How to increase chlamydia testing in primary care: a qualitative exploration with young people and application of a meta-theoretical model

Abstract

ObjectiveThe objective of this study was to explore young people’s perspectives barriers to chlamydia testing in general practice and potential intervention functions and implementation strategies to overcome identified barriers, using a meta-theoretical framework (the Behaviour Change Wheel (BCW)).MethodsTwenty-eight semistructured individual interviews were conducted with 16–24 year olds from across the UK. Purposive and convenience sampling methods were used (eg, youth organisations, charities, online platforms and chain-referrals). An inductive thematic analysis was first conducted, followed by thematic categorisation using the BCW.ResultsParticipants identified several barriers to testing: conducting self-sampling inaccurately (physical capability); lack of information and awareness (psychological capability); testing not seen as a priority and perceived low risk (reflective motivation); embarrassment, fear and guilt (automatic motivation); the UK primary care context and location of toilets (physical opportunity) and stigma (social opportunity). Potential intervention functions raised by participants included education (eg, increase awareness of chlamydia); persuasion (eg, use of imagery/data to alter beliefs); environmental restructuring (eg, alternative sampling methods) and modelling (eg, credible sources such as celebrities). Potential implementation strategies and policy categories discussed were communication and marketing (eg, social media); service provision (eg, introduction of a young person’s health-check) and guidelines (eg, standard questions for healthcare providers).ConclusionsThe BCW provided a useful framework for conceptually exploring the wide range of barriers to testing identified and possible intervention functions and policy categories to overcome said barriers. While greater education and awareness and expanded opportunities for testing were considered important, this alone will not bring about dramatic increases in testing. A societal and structural shift towards the normalisation of chlamydia testing is needed, alongside approaches which recognise the heterogeneity of this population. To ensure optimal and inclusive healthcare, researchers, clinicians and policy makers alike must consider patient diversity and the wider health issues affecting all young people.

Young people’s perceptions of accessing a community pharmacy for a chlamydia testing kit: a qualitative study based in North East England

“…This is similar to findings from a study on young people’s views on testing in general practice who preferred the guidance of a healthcare professional on how to self-sample for chlamydia. 26 Furthermore, where young people in the present study had concerns about whether STIs could be treated or not, the option of returning to the same pharmacist to obtain chlamydia treatment was both convenient and reassuring for them. Therefore, a potential pharmacy test-and-treat service may encourage further uptake compared with testing alone.…”

“…A key finding of this study was the role played by young people’s concerns about stigma in obstructing uptake of testing for chlamydia, which is consistent with the literature. 22–25 Furthermore, this paper adds to studies where young people had privacy concerns about the pharmacy environment 6 12 14 18 and about other comparable settings for testing, including general practice 26 and non-medical venues, 27 by suggesting that the concern is linked to perceived stigma. While young people in the present study who used a pharmacy sexual health service and chlamydia testing were happy with the service, promotional activities should also focus on young people who felt uncomfortable in accessing the pharmacy and young men, due to privacy and stigma concerns.…”

A Systematic Review of New Approaches to Sexually Transmitted Infection Screening Framed in the Capability, Opportunity, Motivation, and Behavior Model of Implementation Science

“…When implementing new programs, there is a need for patient buy-in and acceptance of new STI testing and treatment services. For self-sampling programs, McDonagh et al 19 interviewed 28 people aged 16 to 24 years in the United Kingdom. Participants noted several barriers to testing including physical capability, psychological capabilities, reflective motivation, automatic motivation, physical opportunity, and social opportunity.…”

“…Studies in this review showed that self-sampling is generally acceptable to patients. 19 , 22 , 23 However, patient characteristics such as previous interactions with the health care system were shown to affect willingness to wait for results during a visit. Therefore, it is important continue to evaluate the acceptability of these programs among patients and providers to understand how their willingness to promote and use new services impacts adoption and utilization new screening strategies.…”

How can we increase notification of exposure to STIs between gay and bisexual men?: intervention development using stakeholder engagement, qualitative methods and behavioural science

“…In this way, our analyses move the field forwards from simple descriptions of barriers and facilitators to notification, and instead provide detailed and concrete ways of intervening. These approaches have been used to improve various health outcomes such as increasing chlamydia testing in primary care (McDonagh et al, 2020) and enhancing nurses' use of electronic medication management systems (Debono et al, 2017).…”