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Randomized Controlled Trial
. 2022 Feb 11;12(2):e057348.
doi: 10.1136/bmjopen-2021-057348.

Improving effective contraception uptake through provision of bridging contraception within community pharmacies: findings from the Bridge-it Study process evaluation

Susan Patterson  1 , Lisa McDaid  2   3 , Kristina Saunders  4 , Claire Battison  5 , Anna Glasier  6 , Andrew Radley  7   8 , Judith M Stephenson  9 , Anne Johnstone  6 , Alessandra Morelli  10 , Deirdre Sally  11 , Nicola Stewart  11 , Sharon Tracey Cameron  6   12
Affiliations
Randomized Controlled Trial

Improving effective contraception uptake through provision of bridging contraception within community pharmacies: findings from the Bridge-it Study process evaluation

Susan Patterson et al. BMJ Open. .

Abstract

Objective: 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).

Research design and methods: 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.

Results: 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.

Conclusions: 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.

Trial registration number: ISRCTN70616901.

Keywords: primary care; public health; qualitative research.

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Conflict of interest statement

Competing interests: STC reports grants from the National Institute for Health Research (Health Technology Assessment (NIHR HTA) Programme), during the conduct of the study. AG is a consultant to HRA Pharma. AR reports receiving research grants from Gilead Sciences, Bristol-Myers Squibb, AbbVie and Roche; honorariums from Gilead Sciences; and personal fees from AbbVie. AM reports grants from NIHR HTA during the conduct of this study. AM is a clinical support bank midwife for SH:24 and a research midwife at Oxford University. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
The Bridge-it study process evaluation framework. EC, emergency contraception; POP, progestogen only pill; SRH, sexual and reproductive health.
Figure 2
Figure 2
Breakdown of main study and process evaluation (PE) recruitment and sites. SRH, sexual and reproductive health
See this image and copyright information in PMC

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