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  • Increasing chlamydia screening tests in general practice: a modified Zelen prospective Cluster Randomised Controlled Trial evaluating a complex intervention based on the Theory of Planned Behaviour

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Health services research
Original article
Increasing chlamydia screening tests in general practice: a modified Zelen prospective Cluster Randomised Controlled Trial evaluating a complex intervention based on the Theory of Planned Behaviour
  1. Cliodna A M McNulty1,
  2. Angela H Hogan2,
  3. Ellie J Ricketts3,
  4. Louise Wallace4,
  5. Isabel Oliver5,
  6. Rona Campbell6,
  7. Sebastian Kalwij7,
  8. Elaine O'Connell3,
  9. Andre Charlett8
  1. 1Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, and Cardiff University, Cardiff, UK
  2. 2(Previously) Public Health England Primary Care Unit, (Currently) Personalised Medicine Consortium Integrated Biobank of Luxembourg, Luxembourg, Luxembourg
  3. 3Public Health England Primary Care Unit
  4. 4Applied Research Centre Health & Lifestyle Interventions, Coventry University, Coventry, UK
  5. 5PHE South West, Public Health England, and University of Bristol, Bristol, UK
  6. 6School of Social and Community Medicine, University of Bristol, Bristol, UK
  7. 7Amersham Vale Training Practice, London, UK
  8. 8Modelling and Economics Department, Public Health England 61 Colindale Avenue, London, UK
  1. Correspondence to Dr Cliodna AM McNulty, Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK; cliodna.mcnulty{at}phe.gov.uk

Abstract

Objective To determine if a structured complex intervention increases opportunistic chlamydia screening testing of patients aged 15–24 years attending English general practitioner (GP) practices.

Methods A prospective, Cluster Randomised Controlled Trial with a modified Zelen design involving 160 practices in South West England in 2010. The intervention was based on the Theory of Planned Behaviour (TPB). It comprised of practice-based education with up to two additional contacts to increase the importance of screening to GP staff and their confidence to offer tests through skill development (including videos). Practical resources (targets, posters, invitation cards, computer reminders, newsletters including feedback) aimed to actively influence social cognitions of staff, increasing their testing intention.

Results Data from 76 intervention and 81 control practices were analysed. In intervention practices, chlamydia screening test rates were 2.43/100 15–24-year-olds registered preintervention, 4.34 during intervention and 3.46 postintervention; controls testing rates were 2.61/100 registered patients prior intervention, 3.0 during intervention and 2.82 postintervention. During the intervention period, testing in intervention practices was 1.76 times as great (CI 1.24 to 2.48) as controls; this persisted for 9 months postintervention (1.57 times as great, CI 1.27 to 2.30). Chlamydia infections detected increased in intervention practices from 2.1/1000 registered 15–24-year-olds prior intervention to 2.5 during the intervention compared with 2.0 and 2.3/1000 in controls (Estimated Rate Ratio intervention versus controls 1.4 (CI 1.01 to 1.93).

Conclusions This complex intervention doubled chlamydia screening tests in fully engaged practices. The modified Zelen design gave realistic measures of practice full engagement (63%) and efficacy of this educational intervention in general practice; it should be used more often.

Trial registration The trial was registered on the UK Clinical Research Network Study Portfolio database. UKCRN number 9722.

  • GENERAL PRACTICE
  • EDUCATION
  • CHLAMYDIA INFECTION
  • BEHAVIOURAL INTERVENTIONS

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/sextrans-2013-051029

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