Thirty interviews were conducted with nine male and 21 female patients, aged 16–24 years. Eighteen participants were aged ≥21 years and 12 participants were aged 16–20 years. None of the participants objected to any questions and all interviews were completed in full.
There were no obvious differences in opinions or attitudes between locations or age of participants. The only differences observed were between female and male preferences for method of chlamydia testing and the sex of staff, as described below.
Patient preferences for location, method, and member of staff
Several participants indicated that they had never been offered a chlamydia test or discussed contraception with their GP. However, nearly all participants interviewed would be happy to be screened for chlamydia in their GP practice:
‘If I was concerned about chlamydia, I’d rather do it at my GP’s surgery because my GP knows me and I’d feel more sort of comfortable discussing options with them, and knowing that they know my history and stuff like that.’
(Patient 2, female [F], age 24 years, Islington)
Many would be happy and indeed prefer to discuss contraception with their GP, although several said they preferred to purchase condoms from a shop:
‘You’d rather have your doctor give it to you, or say you know, here this is a private room no one’s around, you know, it’s easier to get condoms, and you’d feel more comfortable getting condoms or talking about contraception here than to go a health clinic, wait up, queue up. Umm, and just ask them, “Can I have some condoms?”’
(Patient 18, male [M], age 16 years, Warwickshire)
Furthermore, most participants reported being happy to receive an HIV test as part of a new patient registry, as a result of an indicator illness, or as a result of a sexual health background discussion.
Several participants said they would not mind being offered a chlamydia screen in an unrelated consultation, and a few identified the importance of this as it captures those that would not raise the topic themselves:
‘Probably preferable here, it’s more convenient, you can sort of kill two birds with one stone, see the doctor and get two things done at once.’
(Patient 8, F, age 23 years, Bournemouth and Poole)
Several participants reported that being offered an HIV test was a good precaution to take because they would not want to go undiagnosed:
‘I’d think that’s fine, like it’s doctor patient confidentiality, you know, it is about your health and it’s better to just to open up so that they can help you.’
(Patient 15, F, age 24 years, Islington)
One male participant preferred attending a sexual health clinic over his GP practice for chlamydia screening and contraception advice because its location was convenient:
‘And you can go in your lunch break, and it was just convenience basically … Yes, it’s not really that I wouldn’t go to my GP, I would but … it’s just often with GPs you know it takes longer ... to get an appointment, and that’s basically it.’
(Patient 14, F, age 21 years, Islington)
Preferences for the method of chlamydia test, staff member, and the sex of staff all elicited mixed views. Although several female participants preferred the self-taken swab method, a few preferred providing urine. Several preferred taking the chlamydia test straight away rather than taking it home because they reported that they might forget to return it, did not want to carry the sample around with them, and did not like the idea of posting the sample back. Some did not mind either way:
‘I would, I don’t really think I’d have a preference for it, I wouldn’t mind.’
(Patient 15, F, age 24 years, Islington)
Some were happy for the receptionist to offer the chlamydia test, whereas some indicated that it might not be appropriate because of the practice layout:
‘I think the receptionists … once again I think it depends on the area of the surgery, or like the layout maybe, because I don’t think the new medical centre … you’ve got from, this is the couch and there’s about a metre, two metres before the reception desk, and I think it all depends on the layout of the room.’
(Patient 1, M, age 24 years, Islington)
Preference for the staff member appeared to be related to the patient’s sex because some females would prefer a female clinician, although few mentioned this at all:
‘Being a guy, I think you’d want to see a guy for it, and probably most ladies would want to see a female doctor for it.’
(Patient 7, M, age 22 years, Bournemouth and Poole)
‘I think if I was doing an actual chlamydia test, I’d rather it was a female, but in terms of contraception I wouldn’t really mind.’
(Patient 13, F, age 24 years, Plymouth)
‘I think probably nurse I’d feel most comfortable with, because it’s usually the nurse who I have an appointment with to get the contraceptive pill, so I feel I’d probably feel sort of most comfortable with that.’
(Patient 6, F, age 23 years, Islington)
Other important factors for patients
The convenience of taking a test
The most important factor to participants was convenience, described by most as being facilitated by proximity to the test location, having a range of chlamydia testing methods available, having a simple procedure, and patients having enough knowledge about the testing procedure to facilitate the whole process:
‘At our medical centre there’s a box, a big like box, with chlamydia tests in the bathroom, which I think’s a good idea because then when you’re in there you’re kind of, oh I can do this while I’m here.’
(Patient 1, M, age 24 years, Islington)
‘It’s good anyway, you know for it to be available in as many places as possible.’
(Patient 14, F, age 21 years, Islington)
‘They usually always ask me to take the chlamydia swab into the toilet, and they explain the instructions to me before I go in, and, uh, once you’re in the toilet there’s instructions posted on the back of the wall, and just to remind you what you need to do and yeah, and that’s helpful as well because I get quite nervous about whether I’m doing it properly.’
(Patient 17, F, age 23 years, Bournemouth and Poole)
The offer of testing should be routine
Many participants reported that sexual health should be raised routinely in consultations. Thus, participants reported that it was important for staff to indicate that the offer was made because the patient met the target demographic, as it eliminates the perception of being given the offer due to a suspected likelihood of having a sexually transmitted infection:
‘It should be, it should be more openly spoken about, I think.’
(Patient 5, F, age 18 years, Islington, on discussing chlamydia and contraception with a GP)
Interviewer:‘How should the staff ask you to do the (chlamydia) test?’
Patient:‘Ummm, I suppose not in a way that it sounds like you’ve been sleeping around, like.’
(Patient 21, F, age 21 years, Islington)
‘Yeah, I mean, if they just offered it to everyone at that age then you know that you haven’t been singled out, you know, it’s not an embarrassing thing to … you can’t change your age sort of thing [laughs], it’s not because of who you are or what they think, and sort of thing.’
(Patient 12, F, age 20 years, Bournemouth and Poole, on 3Cs and HIV)
‘I think they need to phrase it as part of a like a drive screening drive, that it wasn’t a personal thing.’
(Patient 29, M, age 21 years, Islington, on chlamydia screening)
Reassurance around testing is key
Participants felt that an important part of being offered an HIV test is having the ‘right kind of doctor’ to discuss HIV with, in addition to having support available for positive results. Several participants felt that the topic of HIV should be broached carefully to avoid unnecessarily alarming patients. This issue was stressed particularly when participants were provided with examples of HIV indicator illnesses and conditions:
‘You need someone to kind of profile that person’s risk factor before they do that test, because if there’s a chance of it being positive you kind of need to offer support with it as well.’
(Patient 29, M, age 21 years, Islington)
‘Fine, absolutely fine, it might be a bit worrying at first but as long as you’re reassured that you know, that necessarily wasn’t the case, it’s just routine I’d be fine.’
(Patient 19, M, age 16 years, Warwickshire)
Barriers and perceived barriers to discussing and accepting an offer of 3Cs and HIV
Embarrassment and unease around testing
Participants said they themselves or others do not necessarily want to discuss chlamydia screening or contraception in a non-sexual health consultation, or would worry that their parents may find out. Other situations identified as causing embarrassment and unease included having to walk through reception with a urine sample or taking the test in front of a GP, or if the GP sees their family members:
‘I’d probably do it … it’s not, you’re just screening but I think sometimes people are embarrassed by the fact that they then have to walk through the waiting room with a pot.’
(Patient 1, M, age 24 years, Islington)
‘Umm, good actually, because umm I’ve been to get one and it’s quite embarrassing to ask someone, so if they offer it it’s easier just to say “yeah”.’
(Patient 8, F, age 23 years, Bournemouth and Poole, on chlamydia screening in GP practices)
‘I think free condoms should be offered routinely for anyone that’s in the sort of teenage to twenties age bracket, ummm because people might be embarrassed to ask about them and might be less likely to go to the GP about that kind of thing.’
(Patient 2, F, age 24 years, Islington)
Patient:‘Should be OK unless, I don’t know, if my parents were around it would be a bit awkward.’
Interviewer:‘Ok yep and do you go to the surgery often with your parents?’
P:‘Most of the time it is with my parents, yeah.’
(Patient 4, M, age 19 years, Islington, on chlamydia screening in GP practices)
‘For a urine test, I mean when I’ve had to do them here before for different things, ummm, it is a bit, you’ve got to walk past the really busy reception with your … with your wee sample or something, but I mean that’s a problem in a lot of places.’
(Patient 12, F, age 20 years, Bournemouth and Poole)
‘Again, it would feel a little bit … quite strange for my GP suddenly, just talked about where I could get condoms from at the end of, umm, a consultation, ummm, but it would just feel sort of … a bit random.’
(Patient 29, M, age 21 years, Islington)
‘Yeah, I think it has to be done really, it may be a bit embarrassing at first for some people but I think it has to be done.’
(Patient 6, F, age 23 years, Islington, on HIV testing)
Some participants perceived that for other patients it may be inappropriate for GP staff to raise 3Cs and HIV testing in an unrelated consultation if the patient was religious, as it could cause offence:
‘Some might … not use I don’t know, maybe just religious reasons.’
(Patient 3, F, age 24 years, Islington)
‘Yeah, I think some people might be, may be offended if they were asked you know, people who never had sex or whatever, or like people who are religious.’
(Patient 9, M, age 20, Bournemouth and Poole)
‘I think I’d be a bit offended if my GP just said I think you need to consider whether you’ve got chlamydia or not.’
(Patient 29, M, age 21 years, Islington)
‘Oh I don’t know, I think they should check it’s not that first, I don’t know. I don’t know, because I know some people would take major offence to that, I know a lot of people if you said “Oh you might have HIV” they’d kick off and be like “You know, what you trying to say?”’
(Patient 7, M, age 22 years, Bournemouth and Poole)
Time
A few participants were concerned that having a chlamydia screening or contraception discussions in an unrelated consultation would take time away from their original reason for visiting the GP, reducing the quality of that consultation, or result in the need to book an additional appointment. Some participants felt that 3Cs and HIV should be offered if there is time at the end of the consultation to avoid this:
‘I just think make it at the end of the appointment to say, ummm yeah, “We’re doing this national screening programme because chlamydia’s really quite common in your age group, do you just wanna do the screening?”’
(Patient 29, M, age 21 years, Islington)
‘You know, killing two birds one stone … when you see the doctor once every six months say get checked.’
(Patient 8, F, age 23 years, Bournemouth and Poole, on chlamydia testing)
‘So I think it should just be added on, obviously deal with the problem first whatever it may be, cold, flu, whatever it is, and just add it on.’
(Patient 5, F, age 18 years, Islington, on chlamydia screening and contraception)
‘Well because, this I think, this clinic is quite busy, so usually an appointment’s sort of 3/4 weeks you know … I think I saw them a month ago so it’s a bit bad timing for exams, but like I could see them afterwards I suppose.’
(Patient 15, F, age 24 years, Islington)
‘Doing a urine sample there and then is, ummm, is just extra GP time and maybe that would take away from time you need to actually talk about the problem that you came in for.’
(Patient 29, M, age 21 years, Islington)
Two participants said it would be useful to have the issue of sexual health raised at every visit:
‘I suppose if it is raised each time then, and they are sure you’re up to date, and that sort of thing, it would become a part of the consultation I suppose, it’d be a normal thing to be asked until you’re older, sort of thing, yeah.’
(Patient 12, F, age 20 years, Bournemouth and Poole, on chlamydia screening)
Facilitators and suggestions for raising awareness and highlighting the importance of trust and confidentiality
Raising awareness of sexual health services
Two individuals felt that awareness should be raised around GP practices offering sexual health services:
‘Just say “We offer chlamydia screening here”, or I don’t know, “When was the last time you had a check up, like sexual health check up?”’
(Patient 9, M, age 20 years, Bournemouth and Poole)
Indeed, some participants were not aware that they could get a chlamydia test at their GP practice:
‘There could be a bit more awareness I suppose of where people can go.’
(Patient 23, F, age 17 years, Islington)
One individual stated that they would be pleased to know that they had been offered all the sexual health services available from their GP.
One female highlighted the importance of discussing all contraception options along with condoms:
‘So I think it’s better to outline the different options and let the patient make up their mind about which one’s best.’
(Patient 6, F, age 23 years, Islington)
Several reported that posters in waiting rooms can raise awareness; however, a few reported that they do not look at posters as there are often too many:
‘I think even like in a lot of surgeries, just waiting around I like to read everything on the wall and stuff, but there’s never really much about things like that, there’s never really anything about … unless you go to a GUM clinic then it’s everywhere.’
(Patient 7, M, age 22 years, Bournemouth and Poole)
Trust in GP staff, and reassuring confidentiality
Several participants mentioned the benefits of having trust in their GP or their GP practice, and a few placed a high value on the professionalism of their GP when discussing sexual health:
‘I think it’s probably a combination of the fact that people are embarrassed to talk about sexual health, GPs don’t necessarily bring it up every time so they may not know it’s available, and, ummm, I think that kids might be worried that it’s gonna go on their record, that they asked for this or that, they’ve talked about it and that their parents will find out. That they’re sort of sexual active when they … want to conceal that, umm, so I think it’s probably a combination of factors, I think GPs should make it clear to everyone when they offer them the chlamydia test that it’s confidential and they’re not going to go and tell their parents about it.’
(Patient 2, F, age 24 years, Islington)
‘So, urm, I think, umm, discretion and support and explaining it properly with the person.’
(Patient 23, F, age 17 years, Islington, on chlamydia screening)
‘I’ve been coming to this surgery for a long time and I trust all my doctors and everyone that I’ve met in this surgery, feels like a family which I can trust.’
(Patient 28, F, age 24 years, Warwickshire)
‘I think it might just be my experience with them has been really opening and helpful, that I think I wouldn’t feel judged by them.’
(Patient 1, M, age 24 years, Islington)
‘I would definitely like to have the screening at the GP because I trust them more than anywhere else.’
(Patient 28, F, age 24 years, Warwickshire)
Knowledge of chlamydia, screening, chlamydia treatment, contraception, and sexual health services
Nearly all participants knew at least one fact about chlamydia and screening: around where to obtain a test, duration to receive results, or methods of testing:
‘I know, it’s well, you screen people for chlamydia like, test to see if they have chlamydia, and I think you can use, umm, swabs, and that’s all I really know about it.’
(Patient 15, F, age 24 years, Islington)
‘Umm, I know it’s done by a nurse, and I know that you can come in, get it done and get the results in a few days.’
(Patient 27, F, age 22 years, Warwickshire, on chlamydia tests)
‘Chlamydia screening is when you, umm, just run a test, with kind of as many people as possible, just to try and pick up any cases that might be undetected.’
(Patient 29, M, age 21 years, Islington)
Interviewer:‘Is that a test you’ve had before?’
Patient:‘Yeah, I’ve had that before’
I:‘How long did you wait for your result?’
P:‘Uh, about, no it was straight away, it’s like 5 minutes.’
(Patient 14, F, age 21 years, Islington, on HIV tests)
Others were less knowledgeable. Several participants had a lack of understanding on what chlamydia or a chlamydia screening was, treatment for chlamydia, and which health service to use if one was presenting with symptoms, while two individuals did not know how to obtain condoms:
‘I mean, even I don’t really know what chlamydia is and I’m 24, so a lot of young people don’t know.’
(Patient 2, F, age 24 years, Islington)
‘Ummm, what is a chlamydia screening?’
(Patient 3, F, age 24 years, Islington)
Interviewer:‘Do you know what the screening means?’
Patient:‘Not really, is it a test or something?’
(Patient 20, F, age 24 years, Islington)
Interviewer:‘Do you understand the word chlamydia at all?’
Patient:‘Not, not exactly, I’ve sort of, the word sounds familiar but yeah, I’m not entirely sure of the meaning.’
(Patient 25, M, age 17 years, Warwickshire)
‘I don’t know where they are to be honest, I don’t know where there is one.’
(Patient 8, F, age 23 years, Bournemouth and Poole, on sexual health clinics)
Interviewer:‘Have you been to places like that?’
Patient:‘No, what would they do?’
(Patient 5, F, age 18 years, Islington, on sexual health clinics)
‘Jeez, didn’t realise it was that high, I thought HIV was really rare.’
(Patient 7, M, age 22 years, Bournemouth and Poole, on prevalence of HIV)
‘I don’t know, I don’t really understand HIV to be honest.’
(Patient 10, F, age 23 years, Bournemouth and Poole)
