What can be learnt from a qualitative evaluation of implementing a rapid sexual health testing, diagnosis and treatment service?

Ava Lorenc, Emer Brangan, Joanna M. Kesten, Paddy J. Horner, Michael Clarke, Megan Crofts, Jonathan Steer, Jonathan Turner, Peter Muir, Jeremy Horwood*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)
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Objectives: To investigate experiences of implementing a new rapid sexual health testing, diagnosis and treatment service. 

Design: A theory-based qualitative evaluation with a focused ethnographic approach using non-participant observations and interviews with patient and clinic staff. Normalisation process theory was used to structure interview questions and thematic analysis. 

Setting: A sexual health centre in Bristol, UK. 

Participants: 26 patients and 21 staff involved in the rapid sexually transmitted infection (STI) service were interviewed. Purposive sampling was aimed for a range of views and experiences and sociodemographics and STI results for patients, job grades and roles for staff. 40 hours of observations were conducted. 

Results: Implementation of the new service required co-ordinated changes in practice across multiple staff teams. Patients also needed to make changes to how they accessed the service. Multiple small 'pilots' of process changes were necessary to find workable options. For example, the service was introduced in phases beginning with male patients. This responsive operating mode created challenges for delivering comprehensive training and communication in advance to all staff. However, staff worked together to adjust and improve the new service, and morale was buoyed through observing positive impacts on patient care. Patients valued faster results and avoiding unnecessary treatment. Patients reported that they were willing to drop-off self-samples and return for a follow-up appointment, enabling infection-specific treatment in accordance with test results, thus improving antimicrobial stewardship. 

Conclusions: The new service was acceptable to staff and patients. Implementation of service changes to improve access and delivery of care in the context of stretched resources can pose challenges for staff at all levels. Early evaluation of pilots of process changes played an important role in the success of the service by rapidly feeding back issues for adjustment. Visibility to staff of positive impacts on patient care is important in maintaining morale.

Original languageEnglish
Article numbere050109
JournalBMJ Open
Issue number10
Early online date22 Oct 2021
Publication statusPublished - 22 Oct 2021

Bibliographical note

Funding Information: Funded by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West at University Hospitals Bristol and Weston NHS Foundation Trust and NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at University of Bristol in partnership with Public Health England (PHE). Award number P315. The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or PHE.

Open Access: This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/ by/ 4. 0/.

Publisher Copyright: © Authors 2021

Citation: Lorenc A, Brangan E, Kesten JM, et al. What can be learnt from a qualitative evaluation of implementing a rapid sexual health testing, diagnosis and treatment service? BMJ Open. 2021;11:e050109.

DOI: 10.1136/bmjopen-2021-050109


  • COVID-19
  • change management
  • organisational development
  • qualitative research
  • sexual medicine


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