Analysing community perspectives on sexual health service utilization: a mixed method study in Italy

Abstract Background Sexually transmitted infections (STIs) are still prevalent among young and hard-to-reach populations in Italy, with 25% of diagnosed cases occurring in people aged ≤25 years. Evidence suggests that low perceived risk, lack of knowledge, institutional barriers, fear of stigma limit uptake of STI prevention services. This study examines the determinants of service uptake in the district of Foggia, Italy, incorporating the perspectives of young adults, health care workers (HCWs) and civil society organisations (CSOs). Methods This cross-sectional study uses mixed methods (protocol approved on 17Dec2024). Comprehensive service mapping will identify the geographical distribution of all public/private IST services, structural accessibility parameters and confidentiality safeguards; three knowledge, attitudes and practices (KAP) surveys, focus group discussions and in-depth interviews with 18-25-year-olds, HCWs and CSO representatives will describe STI knowledge levels, service utilisation patterns and perceived barriers among these target groups. Results Started in Jan, the study ends on 31May2025. On 30Apr, 31 services completed the mapping exercise, 644 18-25-year-olds, 60 HCWs and 24 CSO representatives responded to KAP surveys. Three focus groups were conducted with young people, one with HCWs and one with CSO representatives. Ten in-depth interviews were also conducted with HCWs and CSO representatives. Further activities are planned to further involve the target groups in qualitative research. Conclusions Despite several challenges in engaging HCWs and CSOs, strategic outreach efforts through direct personal contact and targeted communication ultimately result in sufficient representation of diverse perspectives. Findings may inform local policy changes regarding service delivery frameworks, HCW training requirements and implementation of inclusive communication to reduce stigma and increase uptake of STI prevention services. Key messages • The study provides comprehensive assessment of STI service utilization determinants from multiple stakeholder perspectives, focusing on communication barriers among young and hard-to-reach populations. • Evidence generated will directly inform implementation of user-centred service design models addressing stigma and accessibility barriers in preventive sexual health services.