MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
BMJ Open. 2022 Feb 11;12(2):e057348. doi: 10.1136/bmjopen-2021-057348.
To present process evaluation results from the Bridge-it Study, a pragmatic cluster randomised cross-over trial to improve effective contraception uptake through provision of the progestogen only pill (POP) plus sexual and reproductive health (SRH) clinic rapid-access to women presenting to community pharmacies for emergency contraception (EC).
A multimethod process evaluation was conducted to assess intervention implementation, mechanisms of change and contextual factors. Data were gathered from screening logs (n=599), observations of pharmacist training, analysis of data from 4-month follow-up questionnaires (n=406), monitoring of contemporaneous events and qualitative interviews with 22 pharmacists, 5 SRH clinical staff and 36 study participants in three participating UK sites in Lothian, Tayside and London.
The intervention was largely delivered as intended and was acceptable. Pharmacists', SRH clinical staff and participants' accounts highlighted that providing a supply of POP with EC from the pharmacy as routine practice may have positive impacts on contraceptive practices in the short term, and potentially longer term. Key mechanisms of change included ease of access, increased awareness of contraception and services, and greater motivation and perceptions of self-efficacy. Few participants took up the offer to attend an SRH service (rapid-access component), and existing barriers within the SRH context were apparent (eg, lack of staff). Participant accounts highlight persistent barriers to accessing and using routine effective contraception remain.
Implementation appeared to be acceptable and feasible, highlighting the potential for provision of POP within EC consultations as routine practice in community pharmacies. However, lack of engagement with the rapid access component of the intervention and existing barriers within the SRH context suggest that signposting to SRH services may be sufficient. Wider implementation should consider ways to address key implementation challenges to increase effectiveness and sustainability, and to overcome persistent barriers to accessing and using effective contraception.
ISRCTN70616901.
介绍 Bridge-it 研究的过程评估结果，这是一项实用的集群随机交叉试验，旨在通过提供仅孕激素避孕药（POP）和性与生殖健康（SRH）诊所快速通道，提高向社区药房寻求紧急避孕（EC）的女性有效避孕方法的使用率。
采用多方法的过程评估来评估干预措施的实施、变化机制和背景因素。数据来自于 599 名女性的筛查记录、对药剂师培训的观察、4 个月随访问卷（n=406）的数据分析、同期事件监测以及对来自英国三个参与地点（洛锡安、泰赛德和伦敦）的 22 名药剂师、5 名 SRH 临床工作人员和 36 名研究参与者的定性访谈。
干预措施基本按照预期实施，并具有可接受性。药剂师、SRH 临床工作人员和参与者的描述表明，将药房提供 POP 与 EC 作为常规做法，可能会对短期和潜在长期的避孕措施产生积极影响。关键的变化机制包括便利的获取途径、提高对避孕和服务的认识，以及增强动机和自我效能感。很少有参与者接受了参加 SRH 服务（快速通道组件）的邀请，并且在 SRH 背景下存在明显的现有障碍（例如，缺乏工作人员）。参与者的描述突出了持续存在的获取和使用常规有效避孕方法的障碍。
实施似乎是可以接受和可行的，突显了在社区药房中提供 POP 作为 EC 咨询常规做法的潜力。然而，由于干预措施的快速通道组件缺乏参与以及 SRH 背景下的现有障碍，因此向 SRH 服务机构提供转介可能就足够了。更广泛的实施应考虑解决关键实施挑战的方法，以提高效果和可持续性，并克服获取和使用有效避孕方法的持续障碍。
ISRCTN70616901。
