Background
Methods
Research setting
Study design
General Practice Number | GP (n) | Nurses & Othera(n) | Gender of HCP interviewed Male/Female | Interviews Total (n) |
---|---|---|---|---|
1 | 1 | 1 | 1/1 | 2 |
2 | 0 | 1 | 0/1 | 1 |
3 | 0 | 1 | 0/1 | 1 |
4 | 2 | 2 | 0/4 | 4 |
5 | 0 | 2 | 1/1 | 2 |
6 | 2 | 0 | 1/1 | 2 |
7 | 1 | 0 | 0/1 | 1 |
8 | 0 | 1 | 0/1 | 1 |
9 | 6 | 1 | 2/5 | 7 |
10 | 0 | 1 | 0/1 | 1 |
11 | 1 | 0 | 0/1 | 1 |
12 | 2 | 0 | 0/2 | 2 |
13 | 1 | 0 | 0/1 | 1 |
Total | 26 |
NPT Construct | Theme | Subtheme |
---|---|---|
Coherence | ||
Pre-training HIV testing | ||
Testing situations (e.g. opportunistic, patient characteristics and behaviours, appointment type, consultation presentation with “obvious” indicator conditions) | ||
Perceived adequacy | ||
Frequency | ||
Nurse vs GP testing | ||
Patient acceptability | ||
Confidence to offer a test | ||
Pre-training HCP knowledge | ||
Perceived need for training | ||
Cognitive participation | ||
Experience of training | ||
Content (e.g. appropriate to knowledge level) | ||
Delivery (e.g. location, length, interactive format) | ||
Impact of training | ||
Intentions to change testing practice | ||
Awareness and knowledge (e.g. need to test early, indicator conditions, HIV prevalence in practice population) | ||
Confidence to test | ||
Collective action | ||
When to test | ||
HIV testing normalised / viewed as routine | ||
Increased consideration of HIV testing | ||
Presence of indicator conditions and atypical, unexplained and persistent infections | ||
Patient response to offer of HIV test | ||
Nurses and Healthcare Assistants empowered to offer HIV tests | ||
Changes in number of HIV tests | ||
How testing is offered | ||
Language used in consultation | ||
Pre-test counselling and consent | ||
Reflexive monitoring | ||
Barriers to HIV testing | ||
Presence of relatives in consultation | ||
Language barriers | ||
Multiple problems to address in consultation | ||
Changing the subject to HIV / phrases to use | ||
Appointment time constraints | ||
Lack of opportunity to test | ||
Patient acceptability and agenda | ||
Improvements to training | ||
Role play exercises and case examples | ||
More information on managing positive results | ||
Length of training | ||
Follow-up training and email reminders | ||
Primary care system changes (e.g. computer prompts, and universal screening) |
Results
Coherence
It was very ad hoc and a bit chaotic, and it would be really just if we thought of it.
If you’d have asked me that before the teaching I would’ve very much said the communication side, the getting across, and the worry that the patients would feel that I was judging them.
I think it’s [educational intervention] extremely necessary, (…) for our practice population it’s extremely relevant.
I think we actually have a very low [HIV] incidence because the vast amount [of patients] were diagnosed sort of 10 years ago (…) actually the prevalence may seem great but whether we were really a target audience is not quite as clear to me.
I would have thought we’re reasonably clued-up on this kind of thing because of the population we work in.
Cognitive participation
I liked the way it was very informal, lots of opportunity to ask questions, that was really useful, but I loved the way she delivered these messages all the way through (…) she let people chat around the subjects and then she brought them to the conclusion.
It’s nice to know what service is available and there are specialists who would be able to help or give some advice.
‘Think HIV’ so in a much wider set of conditions or symptoms, or situations, to actually be thinking about testing (…) I think it’s my thresholds and my internal alarm bells, probably have got a lower setting now than they did before.
I would probably now offer it more readily if needed rather than being panicky and scared about offering it.
I think it was just really ways (…) incorporate it into the consultation (…) if somebody was disclosing…you know if a man was disclosing to you that they’d you know had sex with another man or drug user etc., then how you can actually move that consultation on to say why we want to test and you know little scenarios of how you could ask you know, ask that and inform the patient – I thought that was really good.
Collective action
When to test
I think [the key take home message from the training is] don’t be afraid to ask the question or offer the test, because we always assume there are certain high-risk groups so we should just be focusing on them and in fact it’s out there, anybody could be affected, its perhaps where you least expect it.
I mean obviously for high-risk groups it’s different, I think about HIV a lot more, you know, if I see a homosexual man or an intravenous drug user, or a sex worker or something. Then I think about it, but in the general population I think about it far less.
… Immune things or you know recurrent viral illnesses, recurrent bacterial infections, things that normally in my mind I’d jump straight to ‘oh we need to check they’re not diabetic’ are now also kind of jumping in to my mind ‘oh we need to check for HIV status as well’ which again is a change.
Practice 4, Female, Doctor, Interview 18They’ve taken it better than I originally maybe thought they had and maybe that’s why I have become more relaxed about it myself. … my own worry I think as I said at the beginning would be that they would feel that I was judging their behaviours and, but actually you know…maybe it’s the way that I’m now quite confident in putting it.
Practice 12, Female, Doctor, Interview 8I think the training was quite good about encouraging us to normalise it [HIV testing] and you know opening it up to be a more frequent test that we do … and I think with that would follow that people expect it more and don’t consider it to be a judgmental or negative thing to be doing like it perhaps was in the past.
Now I can make a decision of who I need to do it on and I don’t have to run to the GP and ask him all the time.
I’ve requested two patients have HIV tests since the training which is probably about the same as I’ve done in the year prior to that, so in other words I’ve increased my frequency of testing.
I would be keen to try and increase my screening but as, yet I haven’t sort of felt ‘oh this is a case where that’s relevant’.
How testing is offered
In the past, one of the things you know if I did think of it, then it would be ‘how am I going to get this into the discussion? What other discussions are gonna be raised? We’re already 10-15 minutes into a 10-minute appointment … ’ whereas now I can say ‘well we need to check some bloods, as part of those blood tests I want to check your kidneys, your liver, and if it’s ok with you I’m also gonna add on an HIV test because that can also have quite a big impact on your physical health’ (…) it may well be negative but it’s better to check for it.’
I don’t think we’d have a leg to stand on if we did an HIV test on somebody without them knowing and it came back positive (…) so that I didn’t agree with her [intervention deliverer] (…) and because there’s stigma attached to HIV testing it’s particularly important that consent is documented.
Reflexive monitoring
You’ve got ten minutes, and the HIV testing is not top of your list. And so what I would normally do in that situation is tell them to come back and see the nurse or make another appointment for a sexual health screen, which I appreciate isn’t ideal, because you should seize the moment, but there’s only so many moments in a consultation and you’ve often run out by that point.
There were some practices who when they have negative results all the results are given out by reception (…). There were other practices that had a policy where HIV tests specifically were given out only by GPs, whether they were positive or negative, so then the thought of increasing the amount of HIV tests that they were going to have to manage was just insurmountable, so in a couple of those practices (…) I spent quite a long time talking about results management (…) giving them an opportunity to reflect on why they have that policy for an HIV test and not for other tests and whether that was really appropriate.