Background In Australia, despite dramatic increases in chlamydia notifications and recommendations that young people be tested annually, testing rates in general practice remain low. ACCEPt is a randomised controlled trial to evaluate the impact of chlamydia testing on prevalence. General practitioners (GPs) in the intervention arm received regular feedback on testing performance, visual reminders and incentive payments to facilitate increased testing. To assess the acceptability of the intervention, participating GPs were interviewed at baseline and midpoint to investigate their chlamydia management practices and their opinions about the intervention.
Methods Semi-structured interviews were conducted with purposively sampled GPs prior to randomization (baseline) and after one year in the intervention (midpoint) until saturation was reached. Data were analysed both thematically and using Normalisation Process Theory (NPT), a framework that explains how complex interventions can be successfully implemented, embedded and integrated in institutional settings. Emerging themes from each timepoint were compared and interpreted within the NPT framework.
Results A total of 44 GPs at baseline and 24 GPs at midpoint were interviewed. The ACCEPt intervention increased GPs’ comfort and ease in offering a test, and were associated with a shift in attitudes from symptom-based testing to age-based testing. Many GPs highlighted that feedback, a key aspect to embedding the intervention, was a major driver of increased testing. The intervention was gradually implemented over time through increasing awareness and engagement with education and exposure to the project. Logistical issues, such as remembering to offer a test, were overcome with practical facilitators like computer alerts. However, integration was limited as not all GPs utilised the intervention components or other clinic staff to increase testing because of restrictions in clinic structure.
Conclusion GPs reported that the ACCEPt intervention and its implementation within the NPT framework have been effective at facilitating chlamydia testing in general practice.
Disclosure of interest statement ACCEPt was commissioned and funded by the Australian Government Department of Health and Ageing. Additional funding has been received from the National Health and Medical Research Council, the Victorian Department of Health and NSW Health.
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