A qualitative exploration of young people’s, pharmacists’, and contract managers’ perceptions about community pharmacy chlamydia testing

Abstract

Chlamydia is the most common bacterial sexually transmitted infection in England. Young people aged 15-24 are at greatest risk of the infection. As most individuals with chlamydia are asymptomatic, it is often left untreated. This increases the risk of transmission and also of serious adverse health consequences such as infertility in both sexes. Free chlamydia testing is available for young people in a range of settings, including community pharmacies, to increase detection and treatment of the infection.

Despite their geographical accessibility, uptake in England of chlamydia testing from community pharmacies has been low for the past few years running at 1% compared with other health- and non-healthcare settings. Following the establishment of testing in community pharmacies in 2008, several studies investigated feasibility of the pharmacy service, as well as pharmacists’ and clients’ experiences. However, there has been very little research since and testing activity remains low, necessitating further investigation in to why this may be. This study contributes to plugging that gap.

In-depth interviews were conducted with 26 young people, 22 pharmacists, and two contract managers in North East England to understand the multi-faceted perceptions of various stakeholders about testing, potential treatment, and suggested improvements to the service. Data from the interviews were subjected to thematic analysis. The Health Belief Model and Normalisation Process Theory Model were also applied to the results, to further analyse the findings.

The study found that young people’s concerns about stigma and the long-term health consequences of chlamydia appeared to obstruct uptake of testing. Furthermore, gaps identified in the work processes involved in testing meant it was not fully integrated with other sexual health services. Promoting a confidential, young people-friendly, comprehensive pharmacy chlamydia testing service may increase a young person’s self-efficacy to be tested. Additionally, pharmacists should be supported to feel well-equipped to address young people’s perceived risk of chlamydia. Key findings from different stakeholders enabled the development of recommendations for local policy makers to maximise community pharmacy chlamydia testing.