A Qualitative Exploration of Barriers to, and Interventions to Improve, Chlamydia Retesting in England Using the Behavior Change Wheel
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.006 | 0.007 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".