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Table 6 Key determinants of success and barriers identified and potential tools to overcome them

From: Tools to overcome potential barriers to chlamydia screening in general practice: Qualitative evaluation of the implementation of a complex intervention

Key determinants of success

Actions needed to facilitate them

Attendance at workshop of all general practice staff

When workshops are organised ask and encourage all staff to attend.

Attendance at workshop by key staff able to drive forward screening

Ensure correct staff whose role it is to undertake, facilitate or lead screening attend the workshop.

Increased confidence to offer screening through using scripts and practice, so normalised into routine practice

Using scripts in the training, and encouragement post training – stressing that the process of offering tests will increase confidence and positive feedback from patients.

Provision of resources for flexible use

Ensure that resources provided are in a format that can be adapted for individual general practice needs.

Use of computer prompts

Raise this in training and when and how they are going to be used, and who is going to set them up.

Tests are performed in the general practice before the patient leaves

Stress importance in training and plan how this can be attained in each general practice.

Encouragement of reflective practice post workshop led by “chlamydia champion”

Encourage action planning and agree staff roles going forward. General practice lead to follow up with communications about successes and testing rates and sexual health news in general practice.

Feedback on screening efforts

Feedback general practice screening rates on a regular basis, and identify individual in the general practice to this to other staff.

Barriers

Tools to overcome barrier

Forgetting to offer chlamydia screen

Using computer prompts and posters, and identify individual to take this forward.

Not wishing to offer chlamydia screening in non-sexual health consultations

Staff changing the way they offer a chlamydia screen by stating that they are testing everyone aged between 15 and 24, and having a general prompt for all ages.

When sexual health is a low priority in the general practice

Ensure individual responsible for deciding if general practice will prioritise chlamydia screening attends the training.

Having a designated general practice lead to drive screening.

Ensure lead and general practice keep screening as a priority, and send around reminders and forward newsletters to all staff.

Perception of time involved in offering chlamydia screen, and monitoring screening rates

Use the scripts; stress that staff report that using them increases confidence and fluency in making the offer.

Making sure there are posters to refer to, kits easily accessible and invitation cards available to give to patients.

Suggest audits as part of professional development of all staff.

Patients not returning the chlamydia test

Feeding back that other general practice staff ask the patient to do the test prior to leaving the general practice, and this is what patients want too.

Ongoing perception that patients may be irritated if they are offered screening

Stress patients views in the training, lead to facilitate ongoing discussions in general practice around feedback from patients.

Lack of privacy in reception area to give out invitation cards

Stress in training that offer should be made to all in age group so not seen as judgemental by staff; and teach receptionists to use script saying "we are offering this test to all 15–24 year olds, read about it on this card."

Targets being too high for general practices with very low screening rates

Stress importance in the workshop training of discussing realistic screening rates for individual general practices with numbers and actions needed to attain them.