title: Chlamydia screening in England: a qualitative study of the narrative behind the policy.
abstract: BACKGROUND
  The rationale for the English National Chlamydia Screening Programme (NCSP) has been questioned. There has been little analysis, however, of what drove the NCSP's establishment and how it was implemented. Such analysis will help inform the future development of the NCSP. This study used a qualitative, theory-driven approach to evaluate the rationale for the NCSP's establishment and implementation.
  
  
  METHODS
  Semi-structured interviews with 14 experts in chlamydia screening were undertaken. The interview data were analysed with policy documents and commentaries from peer-reviewed journals (published 1996-2010) using the Framework approach.
  
  
  RESULTS
  Two themes drove the NCSP's establishment and implementation. The first, chlamydia control, was prominently referenced in documents and interviews. The second theme concerned the potential for chlamydia screening to advance wider improvements in sexual health. In particular, screening was expected to promote sexual health services in primary care and encourage discussion of sexual health with young people. While this theme was only indirectly referenced in policy documents, it was cited by interviewees as a strong influence on implementation in the early years. However, by full rollout of the Programme, a focus on screening volume may have limited the NCSP's capacity to improve broader aspects of sexual health.
  
  
  CONCLUSIONS
  A combination of explicit and implicit drivers underpinned the Programme's establishment. This combination may explain why there was widespread support for its introduction and why implementation of the NCSP was inconsistent. The potential to improve young people's sexual health more comprehensively should be made explicit in future planning of the NCSP.
authors.affiliation: UCL Department of Applied Health Research, Department of Epidemiology and Public Health, UCL, 1-19 Torrington Place, London, WC1E 6BT, UK. j.sheringham@ucl.ac.uk
authors.forename: Jessica
authors.initials: J
authors.lastname: Sheringham
authors.forename: Paula
authors.initials: P
authors.lastname: Baraitser
authors.forename: Ian
authors.initials: I
authors.lastname: Simms
authors.forename: Graham
authors.initials: G
authors.lastname: Hart
authors.forename: Rosalind
authors.initials: R
authors.lastname: Raine
mesh_terms: D026683:Advisory Committees; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000517:prevention & control; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003153:Community Health Services / Q000458:organization & administration / Q000592:standards; D003625:Data Collection; D004739:England; D055317:Evidence-Based Practice; D005260:Female; D006284:Health Plan Implementation; D006291:Health Policy; D006293:Health Promotion / Q000379:methods* / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000592:standards*; D033262:Narration; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D016730:Program Development; D036301:Qualitative Research; D060728:Reproductive Health / Q000193:education / Q000592:standards; D012932:Social Facilitation