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Original research
How to increase chlamydia testing in primary care: a qualitative exploration with young people and application of a meta-theoretical model
  1. Lorraine K McDonagh1,2,
  2. Hannah Harwood3,
  3. John M Saunders2,4,
  4. Jackie A Cassell2,5,
  5. Greta Rait1,2
  1. 1Research Department of Primary Care and Population Health, University College London, London, UK
  2. 2National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
  3. 3Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
  4. 4National Chlamydia Screening Programme, PHE, London, UK
  5. 5Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, Brighton and Hove, UK
  1. Correspondence to Dr Lorraine K McDonagh, Research Department of Primary Care and Population Health, UCL, London NW3 2PF, UK; l.mcdonagh{at}


Objective The objective of this study was to explore young people’s perspectives barriers to chlamydia testing in general practice and potential intervention functions and implementation strategies to overcome identified barriers, using a meta-theoretical framework (the Behaviour Change Wheel (BCW)).

Methods Twenty-eight semistructured individual interviews were conducted with 16–24 year olds from across the UK. Purposive and convenience sampling methods were used (eg, youth organisations, charities, online platforms and chain-referrals). An inductive thematic analysis was first conducted, followed by thematic categorisation using the BCW.

Results Participants identified several barriers to testing: conducting self-sampling inaccurately (physical capability); lack of information and awareness (psychological capability); testing not seen as a priority and perceived low risk (reflective motivation); embarrassment, fear and guilt (automatic motivation); the UK primary care context and location of toilets (physical opportunity) and stigma (social opportunity). Potential intervention functions raised by participants included education (eg, increase awareness of chlamydia); persuasion (eg, use of imagery/data to alter beliefs); environmental restructuring (eg, alternative sampling methods) and modelling (eg, credible sources such as celebrities). Potential implementation strategies and policy categories discussed were communication and marketing (eg, social media); service provision (eg, introduction of a young person’s health-check) and guidelines (eg, standard questions for healthcare providers).

Conclusions The BCW provided a useful framework for conceptually exploring the wide range of barriers to testing identified and possible intervention functions and policy categories to overcome said barriers. While greater education and awareness and expanded opportunities for testing were considered important, this alone will not bring about dramatic increases in testing. A societal and structural shift towards the normalisation of chlamydia testing is needed, alongside approaches which recognise the heterogeneity of this population. To ensure optimal and inclusive healthcare, researchers, clinicians and policy makers alike must consider patient diversity and the wider health issues affecting all young people.

  • adolescent
  • behavioural science
  • chlamydia infection
  • general practice
  • qualitative research

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  • Handling editor Jo Gibbs

  • Twitter @Dr_L_McDonagh, @saunders_j

  • Contributors LM developed and refined the study protocol with contributions from HH, GR, JAC and JMS. LM prepared the manuscript. HH undertook data collection. LM and HH reviewed the transcripts and conducted data coding. LM conducted theme development, interpretation and report writing. LM conducted the model categorisation with input from all coauthors. GR, JAC and JMS provided methodological guidance and contributed to the coding, theme development, data interpretation, data synthesis and model categorisation. All authors read and approved the final manuscript.

  • Funding The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine (LSHTM).

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or Public Health England.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the UCL Research Ethics Committee (project ID number: 10319/001).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Due to participant privacy concerns, data are not available for sharing.

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