چکیده (انگلیسی):

Background:Chlamydia trachomatisremains a significant public health problem. We used a complex intervention,
with general practice staff, consisting of practice based workshops, posters, computer prompts and testing
feedback and feedback to increase routine chlamydia screening tests in under 25 year olds in South West England.
We aimed to evaluate how intervention components were received by staff and to understand what determined
their implementation into ongoing practice.
Methods:We used face-to-face and telephone individual interviews with 29 general practice staff analysed
thematically within a Normalisation Process Theory Framework which explores: 1.Coherence(if participants
understand the purpose of the intervention); 2.Cognitive participation(engagement with and implementation of
the intervention); 3.Collective action(work actually undertaken that drives the intervention forwards); 4. Reflexive
monitoring(assessment of the impact of the intervention).
Results:Our results showedcoherenceas all staff including receptionists understood the purpose of the training
was to make them aware of the value of chlamydia screening tests and how to increase this in their general
practice. The training was described by nearly all staff as being of high quality and responsible for creating a shared
understanding between staff of how to undertake routine chlamydia screening.
Cognitive participationin many general practice staff teams was demonstrated through their engagement by
meeting after the training to discuss implementation, which confirmed the role of each staff member and the use
of materials. However several participants still felt unable to discuss chlamydia in many consultations or described
sexual health as low priority among colleagues. National targets were considered so high for some general practice
staff that they didn’t engage with the screening intervention.
Collective actionwork undertaken to drive the intervention included use of computer prompts which helped staff
remember to make the offer, testing rate feedback and having a designated lead. Ensuring patients collected
samples when still in the general practice was not attained in most general practices.
Reflexive monitoringshowed positive feedback from patients and other staff about the value of screening, and
feedback about the general practices testing rates helped sustain activity.
Conclusions:A complex intervention including interactive workshops, materials to help implementation and
feedback can help chlamydia screening testing increase in general practices.