journal of Health Services 2007; Volume 37: 89-109.
[4]	Ladd J, Hsieh YH, Barnes M, Quinn N, Jett-Goheen M, Gaydos CA. Female users of internet-based screening for rectal STIs: descriptive statistics and correlates of positivity. Sex Transm Infect. 2014; 90 (6): 485-90.
[5]	Op de Coul EL, Gotz HM, van Bergen JE, Fennema JS, Hoebe CJ, Koekenbier RH et al. Who participates in the Dutch Chlamydia screening? A study on demographic and behavioral correlates of participation and positivity. Sex Transm Dis. 2012; 39 (2): 97-103.
[6]	Woodhall SC, Sile B, Talebi A, Nardone A, Baraitser P. Internet testing for Chlamydia trachomatis in England, 2006 to 2010. BMC Public Health. 2012; 12: 1095.
[7]	Level of Internet access- household [database on the Internet] 2013. Available from: http://epp.eurostat.ec.europa.eu/tgm/table.do?tab=table&init=1&plugin=1&language=en&pcode=tin00134
[8]	Findahl O. The Swedes and the Internet 2011. Stockholm: The Internet Infrastructure Foundation 2011. Report No.: 978-91-978952-1-7.
[9]	Findahl O. The Swedes and the Internet 2007: The Internet Infrastructure Foundation 2007. Report No.: 978-91-978952-1-3
[10]	Findahl O. The Swedes and the Internet 2000: The Internet Infrastructure Foundation 2000. Report No.: 978-91-978952-1-0
[11]	Greenland KE, Op de Coul EL, van Bergen JE, Brouwers EE, Fennema HJ, Gotz HM et al. Acceptability of the internet-based Chlamydia screening implementation in the Netherlands and insights into nonresponse. Sex Transm Dis. 2011; 38 (6): 467-74.
[12]	Findahl O. The Swedes and the Internet 2008: The Internet Infrastructure Foundation 2008. Report No.: 978-91-978952-1-4
[13]	Findahl O. The Swedes and the Internet: The Internet Infrastructure Foundation 2012. Report No.: 978-91-978952-1-9
[14]	Sharma A, Sullivan PS, Khosropour CM. Willingness to Take a Free Home HIV Test and Associated Factors among Internet-Using Men Who Have Sex with Men. J Int Assoc Physicians AIDS Care (Chic). 10 (6): 357-64.