A Qualitative Exploration of Barriers to, and Interventions to Improve, Chlamydia Retesting in England Using the Behavior Change Wheel

Background

Chlamydia is the most diagnosed sexually transmitted infection among young people in England. Repeat infections are common, and the risk of complications from chlamydia increases with the number of lifetime infections. National guidelines recommend retesting 3 to 6 months after treatment; however, retesting rates remain low at 10% to 14%. The objectives of this study were to explore barriers to, and identify potential interventions to improve, chlamydia retesting among young people in England, using the behavior change wheel.

Methods

Qualitative semistructured interviews were conducted with 22 people aged 16 to 24 years who had previously been diagnosed with chlamydia. Participants were recruited from sexual health services in London, the South West, and the North West of England. An inductive thematic analysis was conducted, followed by thematic categorization to the behavior change wheel.

Results

Barriers to retesting included low awareness and knowledge of the recommendation, and differences in how the term “retest” was interpreted. Participants' experience of the initial test influenced their willingness or intention to retest. Possible interventions to overcome barriers include routine discussions of retesting at diagnosis and the rationale behind the recommendation, retesting reminders from service providers, and opt-in self-sampling kits.

Conclusions

Lack of awareness and varied interpretations of retest present challenges to retesting. Interventions such as routine discussions, text reminders, opt-in self-sampling kits, and clear guidance could improve awareness and understanding, and streamline the process. Future strategies should be developed with stakeholders and patients and assessed for acceptability, practicability, effectiveness, affordability, side-effects, and equity to maximize their real-world implementation and public health impact.

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