Abstract
Background: Chlamydia is the most common Sexually Transmitted Infection (STI) in England (Public Health England, 2016) and the impact of the infection has serious health and financial implications (World Health Organisation (WHO), 2003). The stigmatisation of STIs is linked to self-conscious emotions (Earl, Nisson & Abarracin, 2015) which could have a negative impact for treatment as physician communication which promotes shame has been found to influence adherence to treatment for health problems (Harris & Darby, 2009). Aim: The aim of this study was to further understand the effect of practitioner-patient communication, particularly the effect of guilt-promoting, shame-promoting or neutral communication on likelihood of following medical advice for chlamydia. Method: 140 females aged 18-25 took part in an online experiment. Participants were randomly allocated to one of three practitioner communication conditions: 1) designed to induce shame (internal focus on self) 2) designed to induce guilt (external focus on behaviour) 3) designed to be neutral. Participants then answered questions about their likelihood of adhering to medical advice (take medication, use condoms in future, make and attend follow-up appointments (NHS choices, 2015)). Participants also completed measures of shame and guilt proneness. Results: Counter to expectation, both the shame and guilt promoting communication had a significantly positive effect on some aspects of likely adherence to medical advice. There was no evidence that shame and guilt proneness correlated with likeliness to adhere to medical advice for those who received corresponding shame or guilt provoking communication. However, there was a relationship between guilt proneness and intention to perform safe sex in the future and take prescribed antibiotics. Conclusion: Findings might not be as predicted because likelihood of adherence to medical advice may not be suggestive of actual adherence to medical advice. Furthermore, as STIs are so greatly stigmatised by society, it may be that all participants were influenced by the effect of self-conscious emotions. The study also suggests that guilt-proneness may predict intention to follow medical advice of taking antibiotics and practicing safe sex in the future. The study could also be interpreted as suggesting that those who are guilt-prone or receive shame provoking communication are more likely to engage in behaviours that would ensure they would not have to attend a sexual health screening appointment in the future, which is counter to current medical advice of yearly screening for under 25 year olds.