Table 2.

Potential intervention strategies: Interventions options and illustrative quotations to overcome barriers to chlamydia testing in general practice

Intervention options	Themes and subthemes		Illustrative quotations
Education Increasing knowledge or understanding	Increase information and awareness	Transmission	Q2.1: ‘I think it’s a case of both making people aware of chlamydia itself and what the risks are and what the dangers are.’ (P25, female, 18 years)
		GP testing	Q2.2: ‘Just reminding me that I can get it done there I guess, because I forget that I can get it done there as well.’ (P07, female, 20 years) Q2.3: ‘For me personally I would just think if we know that the GP actually does it, then we can actually go there.’ (P19, female, 19 years)
		Testing process	Q2.4: ‘I think they just need to make it out to people that it’s not a real intrusive test, you know, you can do it yourself; like it takes, what, two seconds to do. I think that should probably be highlighted more because, like I said, no-one really said that to me before I was getting it done.’ (P03, female, 22 years)
		Consequences of not testing	Q2.5: ‘Mentioning that chlamydia can lead to infertility because I think a lot of people don’t know that.’ (P07, female, 20 years) Q2.6: ‘It’s only going to benefit you if you get it tested, I think it’s a good question (offer testing) for a doctor to ask, just to make sure, purely because I don’t think enough people actually get tested, they don’t see the benefit of just doing it.’ (P21, female, 22 years)
		Ease of treatment	Q2.7: ‘Because I think a lot of people think it’s going to be invasive and it’s going to be with them for life, but it’s not, it is easily treated.’ (P13, female, 22 years). Q2.8: ‘Having the right information about, about how the test is taking place, and also, yes, so reassurance and it’s not such a big deal to get treated and things like that.’ (P26, male, 20 years)
	Target younger ages groups		Q2.9: ‘Increasing the awareness of it - especially the sort of younger ages - maybe when you get a bit older, you’re more aware of what’s going on, but maybe in your teenage years you’re less sort of savvy about how to go about getting a test.’ (P05, male, 23 years) Q2.10: ‘Stigma, if you were taught from a younger age about these things, you’d probably start feeling more open about them… I think we were told very much what they are but not what all the, erm … you know, what the sort of emotional side of it is, we were not taught that at all.’ (P01, female, 24 years) Q2.11: ‘You also just kind of, you’re young, so you fear the worst, because you just don’t know.’ (P28, female, 16 years) Q2.12: ‘Also again sort of the whole stigma surrounding it, when I was younger that put me off (testing).’ (P18, male, 19 years)
	School-based education	Inclusion early in education	Q2.13: ‘If it was taught earlier in school that you should be doing this yearly, or you should be doing this after every sexual partner.’ (P14, male, 24 years) Q2.14: ‘But also education at school is going to be a massive thing, because I didn’t have that sort of education and I’ve been trying to sort of get help that in the community, and that makes a difference because you’re sort of aware of how lacking in education kids are.’ (P18, male, 19 years) Q2.15: ‘I think we were told what they (STIs) are but not what all the, erm … you know, what the sort of emotional side of it is, we were not taught that at all.’ (P01, female, 24 years)
		Relevance for all	Q2.16: ‘My sex education was shocking… it wasn’t really informative. It didn’t really talk about things you could pick up during sex. It was, it was mainly, ‘Oh this is a period,’ and actually crack on, okay, not very helpful.’ (P26, male, 20 years)
Persuasion Using communication to induce positive or negative feelings, or stimulate action	Framing of communication	Testing as responsible behaviour	Q2.17: ‘You should almost be proud of going to get checked because you’re doing the responsible thing. Even if you’ve done a silly thing, you know slept with someone and had unprotected sex with someone.’ (P12, male, 23 years)
		Testing as healthy behaviour	Q2.18: ‘I think reassurance that it’s not something to be ashamed for, that people go through it, no matter the age and it’s obviously healthier for you, in the long run, to do it.’ (P26, male, 20 years)
		Moral obligation to others	Q2.19: ‘I think it’s also about not having it yourself, so you know you’re not the person that’s passing it on; it’s not just about catching it.’ (P01, female, 24 years)
		Positive reinforcement	Q2.20: ‘When you go and get a test, someone should say that’s a good thing you’re getting a test and feel free to come in again… you’d get some positive reinforcement to sort of tell you that it’s a good thing that you’re doing.’ (P05, male, 23 years)
		Conformity - everyone does it	Q2.21: ‘Reiterate the fact that everybody gets tested at some point, and that it’s not a personal dig at you! You know it is just that everybody needs to get tested at some point… it is just that everybody of all ages and all backgrounds gets tested at some point.’ (P15, female, 24 years)
	Use imagery or data to alter beliefs		Q2.22: ‘You’ve got to give them the fear a little bit… they don’t want to be, but maybe you have to scare them a little bit. there’s always the option to either have horrible pictures or, you know, statistics based on that sort of thing and just make sure that they’re really well publicised.’ (P17, male, 21 years)
	Challenge perceptions of chlamydia		Q2.23: ‘If you do have chlamydia, it doesn’t mean you’re going to be sick for the rest of your life, which I think a lot of younger people might think that! It’s not like that, especially nowadays, but, it definitely should be highlighted more that if you don’t get treated, it will actually affect you.’ (P03, female, 22 years) Q2.24: ‘I think just trying to relinquish the taboo over it a little bit, I guess. People, I think there’s just so much emphasis on like don’t get STIs; it’s like don’t get them, they’re horrible! And it’s actually like, well, chances are you might get it and that’s OK, because it’s really treatable. If you can try and protect yourself from it, that’s the first option, but if you do get it, we can treat it, as long as you test it and you know that there is that option of easily treating it. Prevention is always better than cure, but I just think, not normalising it but in a sense, maybe normalising it and just going, like: This happens to people, don’t feel ashamed, come and get treated, because we all have sex!’ (P04, female, 24 years) Q2.25: ‘I feel like I understand that it’s quite dangerous and I do get anxious about it if I don’t (get tested), so if people don’t even realise that it’s a dangerous thing and they’ve put themselves at risk, if they think it’s not important to get tested, then that definitely needs to be changed, yeah.’ (P22, male, 18 years)
Environmental restructuring Changing the physical or social context	Flexible appointments		Q2.26: ‘I think it would be easier if they didn’t have to book an appointment in advance, if they could just drop in whenever they needed to. Or maybe if the hours weren’t restrictive like they are at some of the clinics… So if it was kind of available most of the time, I think that would help as well.' (P07, female, 20 years) Q2.27: ‘Being more flexible with timings and stuff, and being able to rock up and get an appointment that day, or wait around and get an appointment like at a walk-in; just it being a bit less structured and ease of being able to get in and out essentially…I mean, walk-in sessions are pretty paramount.' (P18, male, 19 years)
	Toilet location		Q2.28: ‘I’ve experienced that once or twice, and when you have to go and do something yourself, like a swab or pee somewhere, and they just give it to you, it’s like you have to walk in there in front of everyone and walk out. And most people are really good, because they have toilets next to the rooms, like the practice rooms and stuff.' (P20, female, 19 years) Q2.29: ‘I had to give a sample and the toilet was right in the patients’ waiting area… it’s that sort of lack of privacy that needs to be addressed.' (P28, female, 16 years)
Modelling Example to aspire to/imitate	Example provision		Q2.30: ‘Give a link to an instructional video or something like that, that kind of just shows it (testing) as well… And with something like a swab you could use a model, like a plastic kind of anatomical model to just show how to do it and things like that, so that it’s kind of physically demonstrated.' (P24, female, 22 years)
	Credible sources		Q2.31: ‘Like how they did with Prince Harry and the HIV testing, if they did something similar but for chlamydia…hm but I suppose who’d want to be the face of chlamydia?' (P10, male, 24 years) Q2.32: ‘If it was on TV shows or something they might think about it a bit more, and if you saw your idols doing it (testing), you might do it too.’ (P07, female, 20 years)
	Friend referrals		Q2.33: ‘Yeah, posters in the place, give out a leaflet and then they can go and give it to their friends or whatever. Encourage them to get tested and pass it (the leaflet) on.’ (P12, male, 23 years) Q2.34: ‘If you could get people to go to testing with their friends, sorta make a day out if it, I think that could help, that’s what helped me before.’ (P15, female, 24 years)

GP, general practitioner; P, participant number; Q, Quote number; STI, sexually transmitted infection.