The online version of this article (doi:10.1186/s12875-017-0618-0) contains supplementary material, which is available to authorised users.
Chlamydia trachomatis (chlamydia) is the most commonly diagnosed sexually transmitted infection (STI) in England; approximately 70% of diagnoses are in sexually active young adults aged under 25. To facilitate opportunistic chlamydia screening in general practice, a complex intervention, based on a previously successful Chlamydia Intervention Randomised Trial (CIRT), was piloted in England. The modified intervention (3Cs and HIV) aimed to encourage general practice staff to routinely offer chlamydia testing to all 15–24 year olds regardless of the type of consultation. However, when the 3Cs (chlamydia screening, signposting to contraceptive services, free condoms) and HIV was offered to a large number of general practitioner (GP) surgeries across England, chlamydia screening was not significantly increased. This qualitative evaluation addresses the following aims:
Explore why the modified intervention did not increase screening across all general practices.
Suggest recommendations for future intervention implementation.
Phone interviews were carried out with 26 practice staff, at least 5 months after their initial educational workshop, exploring their opinions on the workshop and intervention implementation in the real world setting. Interview transcripts were thematically analysed and further examined using the fidelity of implementation model.
Participants who attended had a positive attitude towards the workshops, but attendee numbers were low. Often, the intervention content, as detailed in the educational workshops, was not adhered to: practice staff were unaware of any on-going trainer support; computer prompts were only added to the female contraception template; patients were not encouraged to complete the test immediately; complete chlamydia kits were not always readily available to the clinicians; and videos and posters were not utilised. Staff reported that financial incentives, themselves, were not a motivator; competing priorities and time were identified as major barriers.
Not adhering to the exact intervention model may explain the lack of significant increases in chlamydia screening. To increase fidelity of implementation outside of Randomised Controlled Trial (RCT) conditions, and consequently, improve likelihood of increased screening, future public health interventions in general practices need to have: more specific action planning within the educational workshop; computer prompts added to systems and used; all staff attending the workshop; and on-going practice staff support with feedback of progress on screening and diagnosis rates fed back to all staff.
Public Health England. Sexually transmitted infections and chlamydia screening in England, 2014, vol. 9. 2015.
Akande V, Turner C, Horner P, Horne A, Pacey A. Impact of Chlamydia trachomatis in the reproductive setting: British Fertility Society Guidelines for practice. Hum Fertil. 2010;13(3):115–25. CrossRef
McNulty CA, Hogan AH, Ricketts EJ, Wallace L, Oliver I, Campbell R, Kalwij S, O’Connell E, Charlett A. Increasing chlamydia screening tests in general practice: a modified Zelen prospective Cluster Randomised Controlled Trial evaluating a complex intervention based on the Theory of Planned Behaviour. Sex Transm Infect. 2014;90(3):188–94. CrossRefPubMed
National Institute for Health and Care Excellence (NICE), Public Health England (PHE). HIV testing: increasing uptake among people who may have undiagnosed HIV (Joint NICE and Public Health England guideline). 2016;1–62.
Ajzen I. Perceived behavioral control self-efficiacy locus of control and theory of planned behavior. J Appl Soc Psychol. 2002;32(4):665–83. CrossRef
Town K, McNulty CA, Ricketts EJ, Hartney T, Nardone A, Folkard KA, Charlett A, Dunbar JK. Service evaluation of an educational intervention to improve sexual health services in primary care implemented using a step-wedge design: analysis of chlamydia testing and diagnosis rate changes. BMC Public Health. 2016;16(1):1. CrossRef
Dobson D, Cook TJ. Avoiding type III error in program evaluation: Results from a field experiment. Eval Program Plann. 1980;3(4):269–76. CrossRef
Mihalic S. The importance of implementation fidelity. Emotional and Behavioral Disorders in Youth. 2004;4(4):83–105.
Fusch PI, Ness LR. Are we there yet? Data saturation in qualitative research. Qual Rep. 2015;20(9):1408.
Patton MQ. Qualitative research. In: Wiley Online Library. 2005.
Newton N. The use of semi-structured interviews in qualitative research: strengths and weaknesses. Exploring qualitative methods. 2010;1(1):1–11.
Vogl S. Telephone Versus Face-to-Face Interviews Mode Effect on Semistructured Interviews with Children. Sociol Methodol. 2013;43(1):133–77. CrossRef
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. CrossRef
Walker J, Fairley K, Walker M, Gurrin C, Gunn M, Pirotta V, Carter R, Hocking S. Computer reminders for Chlamydia screening in general practice: a randomized controlled trial. Sex Transm Dis. 2010;37(7):445. PubMed
Bowden J, Currie J, Toyne H, McGuiness C, Lim L, Butler R, Glasgow J. Screening for Chlamydia trachomatis at the time of routine Pap smear in general practice: a cluster randomised controlled trial. Med J Aust. 2008;188(2):76. PubMed
Creswell JW, Clark VLP. Designing and conducting mixed methods research. 2007.
Pope C, Mays N, Popay J. Synthesising Qualitative and Quantitative Health Evidence: A Guide to Methods: A Guide to Methods. UK: McGraw-Hill Education; 2007.
Fisher RJ. Social desirability bias and the validity of indirect questioning. J Consum Res. 1993;20(2):303–15. CrossRef
Lorch R, Hocking J, Guy R, Vaisey A, Wood A, Donovan B, Fairley C, Gunn J, Kaldor J, Temple-Smith M, et al. Do Australian general practitioners believe practice nurses can take a role in chlamydia testing? A qualitative study of attitudes and opinions. BMC Infect Dis. 2015;15:31. CrossRefPubMedPubMedCentral
Lorch R, Hocking J, Temple-Smith J, Law M, Yeung A, Wood A, Vaisey A, Donovan B, Fairley CK, Kaldor J, et al. The chlamydia knowlegde awreness and testing practices of Australian General practitioners and practice nurses: survey findings from the Australian Chlamydia Control Effectiveness Pilot (ACCEPt). BMC Fam Pract. 2013;14(169):1471–2296.
Castka P, Bamber CJ, Sharp JM, Belohoubek P. Factors affecting successful implementation of high performance teams. Team Performance Management: An International Journal. 2001;7(7/8):123–34. CrossRef
Francis D, Young D. Improving work groups, a practical manual for team building. La Jolla: University Associates; 1979.
Robbins H, Finley M. The new why teams don’t work: What goes wrong and how to make it right. San Francisco: Berrett-Koehler Publishers; 2000.
Ricketts EJ, Francischetto EOC, Wallace LM, Hogan A, McNulty CA. Tools to overcome potential barriers to chlamydia screening in general practice: Qualitative evaluation of the implementation of a complex intervention. BMC Fam Pract. 2016;17(1):1. CrossRef
Bilardi E, Fairley K, Temple-Smith J, Pirotta V, McNamee M, Bourke S, Gurrin C, Hellard M, Sanci A, Wills J, et al. Incentive payments to general practitioners aimed at increasing opportunistic testing of young women for chlamydia: a pilot cluster randomised controlled trial. BMC Public Health. 2010;10:70. CrossRefPubMedPubMedCentral
- Exploring why a complex intervention piloted in general practices did not result in an increase in chlamydia screening and diagnosis: a qualitative evaluation using the fidelity of implementation model
D. M. Lecky
E. J. Ricketts
K. A. Folkard
J. K. Dunbar
C. A. M. McNulty
- BioMed Central
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