How effective are general practice interventions aimed at increasing chlamydia testing? A systematic review of behaviour change techniques
Chlamydia is the most common bacterial sexually transmitted infection. Over 126,000 diagnoses were made in England last year, the majority of which were amongst people aged 15-24 years. Chlamydia is often asymptomatic, but can lead to serious sequelae. Testing and early treatment are necessary to prevent adverse consequences and stop onward transmission.
The aim of this systematic review was to: 1) examine the effectiveness of interventions to increase chlamydia testing in general practice, and 2) identify behaviour change techniques used within previous chlamydia testing interventions.
Seven databases were searched (January 2000-October 2018) using search terms relating to context (general practice), outcomes (testing rates), and intervention (chlamydia testing). Data regarding study design and key findings were extracted. Relative risk ratios (RR) were calculated, and a meta-analysis was conducted (six randomized controlled trials [RCTs] that provided adequate information for statistical comparison). Finally, the Behaviour Change Techniques Taxonomy (BCTTv1) was used to categorise and explore techniques used.
664 papers were identified and screened; 20 were included. Interventions focused on clinician education (five studies), alternative specimen collection (four studies), patient education (three studies), prompts (one study), incentives (clinician and/or patient; three studies) and multi-faceted (four studies). Prompts had a modest statistically significant effect in one study. Two out of five studies using practitioner education reported small statistically significant effects, but this was only sustained long-term in one study. Alternative specimen collection (e.g., postal screening, testing with smear tests) was only effective in specific contexts, however, the methods and results were difficult to extrapolate to the wider population. Two studies demonstrated small effects with patient incentives (vouchers), whereas a financial incentive for general practitioners was not effective. Two out of four multi-faceted interventions had a statistically significant effect chlamydia testing. Patient education appeared to be the least effective approach as no interventions achieved a significant effect.
Of 93 possible BCTs, 25 were used across 20 studies. Of 16 domains, 13 were included with the “Goals and Planning” domain featuring most prominently. The most commonly utilized BCTs were “instruction on how to perform a behaviour”, and “information about health consequences”.
It appears that multi-faceted interventions promoting easy, systematic testing have the greatest effectiveness in increasing chlamydia testing in primary care. Conversely, the least successful interventions used purely patient education suggesting interventions should focus on primary care providers, rather than placing the onus young people to request tests. This review suggests that using a variety of BCTs can lead to considerable success in interventions. However, too few papers gave sufficient details of the intervention to fully examine the BCTs used. The use of more theory-based interventions would help to identify successful techniques in order to shape better future interventions.