Abstract
BackgroundChlamydia trachomatis remains a significant public health problem. We used a complex intervention, with general practice staff, consisting of practice based workshops, posters, computer prompts and testing feedback and feedback to increase routine chlamydia screening tests in under 25 year olds in South West England. We aimed to evaluate how intervention components were received by staff and to understand what determined their implementation into ongoing practice.MethodsWe used face-to-face and telephone individual interviews with 29 general practice staff analysed thematically within a Normalisation Process Theory Framework which explores: 1. Coherence (if participants understand the purpose of the intervention); 2. Cognitive participation (engagement with and implementation of the intervention); 3. Collective action (work actually undertaken that drives the intervention forwards); 4. Reflexive monitoring (assessment of the impact of the intervention).ResultsOur results showed coherence as all staff including receptionists understood the purpose of the training was to make them aware of the value of chlamydia screening tests and how to increase this in their general practice. The training was described by nearly all staff as being of high quality and responsible for creating a shared understanding between staff of how to undertake routine chlamydia screening.Cognitive participation in many general practice staff teams was demonstrated through their engagement by meeting after the training to discuss implementation, which confirmed the role of each staff member and the use of materials. However several participants still felt unable to discuss chlamydia in many consultations or described sexual health as low priority among colleagues. National targets were considered so high for some general practice staff that they didn’t engage with the screening intervention.Collective action work undertaken to drive the intervention included use of computer prompts which helped staff remember to make the offer, testing rate feedback and having a designated lead. Ensuring patients collected samples when still in the general practice was not attained in most general practices.Reflexive monitoring showed positive feedback from patients and other staff about the value of screening, and feedback about the general practices testing rates helped sustain activity.ConclusionsA complex intervention including interactive workshops, materials to help implementation and feedback can help chlamydia screening testing increase in general practices.
Highlights
Chlamydia trachomatis remains a significant public health problem
The Chlamydia Intervention Randomised Controlled Trial (CIRT) We have previously reported the effect of a complex intervention that aimed to address reported barriers to chlamydia screening within general practices [19]
COHERENCE Table 2 The training was described by most staff as being of high quality and responsible for creating a shared understanding between staff of how to undertake routine chlamydia screening and why it was important
Summary
We used a complex intervention, with general practice staff, consisting of practice based workshops, posters, computer prompts and testing feedback and feedback to increase routine chlamydia screening tests in under 25 year olds in South West England. Genital Chlamydia trachomatis is the most common sexually transmitted infection reported in Europe and rates continue to rise [1]. The delivery of testing within primary care is a key aim of the National Chlamydia Screening Programme [5] as the majority of young adults visit their general practice at least annually [6]. Once primary care patients have had a chlamydia test they are more likely to test again, are aware of how to avoid infection and have fewer sexual partners [8]
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