BMC Public Health 2009, 9:311 http://www.biomedcentral.com/1471-2458/9/311 limitation is that 80% of the interviews were conducted by telephone with only 20% conducted face-to-face. Tele- phone interviews might be less well-controlled (e.g. par- ticipants may not have been as free to talk as they might have been in a clinical or research setting), and the inter- viewer did not have access to non-verbal responses to guide follow-up questioning. It is therefore possible that additional information might have emerged if the inter- views were conducted face-to-face rather than over the tel- ephone. However, our recruitment of young adults from a number of settings (see table 1) and from two regions of the coun- try is likely to have increased the representativeness of the findings as those of young adults in Ireland. Because of time constraints in the interviews and the willingness of young people to explore the issues that were the main objective of the study, we did not investigate STI-related health seeking behaviors not associated with attending a health service for testing, such as seeking health advice on the internet. This is an important area for future research to address as young adults may engage in a variety of help- seeking activities either as a preliminary to, or in parallel with, health service attendance [22]. Conclusion The findings of this study suggest that there are multiple pathways, catalytic and inhibitory factors that can lead, delay and possibly deter young adults from seeking STI testing. These should be viewed, explored and exploited as opportunities for public health and health service inter- ventions. Health promotion efforts to encourage STI test- ing should promote the STI testing-enablers identified here, reinforcing young people's views that the risk of acquiring a STI through unprotected sex is real; that STI testing is a 'mature' responsible practice and that it would be helping not just young people but also their friends and partners; and reassuring them (assuring that) young people will be judged positively by healthcare providers when they go for testing. Given respondents' stigma- related concerns health promotion materials should also stress the confidentiality of STI testing services. It follows from our findings that health promotion messages should be directed at four specific groups: those leaving and/or entering relationships where condoms have not or will not be used, those who have had unprotected sex and those with STI-related symptoms. Health promotion mes- sages should also emphasise that STIs begin to have an impact upon individuals and can be transmitted to others from shortly after their acquisition. This might help to combat the worrying delays in testing reported in this paper. While there might be some risk of encouraging over-testing in a small number of people, young people's notion of STI testing as a cleansing action should be seen as an opportunity to frame positive messages that build upon those key transition windows of opportunity revealed in these enlightening interviews with young peo- ple. Competing interests The authors declare that they have no competing interests. Authors' contributions MB and RB both analyzed the interview transcripts. MB wrote the first draft and RB revised it. Both authors read and approved the final manuscript. Acknowledgements We thank the respondents who took part in this study. 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