Introduction
Methods
Eligibility criteria
Inclusion criteria | Exclusion criteria |
---|---|
Population: young people (aged 15–24 years) and primary care providers (PCP; general practitioners, practice nurses, nurse practitioners) | Population: exclusively on commercial sex workers, incarcerated people, people living with HIV, victims of sexual or domestic abuse or violence, intravenous drug users, and individuals with no fixed address |
Randomised and non-randomised controlled trials, pre- and post-test designs, non-experiment observational (cross-sectional, case-series, case studies), qualitative (interviews, focus groups), and mixed method paper | Commentary or opinion publications that did not present new data |
Conducted in countries where the model of delivering healthcare in general practice is comparable to the UK (Australia, Denmark, Ireland, Netherlands, and New Zealand) where (1) the GP acts as a gatekeeper to access specialist services and (2) general practice services are publicly financed | Conducted in countries where the healthcare system and general practice setting is not comparable to that of the UK (i.e., USA, Canada) because (1) the role of the GP in these countries differs and specialist services are readily accessible without initial GP contact and (2) most healthcare is delivered privately meaning many have to pay out-of-pocket for insurance and care. Consequently, these different systems will have distinct characteristics and influential barriers and facilitators beyond the scope of this review |
Opportunistic and systematic testing in general practice | Exclusively set outside of general practice, exclusively focused on partner notification, campaigns exclusively focused on health promotion, and testing for diagnostic purposes when symptoms are present |
Search strategy
Data extraction
Quality assessment
Data synthesis and analysis
Results
Author | Location | Participants | Design | Theory | Method | Analysis |
---|---|---|---|---|---|---|
Allison et al. [74] | UK (England) | 26 general practice staff (9 GPs; 13 PNs; 3 practice managers; 1 receptionist) who had participated in an intervention (m = 5; f = 23) | Qualitative | None | Semi-structured interviews | Modified framework analysis |
Bilardi et al. [51] | Australia | 43 GPs; intervention group n = 20 (m = 9; f = 11); control group n = 23 (m = 11; f = 12); age range = < 35–55+ years | Quantitative | None | Questionnaire following pilot cluster RCT | Descriptive (percentages) and mixed-effects logistic regression |
Bilardi et al. [52] | Australia | 14 GPs (m = 6; f = 8) Age: 31–40 years = 4; 41–50 years = 4; 51–60 years = 6 | Quantitative | None | Questionnaire following pilot RCT; interviewer-administered, open ended | Test for equality in proportion and thematic analysis |
Calamai et al. [53] | UK | 55 GPs and PNs (m = 13; f = 42) | Quantitative | None | Questionnaire | Descriptives: frequencies |
Freeman et al. [54] | UK (England) | 156 healthcare staff from 25 practices (72 GPs; 46 PNs; 8 practice managers; 23 administrators and receptionists; others) | Qualitative | None | Focus groups | Stepwise framework analytical approach (inductive) |
Hocking et al. [55] | Australia | GPs (n = 21 interview; n = 225 questionnaires); mean age = 49.8 years | Mixed: qualitative and quantitative | None | Semi-structured interviews and postal questionnaire | Thematic analysis and descriptive statistics |
Khan et al. [56] | Australia | 409 GPs (m = 233; f = 176) | Quantitative | None | Questionnaire (paper, postal) | Correlation analysis, logistic regression |
Lorch et al. [60] | Australia | 556 GPs (m = 338; f = 218) and 118 PNs (m = 2; f = 116) from 143 clinics; age range = 30–59 years | Quantitative | None | Questionnaire (paper) | Descriptives, regression |
Lorch et al. [57] | Australia | 72 PNs (m = 1; f = 71) | Quantitative | None | Questionnaire | Chi-squared paired t test |
Lorch et al. [58] | Australia | 44 GPs (m = 27; f = 16) | Qualitative | None | Semi-structured interviews | Thematically using content analysis |
Lorch et al. [59] | Australia | 23 PNs (m = 1; f = 22); age range = 30–59 years | Qualitative | None | Semi-structured interviews | Thematically using content analysis |
Lorimer et al. [61] | UK (Scotland) | 18 GPs and 8 PNs | Qualitative | None | Semi-structured interviews (telephone) | Framework analysis with thematic coding |
Ma and Clarke [62] | UK (England) | 4 consultants in sexual and reproductive health, 1 consultant in public health, 1 chlamydia screening coordinator, 3 GPs and 3 PNs | Qualitative | None | Semi-structured interviews | Variation of thematic analysis |
McKernon and Azariah [63] | New Zealand | 76 staff participating in pilot trial: 5 receptionists, 5 clinical assistants, 24 nurses, 31 doctors, 10 practice managers (who were also doctors), and 4 operations managers | Quantitative | None | Questionnaire | Descriptives |
McNulty et al. [64] | UK (England) | 12 focus groups of GPs, PNs, practice managers, midwives, and district nurses (total n not reported) | Qualitative | None | Focus groups | Modified grounded theory approach utilising the constant comparative method |
McNulty et al. [65] | UK (England) | General practice staff (GPs, PNs) from high/low testing rates and rural/urban areas (total n not reported) | Qualitative | None | Focus groups | Thematic analysis using constant comparative method |
McNulty et al. [66] | UK (England) | Focus groups: 72 GPs, 46 PNs, 23 receptionists and administrators, 8 practice managers, 7 other staff. Interviews: 5 GPs, 3 nurses, 1 receptionist, 2health care assistants, 1 manager. | Qualitative | Theory of Planned Behaviour | Semi-structured interviews (12) and focus groups (25) | Stepwise framework analytical approach |
McNulty et al. [67] | UK (England) | 9 chlamydia screening co-ordinators from areas with significant screening in general practice | Qualitative | None | Semi-structured interviews (telephone) | Interpretative phenomenological thematic approach |
McNulty et al. [75] | UK (England), Estonia, Sweden, France | 45general practice staff, 18 stakeholders, 13 trainers (England 25, Estonia 15, France 23; Sweden 13) | Qualitative | Theory of Planned Behaviour | Semi-structured interviews | Thematic analysis |
Merritt et al. [68] | Australia | 10 GPs from 6 practices | Uncontrolled before and after trial | None | Meetings every 2 month during intervention | Descriptive statistics |
Perkins et al. [69] | UK (England) | 13 GPs; 14 PNs; 15 practice receptionists; 11 practice managers | Qualitative | None | Semi-structured interviews | Open-coding method |
Ricketts et al. [70] | UK (England) | 29 general practice staff: 9 GPs; 13 PNs; 7 receptionists; from 8 high and low 7 screening intervention practices | Qualitative (evaluation of intervention) | Normalisation Process Theory | Semi-structured interviews | Thematic analysis (within a Normalisation Process Theory Framework) |
Robertson and Williams [71] | UK (Wales) | PNs (7 qualitative; 33 quantitative) | Mixed: qualitative and quantitative | None | Semi-structured interviews and questionnaire | Descriptive statistics |
Senok et al. [72] | UK (Scotland) | 13 GP’s, PNs and administrative staff | Feasibility study for a RCT and qualitative | None | In-depth interviews | Thematic analysis |
Wallace et al. [73] | UK (England) | General practice staff 12 interviews; 5 GPs; 3 PNs; 1 practice manager; 3 receptionists. 55 questionnaires (m = 5; f = 50); 18 GPS; 26 PNs; 9 receptionists; 1 practice manager; 1 research nurse | Mixed: qualitative and quantitative | Theory of Planned Behaviour | Questionnaire (paper = 52; online = 3) | Quantitative: frequencies, t tests, chi-square tests Qualitative: thematic analysis |
Author | Location | Participants | Design | Theory | Method | Analysis |
---|---|---|---|---|---|---|
Balfe et al. [37] | Ireland | 30 YP attending health services for STI test (m = 9 [MSM = 3]); f = 21); age range = 18–29 | Qualitative | None | Semi-structured interviews | Thematic analysis |
Balfe et al. [38] | Ireland | 35 young women; late teens to late 20s | Qualitative | None | Semi-structured interviews | Not reported |
Brugha et al. [39] | Ireland | 6085 YP attending 5 community healthcare settings and 1 GUM clinic, over a 2-week period (m = 2379; f = 3706); age range = 18–29 | Quantitative | None | Questionnaire | Descriptive statistics: frequencies and × 2 cross-tabulations with two-tailed tests |
Ewert et al. [49] | Australia | 28 young men who were university students, age range = 18–25 (mean age = 20.8) | Qualitative | None | Semi-structured interviews | Content and thematic analysis |
Heritage and Jones [40] | UK (England) | 18 YP; 12 via schools, 6 via GP practice (m = 6; f = 12); age range = 16–18 | Qualitative | None | Semi-structured interviews (2) and focus groups (n = 16) | Long-table approach (quotes categorised according to questions) |
Hogan et al. [41] | Ireland | 36 YP attending general practice (m = 9; f = 27); age range = 15–24 (mean age = 21) | Qualitative | Theory of Planned Behaviour | Semi-structured interviews | Thematic analysis |
Jones et al. [48] | UK (England) | 30 young people (m = 9; f = 21) attending general practice; age range 16–24 | Qualitative | Theory of Planned Behaviour | Semi-structured interviews | Thematic framework |
Mac Phail et al. [47] | New Zealand | 956 university students (m = 272; f = 682, tg = 2); age range = 18–29 | Quantitative | None | Questionnaire | Descriptive statistics |
Mills et al. [42] | UK (England) | 45 people registered with 27 general practices who returned postal test kits (m = 19; f = 26; positive = 25, negative = 20); age range = 16–39 | Qualitative | None | Semi-structured interviews | Thematic analysis |
Normansell et al. [50] | UK (England) | 17 multi-ethnic women in further education college; age range = 16–25 | Qualitative | Multiple: Theory of Planned Behaviour, Candidacy, Stigma | Semi-structured interviews | Thematic framework |
Pavlin et al. [43] | Australia | 24 young women; age range = 16–25 | Qualitative | None | Semi-structured interviews | Thematic analysis |
Pimenta et al. [44] | UK (England) | 25 sexually active women attending healthcare settings for any reason (m = 1; f = 24); age range = 16–24 | Qualitative | None | Semi-structured interviews | Content analysis |
Santer et al. [45] | UK (Scotland) | Women: age ≤ 20 attending for contraception/pregnancy testing; ≤ 35 attending for cervical screening (positive = 4, negative = 14, awaiting = 2); age range = 15–31 | Qualitative | None | Semi-structured interviews | Framework approach |
Zakher and Kang [46] | Australia | 185 university students (m = 40; f = 145); age range = 16–25 (mean age = 21) | Quantitative | None | Questionnaire | t tests, ANOVA, chi-square tests |
COM-B Subcomponent | Patient Level | Provider Level | Service Level | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Barrier | Source | Facilitator | Source | Barrier | Source | Facilitator | Source | Barrier | Source | Facilitator | Source | |
Physical capability | Lack of training and skills | Skills-based training | Receptionist involvement | Receptionist involvement | ||||||||
Practice nurse involvement | Practice nurse involvement | |||||||||||
Psychological capability | Lack of patient education, knowledge, and awareness | Increase knowledge, education, and awareness | Lack of provider knowledge and awareness | Increasing knowledge, awareness, and education | Lack of testing guidance | [64] | Prompts and reminders | |||||
Forgetfulness | Forgetfulness | Lack of knowledge, education, and general awareness | Testing guidelines | |||||||||
Reflective motivation | Beliefs regarding perceived risk | Beliefs that testing is responsible, mature, and healthy | Assumptions and perceptions of patients | Increase confidence | Targets set too high | |||||||
Beliefs about consequences of offering | Testing policy: new patients’ health checks | [64] | ||||||||||
Automatic motivation | Embarrassment and shame | Asymptomatic infection worries | Difficult to discuss | Testing policy: based on behaviour | Reward and incentive programmes | |||||||
Fear | ||||||||||||
Feedback on efforts | ||||||||||||
Physical opportunity | Time constraints | PCP offering testing | Time constraints | Mode of testing | Time constraints | Promotional materials | ||||||
Receptionist involvement | Mode of testing | Receptionist involvement | Reception area | Testing policy: inclusion in other consultations | ||||||||
Written invitations | System to record offers | [66] | ||||||||||
Service cost to patient | Simplified laboratory systems | |||||||||||
Absence of systems to record test offers | Support for partner notification | |||||||||||
Lack of support for partner notification | ||||||||||||
Social opportunity | Stigma | Normalisation | Practice social norms | Normalisation | Testing policy: women only | Normalisation | ||||||
Provider-patient relationship | Consultation social context | Cultural norms | Testing policy: blanket testing |