Introduction: Although there have been great strides in the prevention, care and treatment of sexually transmitted infections (STIs, including HIV) in Australia, the increasing trend towards higher rates of some STIs is of concern, especially reports of higher rates of chlamydia in inner regional areas. Reasons for these changes are unclear but suggest there is an inconsistent use of prevention measures and ambivalence towards acting responsibly around sexual behaviours. Understanding an individual's response to the circumstances or contexts in which knowledge about STIs are operationalised in rural communities becomes central to recognising how individuals experience health and illness, especially for developing interventions to prevent the transmission of STIs. The aim of this research is to understand how individuals in rural communities make sense of their experiences in relation to STIs and how rurality influences discussion about STIs and health-seeking behaviours.
Method: In-depth interviews with 24 participants, 18 females and 6 males, aged between 19 and 65 years provide the data for the study. Methodological principles of 'grounded theory' underpin the analysis. An eclectic approach to grounded theory was used in the current study that was derived from a number of authors.
Results: The findings revealed that a number of contexts shape the actions and reactions of rural individuals towards STIs. These include 'public and private world of individuals', 'forms of talking in rural communities' and 'managing information and use of health services'. Factors that shape social life in rural communities such as the social bonds that are present, the relationships developed, and the way in which people behave influence the public and private aspects of rural life. Different forms of talk were identified that indicate that sexual issues are discussed in a number of informal ways and encompass distinct experiences of conveying information with regard to sex and STIs. Managing information and use of health services occurs when individuals assess and identify the need to access services for STIs.
Conclusions: The strength of this research lies in the identification of a number of contexts such as the private-public divide and types of talk where informal mechanisms encourage individuals to conform and comply with community rules and values. Using informal talk as a health promotion and or prevention strategy in rural locations can provide an alternative approach to potentially changing social norms. It would be possible to extend the idea of positive informal talk to include symbols and imagery that encourage individuals to seek treatment and provide a more positive view of 'reputation'. Engaging rural individuals in positive talk about sexual risk, access to treatment for STIs, and provision of accurate knowledge can help to build new 'social norms' that encourage new interpretations.