General practice chlamydia testing: qualitative study of staff approaches using behavioural change theory.

Background: Chlamydia is the most diagnosed bacterial sexually transmitted infection in England, but opportunistic testing remains low in general practice despite high prevalence among young people. Attempts to increase testing have been met with little success; therefore, there is a need to explore why rates remain low and how this may be improved.

Aim: To explore general practice staff perceptions of opportunistic chlamydia testing, including barriers, facilitators, interventions, and policies, using the Behaviour Change Wheel (BCW).

Design and setting: Qualitative interviews and focus groups with general practice staff in England.

Method: 23 semi-structured individual interviews and seven focus groups with general practice staff were conducted. Data was analysed using inductive thematic analysis, followed by thematic categorisation onto the Behaviour Change Wheel.

Results: Participants identified several barriers to chlamydia testing corresponding with BCW components, including low perceived knowledge (psychological capability), general practice context (physical opportunity), cultural norms (social opportunity), testing not prioritised (reflective motivation), and concerns about patient reactions (automatic motivation). Proposed intervention functions included education, persuasion (e.g. posters), incentivisation (e.g. financial incentives), training, and environmental restructuring (e.g. computer reminders). Potential policy categories discussed were communication (e.g. campaigns) and service provision (e.g. GP drop-in sessions at other venues).

Conclusion: This study identified barriers to chlamydia testing in English general practice and potential ways to address these, contributing new insights to existing literature. This research can be utilised to design multi-component, impactful interventions to increase testing in general practice and ultimately reduce harm posed by chlamydia infections.