Background: The rationale for the English National Chlamydia Screening Programme (NCSP) has been questioned. There has been little analysis, however, of what drove the NCSPs 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 NCSPs establishment and mplementation. 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 19962010) using the Framework approach. Results: Two themes drove the NCSPs 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 NCSPs capacity to improve broader aspects of sexual health. Conclusions: A combination of explicit and implicit drivers underpinned the Programmes 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 peoples sexual health more comprehensively should be made explicit in future planning of the NCSP.
Bibliographical noteFunding Information:
We are very grateful to the following for their valuable input into the study and to those who generously provided their time to be interviewed anonymously: Dr Kevin Fenton, Visiting Professor in Epidemiology and Public Health, Centre for Sexual Health, UCL Dr Jane Hocking, Deputy Director, Centre for Women's Health, Gender and Society, Melbourne School of Population Health Dr D. Scott LaMontagne, PhD, MPH, FRSPH, CS – currently at PATH, HPV vaccine project, country research manager; formerly at HPA, NCSP, lead scientist, 2003–2005. Professor Nicola Low, MD MSc FFPH, Professor of Epidemiology and Public Health, University of Bern Dr Anne Mackie, National Screening Committee Director of Programmes Ms Rupal Patel, Terrence Higgins Trust Dr Sarah Randall, Medical Advisor to the NCSP, 2003–2008 Dr Sue Skidmore, Dept of Microbiology, Princess Royal Hospital Professor Judith Stephenson, Margaret Pyke Chair of Sexual & Reproductive Health, University College London This work was supported by the Medical Research Council [grant number G0701660].