Tools to Overcome Potential Barriers to Chlamydia Screening in General Practice: Qualitative Evaluation of the Implementation of a Complex Intervention
BACKGROUND:
Chlamydia
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.
METHODS:
We 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).
RESULTS:
Our
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.
CONCLUSIONS:
A
complex intervention including interactive workshops, materials to help
implementation and feedback can help chlamydia screening testing increase in
general practices.
- 1Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK.
- 2NIHR CLAHRC West Midlands Chronic Disease Theme, Institute of Applied Health Research, University of Birmingham, Edgbaston B15 2TT, Birmingham, UK.
- 3Faculty of Health and Social Care, National Institutes of Health Research Health Services and Delivery Research Programme, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK.
- 4Health Protection Agency Primary Care Unit, Personalised Medicine Consortium Integrated Biobank of Luxembourg 6, Rue Nicolas Ernest Barblé, L-1210, Luxembourg.
- 5Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK. cliodna.mcnulty@phe.gov.uk.
- BMC Fam Pract. 2016 Mar 22;17(1):33. doi: 10.1186/s12875-016-0430-2.
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