What are the facilitators and barriers to chlamydia testing in general practice using the COM-B Model: A systematic review
Chlamydia is a key health priority, with high economic and social costs. There were 206,774 chlamydia diagnoses made in England in 2014. The burden of chlamydia is greatest among young people where the highest prevalence rates are found. Chlamydia is often asymptomatic, and if left undiagnosed/untreated, can pose severe health consequences (i.e., ectopic pregnancy, infertility). Annual testing for sexually active young people is recommended in the UK; however, many of those at risk do not receive testing. General practice has been identified as an ideal setting for testing for multiple reasons, yet previous research to increase testing in this setting has not been effective.
Attempts to change behaviour (e.g., increase testing) should be based in theories of behaviour and behaviour change. One promising theoretical model which may provide insight into the underpinnings of chlamydia testing behaviour is the Capability, Opportunity, and Motivation Model of Behaviour (COM-B Model). This model proposes that behaviour is the result of an interaction between three components: capability, opportunity and motivation. Behaviour change (e.g., getting/providing a chlamydia test), therefore, requires a change in one or more of these components.
The aim of this systematic review is to identify the barriers and facilitators to chlamydia testing for young people in general practice and to use the COM-B Model to explore the theoretical mechanisms of action among these factors.
This review was conducted in accordance with the PRISMA statement. Qualitative, quantitative, and mixed methods studies published after 2000 were included. Seven databases (Medline, PubMed, Embase, Informit, PsycInfo, Scopus, and Web of Science) were searched to identify peer-reviewed publications which examined barriers and facilitators to chlamydia testing in general practice. Papers were critically appraised using the CASP. Data regarding study design and key findings were extracted. The data were analysed using narrative synthesis to identify prominent factors. Finally, the resultant factors were mapped onto the components of the COM-B Model.
A total of 309 papers were identified and screened. Preliminary results indicate that testing can be attributed to facilitators and barriers at the patient level (e.g., knowledge), provider level (e.g., time constraints), and system level (e.g., use of practice nurses). In relation to classifying factors within the COM-B Model, results suggest that knowledge of chlamydia testing can be classified within the capability component; social stigma and access to services can be classified within the opportunity component; and personal beliefs about testing can be classified within the motivation component.
The findings will be used to inform the development of interventions that will facilitate effective and efficient chlamydia testing in general practice. The results will be discussed in relation to implications for policy-makers and commissioners regarding how best to improve the sexual health of young people.