Background: There is low uptake of chlamydia screening in general practices registered with the English National Chlamydia Screening Programme (NCSP). Aims: To explore staff's attitudes and behaviour around chlamydia screening and how screening could be optimized in general practice. Methods: A qualitative study with focus groups and interviews, in general practices in seven NCSP areas. Twenty-five focus groups and 12 interviews undertaken with a purposively selected diverse group of high and low chlamydia-screening practices in 2006-08. Data were collected and analysed using a framework analytical approach. Results: Higher screening practices had more staff with greater belief in patient and population benefits of screening and, as screening was a subjective norm, it was part of every day practice. Many staff in the majority of other practices were uncomfortable raising chlamydia opportunistically and time pressures meant that any extra public health issues covered within a consultation were determined by Quality Outcomes Framework (QOF) targets. All practices would value more training and feedback about their screening rates and results. Practices suggested that use of computer prompts, simplified request forms and more accessible kits could increase screening. Conclusion: Practice staff need more evidence of the value of opportunistic chlamydia screening in men and women; staff development to reduce the barriers to broaching sexual health; simpler request forms and easily accessible kits to increase their ability to offer it within the time pressures of general practice. Increased awareness of chlamydia could be attained through practice meetings, computer templates and reminders, targets and incentives or QOF points with feedback.
Bibliographical noteFunding Information:
Our grateful thanks to all the practice staff for their willing participation in the focus groups and to Medical Research Council for funding the study. Thanks to Lynsey Emmett and the NCSP for providing us with screening data. Thanks are due to Sue Starck, Allison Bates and Jiyoon Knight for transcribing the focus groups and to Mark Walker for his help in the data collection. Thank you to Jill Whiting for organizing the focus groups and steering group meetings and for help with the grant application and ethical approval. Thanks to Louise Wallace for her advice on the TPB. All the authors contributed to the design of the study and had input into the paper. EF, RHJ and CMcN undertook the focus groups and detailed analysis. A Hogan undertook the interviews and interview analysis. E Freeman and C McNulty wrote the paper.
- Chlamydia trachomatis
- Focus groups
- Primary care