School of Population Health & Environmental Sciences, King's College London, London, UK
Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
BMJ Sex Reprod Health. 2020 Apr;46(2):108-115. doi: 10.1136/bmjsrh-2018-200297. Epub 2019 Nov 1.
This study presents the theory of change underpinning an intervention to provide online contraceptive care in an inner London area with high rates of unplanned pregnancy. It aims to suggest attributes of an effective service and to identify key questions for its evaluation.
Thematic analysis of an online sexual and reproductive health programme funding application and 21 semi-structured interviews with a purposive sample of stakeholders selected to provide expertise in contraception and online health.
A theory of change model summarised the positive processes of change which could be initiated through increased access to contraceptive supplies, online information and remote interaction and support. Stakeholders predicted that perceptions of convenience and anonymity of online access would vary across the target population. They stressed the importance of trusting service-users' capabilities for autonomous contraceptive decision-making, but expressed concerns that online access could be detrimental for those requiring more complex care. Concerns were alleviated by the prospect of responsive support through text messaging and phone calls, and when the online service was positioned as part of a broader system of provision including physical services.
This study has revealed priority areas for the ongoing development of an online contraception service and pertinent evaluation questions. Evaluative research should test assumptions within the theory of change model, exploring the characteristics and circumstances of those preferring online access over existing services and the value of convenience, anonymity, autonomous access and responsive support in executing effective contraceptive choices within a new landscape of contraceptive delivery.
本研究提出了一项干预措施的变革理论，该干预措施旨在为伦敦市区一个计划外怀孕率较高的地区提供在线避孕护理。它旨在提出有效服务的属性，并确定其评估的关键问题。
对一个在线性健康和生殖健康项目资助申请进行主题分析，并对 21 名有目的选择的利益相关者进行半结构化访谈，这些利益相关者在避孕和在线健康方面具有专业知识。
变革理论模型总结了通过增加避孕用品供应、在线信息和远程互动与支持，可能引发的积极变革过程。利益相关者预测，在线访问的便利性和匿名性的看法将因目标人群而异。他们强调了信任服务使用者自主避孕决策能力的重要性，但对在线访问可能对那些需要更复杂护理的人造成不利影响表示担忧。通过短信和电话提供响应性支持，以及将在线服务定位为包括物理服务在内的更广泛提供系统的一部分，可以缓解这些担忧。
本研究揭示了在线避孕服务持续发展和相关评估问题的优先领域。评估研究应检验变革理论模型中的假设，探索那些更喜欢在线访问而不是现有服务的人的特征和情况，以及在新的避孕服务提供环境中便利性、匿名性、自主访问和响应性支持在执行有效避孕选择方面的价值。
