‘We're kidding ourselves if we say that contraception is accessible’: a qualitative study of general practitioners’ attitudes towards adolescents’ use of long-acting reversible contraceptives (LARC)

Abstract

INTRODUCTIONAdolescents’ uptake of long-acting reversible contraceptives (LARCs) in New Zealand is low. We created the concept of a proactive LARC provision programme to overcome barriers to LARC uptake. Previously, this concept was discussed with adolescents and positively received. Lack of provider awareness is a barrier to LARC use identified in previous research and by adolescents. AIMWe sought the views of general practitioners (GPs) to gauge whether LARCs and their proactive promotion for use in adolescents may be acceptable to GPs. METHODSNine New Zealand GPs were interviewed about their contraception provision to adolescents and were then asked to comment on the concept of a proactive LARC provision programme. The data collected were transcribed and analysed using a general inductive approach to identify common themes and ideas. We concurrently interviewed and analysed interviews and continued to recruit GPs until thematic saturation was reached. RESULTSSix themes were identified from the interviews: (1) contraceptive decision making; (2) the GP role; (3) sexual activity; (4) social context; (5) gauging adolescent understanding; and (6) youth. When we proposed the concept of a proactive LARC provision programme, the GPs responded positively. DISCUSSIONThe research demonstrates that LARC uptake is affected by limited provider awareness. These findings align with other research internationally that identifies barriers to adolescent contraceptive use. The findings of this study suggest that other GPs may support a proactive LARC provision programme in New Zealand.

Proactively providing contraception to New Zealand adolescents

“…Barriers remain to effective access to contraceptives for adolescents. 1,2 Current provision of contraception to NZ adolescents is reactive (rather than proactive) and not focused on long-acting reversible contraceptives (LARCs), and therefore may not be as effective as it could be. 1,2,5 Of NZ adolescents aged 17 and over, 40.5% have ever had sex, 6 but only 52% of sexually active adolescents in NZ use contraception consistently -consistent adolescent contraception use is actually decreasing.…”

“…17 In qualitative research, PCP for LARCs rather than for all methods was discussed. 1,2 The question of which contraceptives to offer remains unanswered.…”

“…5,12 Adolescents have identified issues with access to contraceptive services requiring time taken out of school, transport to providers, and associated costs. 1,2,5 In addition they have identified barriers to accessing most forms of contraception: including cost and lack of awareness of methods. 1,5,12 Evidence for the effectiveness and social acceptability of PCP Internationally, a promising approach to increasing effectiveness of contraception provision is proactive provision of contraception advice and LARCs to adolescents.…”

“…GPs were mostly positive about the concept, noting the potential to improve contraception access. 2 They did express some doubt about the practical enactment of such a program.…”

From the Editor: The essence of primary health care research

“…We also have an article about long-acting reversible contraception (LARC) for adolescents. 10 Duncan et al explore the potential acceptability to GPs of a proactive approach, where they would routinely offer LARCs to adolescents requesting contraception. Along the way, the researchers found that their participating GPs were often unaware that LARCs are suitable for adolescents and consequently do not routinely offer this form of contraception.…”