What strategies influence general practitioners to deliver public health programmes? An example using the National Chlamydia Screening Programme

General practitioners (GPs) have a role in improving population health through health promotion and disease prevention (HPDP) activities such as immunisations, screening, and lifestyle advice. However, GPs must also respond to the patient’s agenda in a consultation. With limited time in a consultation, it might be difficult for GPs to prioritise HPDP with their patients. My thesis aimed to offer insights into the behavioural determinants of GPs to deliver HPDP. I considered behaviour theories such as Ajzen’s Theory of Planned Behaviour (TPB) to help understand clinician behaviour and how they could be applied to influence their behaviour to deliver HPDP programmes. I conducted an overview of systematic reviews to examine impact of behavioural interventions, directed at GPs, to improve health of their patients. The overview suggested there is insufficient evidence for any type of intervention to be consistently effective in influencing GPs behaviour. The National Chlamydia Screening Programme aims to detect and treat chlamydia infection in young people. Primary Care Trusts used different behaviour interventions to encourage GPs to deliver screening. I interviewed GPs and practice nurses (PNs) in London about their experiences of delivering chlamydia screening and the behavioural interventions, such as those discussed in systematic reviews, to influence their behaviour to deliver other public health programmes. The interview data suggested the constructs of TPB - behavioural beliefs, normative beliefs, and control beliefs – could be used as a conceptual framework to explain why these primary care clinicians might deliver public health care. Strategies used to implement public health programmes need to consider how primary care clinicians might respond to the different constructs of TPB. In addition, organisational factors such as contracts and financial incentives, and perception of intrusion into the patient’s agenda need to be managed carefully as they could either facilitate or impede delivery of public health programmes.