A meta-synthesis of patients’ and health providers’ attitudes towards the use of long-acting reversible contraceptives (LARCs) in primary care.
Problem
Unplanned pregnancies carry increased risks and contribute to health inequality. Access to effective and acceptable contraception is needed for reproductive autonomy and to promote planned, healthy pregnancies. LARCs are safe, efficacious and cost effective but their use lags behind other, user dependent, methods of contraception. Whilst LARC prescription is increasing in sexual and reproductive health services, it is static in primary care, where a majority of women access contraception. This meta-synthesis seeks to understand patients’ and providers’ attitudes to LARC use in primary care. This objective aligns with a NICE research goal: to determine which benefits and drawbacks of LARCs might influence a woman’s choice. Understanding facilitators and barriers enables effective contraceptive counselling. The aim is not to impose LARC use but to facilitate optimal matching of contraception needs to choice.
Approach
The meta-synthesis is registered on Prospero: 156610. The databases CINAHL, Embase, Ovid, PsychInfo and Web of Science were searched for qualitative studies from 2009 to October 2019 using search terms related to ‘LARC’ and ‘General Practice’. Two reviewers independently conducted abstract screening and full text reviews according to inclusion and exclusion criteria. Conflicts were discussed. Quality of included papers was assessed using CASP criteria (ongoing). Papers were not excluded on the basis of methodological robustness but verbatim quotes used to mitigate the risk of low quality papers adversely affecting synthesis. Thematic synthesis described by Thomas and Harden in 2008 has been used to develop analytical themes.
Findings
1441 abstracts were screened and of 82 full text reviews,15 papers met the criteria for inclusion in the meta-synthesis. Papers described research across primary care settings in Europe, USA and Australasia. In the preliminary analysis emergent themes include patients’ views of societal norms, perceptions and misconceptions about LARC effects and acknowledging the individual in contraceptive choice. The analytical framework is being developed and will be presented. Of particular interest in the analysis to date are the similarities and differences between patients’ and health providers’ perceptions. Identifying disconnects here can be used to tailor interventions, better matching patients’ concerns with the information they receive at contraceptive consultations.
Consequences
Despite the effectiveness of LARCs, their use in primary care has remained static over recent years. The results of this meta-synthesis will establish if there is an unmet care need: are surmountable barriers preventing more women using LARCs? Gaining an understanding of patients’ perspectives will enable practitioners to challenge these barriers through improved contraceptive counselling, and provide a framework to evaluate and improve contraceptive services.