Application of the COM-B model to barriers and facilitators to chlamydia testing in general practice for young people and primary care practitioners: a systematic review

Abstract Aim: We aimed to explore service users’ and primary care practitioners’ perspectives on the barriers and facilitators to implementing a cancer risk assessment tool (RAT), QCancer, in general practice consultations. Background: Cancer RATs, including QCancer, are designed to estimate the chances of previously undiagnosed cancer in symptomatic individuals. Little is known about the barriers and facilitators to implementing cancer RATs in primary care consultations. Methods: We used a qualitative design, conducting semi-structured individual interviews and focus groups with a convenience sample of service users and primary care practitioners. Findings: In all, 36 participants (19 service users, 17 practitioners) living in Lincolnshire, were included in the interviews and focus groups. Before asking for their views, participants were introduced to QCancer and shown an example of how it estimated cancer risk. Participants identified barriers to implementing the tool namely: additional consultation time; unnecessary worry; potential for over-referral; practitioner scepticism; need for training on use of the tool; need for evidence of effectiveness; and need to integrate the tool in general practice systems. Participants also identified facilitators to implementing the tool as: supporting decision-making; modifying health behaviours; improving speed of referral; and personalising care. Conclusions: The barriers and facilitators identified should be considered when seeking to implement QCancer in primary care. In addition, further evidence is needed that the use of this tool improves diagnosis rates without an unacceptable increase in harm from unnecessary investigation.

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'The experiences, perspectives, and needs of young people who access support for mental health in primary care: a systematic review'

British Journal of General Practice ◽

10.3399/bjgp.2021.0335 ◽

2021 ◽

pp. BJGP.2021.0335

Author(s):

Rebecca Appleton ◽

Julia Gauly ◽

Faraz Mughal ◽

Swaran Singh ◽

Helena Tuomainen

Keyword(s):

Mental Health ◽

Systematic Review ◽

Primary Care ◽

Health Care ◽

General Practice ◽

Young People ◽

Narrative Synthesis ◽

Internet Searching ◽

Mental Health Support ◽

Health Support

Background: There is an increasing demand for mental health support in primary care, especially for young people. To improve mental health support for young people in general practice (GP), the needs of young people must be considered. Aim: To explore the experiences of young people (aged 12-25) on receiving mental health care in general practice and identify the needs of young people who present for mental health concerns. Design and Setting: A systematic review and narrative synthesis. Method: Six databases were searched for literature relating to young people’s experiences of receiving mental health care in general practice. Additional handsearching and manual internet searching were conducted. Narrative synthesis was employed. Results: Five studies and a further two reports from manual internet searching were included for synthesis. The synthesis generated four themes: the centrality of a trusting relationship; showing empathy and taking concerns seriously; providing time to talk; and reducing barriers to accessing primary care mental health support. Conclusion: To enable high-quality and effective mental health consultations with young people and the development of trust, GPs require unhurried consultations, and the ability to maintain continuity of care.

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Barriers and facilitators of physical activity participation for young people and adults with childhood‐onset physical disability: a mixed methods systematic review

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.14830 ◽

2021 ◽

Author(s):

Georgia Mckenzie ◽

Claire Willis ◽

Nora Shields

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Mixed Methods ◽

Young People ◽

Physical Disability ◽

Barriers And Facilitators ◽

Physical Activity Participation ◽

Activity Participation ◽

Childhood Onset

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Breast Density Notification: A Systematic Review of the Impact on Primary Care Practitioners

Journal of Women s Health ◽

10.1089/jwh.2020.8898 ◽

2021 ◽

Author(s):

Brooke Nickel ◽

Tessa Copp ◽

Meagan Brennan ◽

Rachel Farber ◽

Kirsten McCaffery ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Breast Density ◽

Primary Care Practitioners ◽

The Impact

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Barriers to managing child and adolescent mental health problems: a systematic review of primary care practitioners’ perceptions

British Journal of General Practice ◽

10.3399/bjgp16x687061 ◽

2016 ◽

Vol 66 (651) ◽

pp. e693-e707 ◽

Cited By ~ 42

Author(s):

Doireann O’Brien ◽

Kate Harvey ◽

Jessica Howse ◽

Tessa Reardon ◽

Cathy Creswell

Keyword(s):

Mental Health ◽

Systematic Review ◽

Primary Care ◽

Mental Health Problems ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Health Problems ◽

Primary Care Practitioners

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International barriers and facilitators for cervical cancer screening among young people: a systematic review

10.22541/au.159620944.40309212/v2 ◽

2021 ◽

Author(s):

Abirami Kirubarajan ◽

Shannon Leung ◽

Xinglin Li ◽

Matthew Yau ◽

Mara Sobel

Keyword(s):

Systematic Review ◽

Cervical Cancer ◽

Cancer Screening ◽

Young People ◽

Cervical Cancer Screening ◽

Low Income ◽

Healthcare Providers ◽

Barriers And Facilitators ◽

Low Income Countries ◽

Age Group

Background Though cervical cancer is one of the leading causes of death globally, its incidence is nearly entirely preventable. Young people have been an international priority for screening. However, in both high-income and low-income countries, young people have not been screened appropriately according to country-specific guidelines and in many countries, screening rates for this age-group have even dropped. Objectives The aim of this systematic review was to systematically characterize the existing literature on barriers and facilitators for cervical cancer screening among young people globally. Search Strategy We conducted a systematic review following PRISMA guidelines of four databases: Medline-OVID, EMBASE, CINAHL, and ClinicalTrials.Gov. Selection Criteria We only examined original, peer-reviewed literature. Databases were examined from inception until the date of our literature searches (12/03/2020). Articles were excluded if they did not specifically discuss cervical cancer screening, were not specific to young people, or did not report outcomes or evaluation. Data Collection and Analysis All screening and extraction was completed in duplicate with two independent reviewers. Main Results Of the 2177 original database citations, we included 36 studies that met inclusion criteria. Our systematic review found that there are three large categories of barriers for young people: lack of knowledge/awareness, negative perceptions of the test, and practical barriers to testing. Facilitators included stronger relationships with healthcare providers, social norms, support from family, and self-efficacy. Conclusions Health systems worldwide should address the barriers and facilitators to increase cervical cancer screening rates in young people. Further research is required to understand this age group.

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Systematic review of barriers and enablers to the delivery of palliative care by primary care practitioners

Palliative Medicine ◽

10.1177/0269216319865414 ◽

2019 ◽

Vol 33 (9) ◽

pp. 1131-1145 ◽

Cited By ~ 9

Author(s):

Mariko L Carey ◽

Alison C Zucca ◽

Megan AG Freund ◽

Jamie Bryant ◽

Anne Herrmann ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Palliative Care ◽

Care Delivery ◽

Primary Care Providers ◽

Healthcare Services ◽

Care Providers ◽

Eligibility Criteria ◽

Barriers And Enablers ◽

Primary Care Practitioners

Background: There is increasing demand for primary care practitioners to play a key role in palliative care delivery. Given this, it is important to understand their perceptions of the barriers and enablers to optimal palliative care, and how commonly these are experienced. Aim: To explore the type and prevalence of barriers and enablers to palliative care provision reported by primary care practitioners. Design: A systematic review of quantitative data-based articles was conducted. Data sources: Medline, Embase and PsychINFO databases were searched for articles published between January 2007 and March 2019. Data synthesis: Abstracts were assessed against the eligibility criteria by one reviewer and a random sample of 80 articles were blind coded by a second author. Data were extracted from eligible full-texts by one author and checked by a second. Given the heterogeneity in the included studies’ methods and outcomes, a narrative synthesis was undertaken. Results: Twenty-one studies met the inclusion criteria. The most common barriers related to bureaucratic procedures, communication between healthcare professionals, primary care practitioners’ personal commitments, and their skills or confidence. The most common enablers related to education, nurses and trained respite staff to assist with care delivery, better communication between professionals, and templates to facilitate referral to out-of-hours services. Conclusion: A holistic approach addressing the range of barriers reported in this review is needed to support primary care providers to deliver palliative care. This includes better training and addressing barriers related to the interface between healthcare services.

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How to increase chlamydia testing in primary care: a qualitative exploration with young people and application of a meta-theoretical model

Sexually Transmitted Infections ◽

10.1136/sextrans-2019-054309 ◽

2020 ◽

Vol 96 (8) ◽

pp. 571-581

Author(s):

Lorraine K McDonagh ◽

Hannah Harwood ◽

John M Saunders ◽

Jackie A Cassell ◽

Greta Rait

Keyword(s):

Primary Care ◽

Young People ◽

Sampling Methods ◽

Healthcare Providers ◽

Implementation Strategies ◽

Potential Intervention ◽

Individual Interviews ◽

Chlamydia Testing ◽

Wide Range ◽

The Uk

ObjectiveThe objective of this study was to explore young people’s perspectives barriers to chlamydia testing in general practice and potential intervention functions and implementation strategies to overcome identified barriers, using a meta-theoretical framework (the Behaviour Change Wheel (BCW)).MethodsTwenty-eight semistructured individual interviews were conducted with 16–24 year olds from across the UK. Purposive and convenience sampling methods were used (eg, youth organisations, charities, online platforms and chain-referrals). An inductive thematic analysis was first conducted, followed by thematic categorisation using the BCW.ResultsParticipants identified several barriers to testing: conducting self-sampling inaccurately (physical capability); lack of information and awareness (psychological capability); testing not seen as a priority and perceived low risk (reflective motivation); embarrassment, fear and guilt (automatic motivation); the UK primary care context and location of toilets (physical opportunity) and stigma (social opportunity). Potential intervention functions raised by participants included education (eg, increase awareness of chlamydia); persuasion (eg, use of imagery/data to alter beliefs); environmental restructuring (eg, alternative sampling methods) and modelling (eg, credible sources such as celebrities). Potential implementation strategies and policy categories discussed were communication and marketing (eg, social media); service provision (eg, introduction of a young person’s health-check) and guidelines (eg, standard questions for healthcare providers).ConclusionsThe BCW provided a useful framework for conceptually exploring the wide range of barriers to testing identified and possible intervention functions and policy categories to overcome said barriers. While greater education and awareness and expanded opportunities for testing were considered important, this alone will not bring about dramatic increases in testing. A societal and structural shift towards the normalisation of chlamydia testing is needed, alongside approaches which recognise the heterogeneity of this population. To ensure optimal and inclusive healthcare, researchers, clinicians and policy makers alike must consider patient diversity and the wider health issues affecting all young people.

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