Introduction: Chlamydia is a key health concern, with high economic and social costs. There were over 2 00 000 chlamydia diagnoses made in England in 2015. The burden of Chlamydia is greatest among young people where the highest prevalence rates are found. Annual testing for sexually active young people is recommended; however, many of those at risk do not receive testing. General practice is an ideal setting for testing for multiple reasons; yet, testing here remains low. One theoretical model which may provide insight into the underpinnings of chlamydia testing is the Capability, Opportunity, and Motivation Model of Behaviour (COM-B model). This model proposes that behaviour (getting/providing a chlamydia test) is the result of capability, opportunity, and motivation. The aim of this review is to identify barriers and facilitators to chlamydia testing for young people in general practice, and use the COM-B Model to explore the theoretical mechanisms of action among these factors.
Methods Seven databases were searched to identify peer-reviewed qualitative, quantitative, and mixed methods studies published after 2000. Data regarding study design and key findings were extracted. Data were analysed using thematic analysis and resultant factors were mapped onto the COM-B Model.
Results 315 papers were identified and screened; 28 were included for review. Results indicate that testing can be attributed to facilitators/barriers at the patient level (e.g., knowledge), provider level (e.g., time constraints), and system level (e.g., practice nurses). Regarding the COM-B Model, results suggest that knowledge of testing can be classified within the capability component; social stigma can be classified within the opportunity component; and personal beliefs about testing can be classified within the motivation component.
Conclusion The findings have relevance to healthcare professionals, policy-makers and commissioners in informing how best to improve the sexual health of young people.