BMC Public Health 2009, 9:311 http://www.biomedcentral.com/1471-2458/9/311 Background Sexually transmitted infections (STIs) are increasingly important public health issues in the Republic of Ireland, because of the associated risks of infertility, pelvic inflam- matory disease (PID) and cancer [1-3]. The number of diagnosed STI cases reported to the Irish Health Protec- tion Surveillance Centre (HPSC) increased from 2228 in 1989 to over 10,500 in 2003, with the rate of increase being particularly high amongst young adults [4]. The increase in incidence, in a country that does not have a systematic population screening programme, reflects bet- ter detection techniques, increased opportunistic screen- ing by healthcare professionals; and also proactive decisions by young people to seek STI testing in an envi- ronment that is more open to acknowledging these risks. Given that such willingness provides an opening for pro- moting personal and public health, remarkably little is know about the factors and influences that prompt young people to seek STI testing. Most of the international research on young adults' STI testing practices has focused on barriers rather than on enablers and reasons that encourage them to seek testing [5,6]. The small number of studies that have examined young adults' STI care-seeking have found that it is influenced by factors including: health service characteristics (clinic opening hours, cost), patient characteristics, recognition by individual that they have engaged in 'risky' sexual prac- tices; and sometimes real or suspected symptoms [7]. Researchers [7-10] have argued, consequently, that more work is needed to understand the health seeking activities of young adults in relation to STIs, especially in countries and amongst populations where STI research and system- atic screening have been historically lacking [11]. Under- standing young adults' STI-related care-seeking behaviours is also central to population approaches to controlling the spread of STIs [11]. Better evidence could assist policy makers, programme managers and clinicians in funding, designing and implementing health promo- tion campaigns that address young people's concerns about STI testing processes [7] and thereby encourage demand or client-led STI screening practices [7,8,12]. Sys- tematic population screening is often preferable, espe- cially for largely asymptomatic STIs such as Chlamydia. However, where they are not feasible (Ireland lacks unique health service identifiers at the population level), it is essential to maximize prompt testing-seeking in those at greatest risk of having and transmitting a STI. Drawing on qualitative interviews with thirty young adults (18–29 years) who had previously attended either specialist STI services or community health-care settings for STI testing, in this paper we explore the following questions: What prompts young adults in Ireland to attend health services for STI testing? Do young adults delay in following through on their decision to seek STI testing, and if so, why? What factors support/undermine young adults' deci- sions to seek STI testing? Methods Thirty in-depth interviews were conducted with young adults who had previously attended health services for STI testing in the Republic of Ireland. Respondents were recruited from General Practice (GP) practices, Third Level College health services, Family Planning clinics and spe- cialist STI treatment services for men who have sex with men (MSM). We utilized a qualitative approach because we wanted to explore young people's perspectives in detail. Moreover, the dearth of research on these issues and the hypothesized complexity of young adults' STI care-seeking practices demanded an exploratory method. Qualitative methods have proven efficacy in sexual health research [5]. Respondents were eligible to take part in the study if they were between eighteen and twenty nine years of age (the age group with the greatest increase in detected incidence of STIs in the Republic of Ireland over the previous dec- ade) [4]. We purposely sampled respondents in order to recruit both men and women, respondents of different ages (late teens, early 20 s, mid 20 s, late 20 s), and respondents who had sought STI testing from specialist and community-healthcare settings. Twenty one respond- ents were female, nine were male. Ethical approval for the study was received from the Royal College of Surgeons in Ireland's ethics committee, and from the ethics committee of the Irish College of General Practitioners. Respondents were recruited either by the first author or by a healthcare professional working in the healthcare set- ting. Potential respondents were provided with an infor- mation leaflet, which provided background information on the study, what participation would involve (a one hour interview focusing on respondents' reasons for attending services for STI testing); their freedom to avoid issues and stop the interview at any point; and assurances on anonymity and how information would be recorded and used. Participating respondents were asked to respond 'yes' by text and were given the option of com- pleting the interview by telephone or face-to-face. Twenty four respondents chose to do the interview by phone and six face-to-face. Respondents who completed face-to-face interviews were asked to give written consent to take part in the study; respondents who completed telephone inter- views were asked to give verbal consent. Page 2 of 10 (page number not for citation purposes)