title: Promoting chlamydia screening with posters and leaflets in general practice--a qualitative study.
abstract: BACKGROUND
  General practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP), have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening.
  
  
  METHODS
  Twenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach.
  
  
  RESULTS
  Although two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets.
  
  
  CONCLUSIONS
  The NCSP should consider developing a range of more discrete but eye catching posters and small leaflets specifically to promote chlamydia screening in different scenarios within general practice; coordinators should audit their use. Practice staff need to discuss, with their screening co-ordinator, how different practice staff can promote chlamydia screening most effectively using the NCSP promotional materials, and change them regularly so that they do not loose their impact. Education to change all practice staff's attitudes towards sexual health is needed to reduce their worries about displaying the chlamydia materials, and how they may follow up the advertising up with a verbal offer of screening opportunistically to 15-24 year olds whenever they visit the practice.
authors.affiliation: Gloucestershire Research & Development Support Unit, Gloucestershire Hospitals NHS Foundation Trust, Great Western Road,Gloucester, UK. elaine.freeman@glos.nhs.uk
authors.forename: Elaine
authors.initials: E
authors.lastname: Freeman
authors.forename: Rebecca
authors.initials: R
authors.lastname: Howell-Jones
authors.forename: Isabel
authors.initials: I
authors.lastname: Oliver
authors.forename: Sarah
authors.initials: S
authors.lastname: Randall
authors.forename: William
authors.initials: W
authors.lastname: Ford-Young
authors.forename: Philippa
authors.initials: P
authors.lastname: Beckwith
authors.forename: Cliodna
authors.initials: C
authors.lastname: McNulty
mesh_terms: D000293:Adolescent; D000329:Advertising; D001291:Attitude of Health Personnel; D001296:Audiovisual Aids; D002690:Chlamydia Infections / Q000175:diagnosis*; D004739:England; D005260:Female; D017144:Focus Groups; D058006:General Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening; D010353:Patient Education as Topic / Q000379:methods*; D055815:Young Adult