"Not that sort of practice": the views and behaviour of primary care practitioners in a study of advance provision of emergency contraception.

BACKGROUND

Advance supplies of emergency contraception (EC) were made available to women aged 16-29 through general practice and family planning services in Lothian, Scotland. Although this intervention was not associated with an overall reduction in abortion rates in Lothian, it was hypothesized that some general practices may have been more successful than others in promoting and delivering the intervention.

OBJECTIVE

To investigate, using comparative case studies, whether, and why, some general practices were more successful in promoting and delivering advance supplies of EC than others.

METHODS

Eleven purposively sampled general practices from the 97 participating in the intervention were studied. The number of packs of advance supplies distributed was recorded and distribution rates per 100 eligible women per practice calculated. 44 semi-structured interviews with staff were used to describe the mechanisms through which advance supplies were distributed and health professionals' views of the intervention.

RESULTS

Distribution rates varied from 0.9 to 32.0 per 100 eligible women. Respondents described three mechanisms through which advance supplies were distributed: passive, reactive and proactive. Views about EC, and the suitability of their patient population for advance supplies, varied and configured specific practice contexts that facilitated or hindered the delivery of advance supplies. Favourable views and pro-active mechanisms were associated with higher distribution rates, less favourable or ambivalent views and passive delivery mechanisms with lower distribution rates.

CONCLUSION

If primary care professionals are to actively engage with a sexual health promotion agenda they need to develop appropriate interpersonal skills and address their values, attitudes and cultural competences.