| Title:
|
Access to and quality of sexual and reproductive health services in Britain during the early stages of the COVID-19 pandemic: a qualitative interview study of patient experiences |
| Abstract:
|
INTRODUCTION: Access to quality sexual and reproductive health (SRH) services remains imperative even during a pandemic. Our objective was to understand experiences of delayed or unsuccessful access to SRH services in Britain during the early stages of the COVID-19 pandemic. METHODS: In October and November 2020 we conducted semi-structured telephone interviews with 14 women and six men reporting an unmet need for SRH services in the Natsal-COVID survey a large-scale quasi-representative web-panel survey of sexual health and behaviour during COVID-19 (n=6654). We purposively sampled eligible participants using sociodemographic as. Inductive thematic analysis was used to explore service access and quality and to identify lessons for future SRH service delivery. RESULTS: Twenty participants discussed experiences spanning 10 SRH services including contraception and antenatal/maternity care. Participants reported hesitancy and self-censorship of need. Accessing telemedicine and socially-distanced services required tenacity. Challenges included navigating changing information and procedures; perceptions of gatekeepers as obstructing access; and inflexible appointment systems. Concerns about reconfigured services included reduced privacy; decreased quality of interactions with professionals; reduced informal support; and fewer preventive SRH practices. However some participants also described more streamlined services and staff efforts to compensate for disruptions. Many viewed positively the ongoing blending of telemedicine with in-person care. CONCLUSION: The COVID-19 pandemic impacted access and quality of SRH services. Participants accounts revealed self-censorship of need difficulty navigating shifting service configurations and perceived quality reductions. Telemedicine offers potential if intelligently combined with in-person care. We offer initial evidence-based recommendations for promoting an equitable restoration and future adaption of services. |
| Published:
|
2022-04-20 |
| Journal:
|
BMJ Sex Reprod Health |
| DOI:
|
10.1136/bmjsrh-2021-201413 |
| DOI_URL:
|
http://doi.org/10.1136/bmjsrh-2021-201413 |
| Author Name:
|
Bos Prez Raquel |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/bos_prez_raquel |
| Author Name:
|
Reid David |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/reid_david |
| Author Name:
|
Maxwell Karen J |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/maxwell_karen_j |
| Author Name:
|
Gibbs Jo |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/gibbs_jo |
| Author Name:
|
Dema Emily |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/dema_emily |
| Author Name:
|
Bonell Christopher |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/bonell_christopher |
| Author Name:
|
Mercer Catherine H |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/mercer_catherine_h |
| Author Name:
|
Sonnenberg Pam |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/sonnenberg_pam |
| Author Name:
|
Field Nigel |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/field_nigel |
| Author Name:
|
Mitchell Kirstin R |
| Author link:
|
https://covid19-data.nist.gov/pid/rest/local/author/mitchell_kirstin_r |
| sha:
|
94bf370112baa1d01578e39cfc3be6628a3a2f1c |
| license:
|
cc-by |
| license_url:
|
https://creativecommons.org/licenses/by/4.0/ |
| source_x:
|
Medline; PMC; WHO |
| source_x_url:
|
https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/https://www.who.int/ |
| pubmed_id:
|
35444001 |
| pubmed_id_url:
|
https://www.ncbi.nlm.nih.gov/pubmed/35444001 |
| pmcid:
|
PMC9062459 |
| pmcid_url:
|
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9062459 |
| url:
|
https://doi.org/10.1136/bmjsrh-2021-201413
https://www.ncbi.nlm.nih.gov/pubmed/35444001/ |
| has_full_text:
|
TRUE |
| Keywords Extracted from Text Content:
|
people
backlogs
patients
I'd left
de-prioritise
[18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29]
Natsal-COVID Wave 1
lockdown
Wave 1
men
...
face-toface
Quotas
line
Natsal-COVID
e-voucher
cervical cancer
... I
Patient
RBP
patient
women
coronavirus
KJM
People
childcare
£
UK
cervical
COVID-19
BASHH
children
STIs
NHS
urine
participants
KRM
Fieldnotes
Prioritise cross-sector
cervical smear
SARS-CoV-2
overthe-phone
DR
[18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29]
centre
her
Ensure
Patient
Bosó Pérez http://orcid.org/0000-0001-7342-4566 Karen J Maxwell http://orcid.org/0000-0002-2264-6510 Christopher Bonell http://orcid.org/0000-0002-6253-6498
Patients |
| Extracted Text Content in Record:
|
First 5000 Characters:Responding to rising COVID-19 cases, the UK announced a national lockdown in March 2020, imposing stay-at-home orders and discouraging non-essential contact including between healthcare workers and patients. To minimise SARS-CoV-2 transmission, providers rapidly adjusted how they delivered sexual and Key messages ► In describing their experiences of delayed or unsuccessful attempts to access SRH services, participants reported feeling hesitant and some selfcensored their need. ► Challenges to accessing services included confusing and inconsistent information and procedures, and gatekeepers who were perceived as obstructive. ► Participants observed new efficiencies within services, including telemedicine, but also perceived reduced privacy and quality of interaction with providers.
reproductive health (SRH) services through new protocols, staff redeployment and site closures. 1 2 Early abortion care via telemedicine was an example of successful adaptability, reducing waiting times and barriers to access 3 and increasing satisfaction. [4] [5] [6] However, other essential SRH services such as longacting reversible contraception (LARC) provision or asymptomatic sexually transmitted infection (STI) screening were halted or reduced. 1 7 Providers tried to prioritise those with most need who could not be managed remotely for in-person care. 8 Access to SRH services remains imperative even during a pandemic. 9 People have a right to sexual expression, reproductive autonomy, safe childbirth and a life free from infection. 10 The population need for services such as routine and emergency contraception, STI testing and treatment, sexual problems advice or antenatal care is continual. Disruptions to these services can have significant repercussions including unplanned pregnancy, undiagnosed STIs and sexual dysfunction.
The Natsal-COVID study sought to understand the initial impact of service reduction and reconfiguration in Britain (consisting of England, Scotland and Wales). 11 SRH services in Britain are delivered by a range of providers including general practitioners (GPs), specialist integrated sexual health services and screening programmes (e.g., chlamydia or cervical cancer screening). Natsal-COVID Wave 1, undertaken in July-August 2020, is a quasi-representative webpanel survey designed to understand the early impact of the pandemic on SRH. The study highlighted unmet need for SRH services, with one in 10 survey participants reporting unsuccessful attempts to access SRH services and one in five men needing but being unable to access condoms. 12 Other UK studies found that men who have sex with men and young people experienced an unmet need for STI testing, contraception and condom access. [13] [14] [15] This paper describes the results from qualitative follow-up interviews with Natsal-COVID participants exploring the experiences of unmet or delayed SRH need in the general population. Learning from patient perspectives is crucial to inform recovery and rebuilding efforts during and after COVID-19. 8 The study aimed to explore: (1) what challenges arose for patients attempting to access and navigate SRH services during the pandemic, and (2) how COVID-19 protocols and reduced staffing affected patient perceptions of service quality.
Natsal-COVID is a mixed-method study exploring the impact of the COVID-19 pandemic on sexual behaviour, relationships and SRH. 11 Following the Wave 1 web-panel survey, follow-up qualitative interviews were carried out to explore sexuality-related topics relevant during the pandemic. This paper draws on interviews with 20 of the 311 participants who, in the survey, reported unmet SRH access since lockdown and agreed to recontact. Quotas were applied to ensure variation by age, gender, ethnicity and region. We sought to include a minimum number of participants living in Scotland and Wales, and to oversample women to reflect their higher use of SRH services. Ethical approval was obtained from the University of Glasgow MVLS College Ethics Committee (20019174) and LSHTM Research Ethics Committee (22565).
The research team telephoned individuals who agreed to recontact, fell within the pre-specified quotas and provided valid contact details. An introductory call explained the study and confirmed eligibility. Those interested were emailed a study information sheet and given the opportunity to ask questions. Informed consent to participate was sought and recorded prior to interview. Interviews were conducted by three trained qualitative interviewers (DR, KJM and RBP) between 2 October 2020 and 16 November 2020. All interviews were conducted by telephone, lasting 45-90 min. The interview guide explored the context of help-seeking, experiences of attempting to access SRH services, impact of unmet or delayed need, and attitudes and experiences with telemedicine (see online supplemental material). Fieldnotes (summaries and reflections) were recorded after each interview. Participants were offere |
| Keywords Extracted from PMC Text:
|
KRM
40–49
RBP
cervical smear
children
wall
analysed16
reduced.1 7
line
KJM
patient
men
DR
STIs
UK
centre
£
access.13–15
long-acting
Natsal-COVID Wave 1
Wave 1
lockdown
NHS
people
cervical cancer
SARS-CoV-2
childcare
care.8
de-prioritise
Quotas
Fieldnotes
's
condoms.12
45–90
People
COVID-19.8
e-voucher
patients
access3
women
COVID-19
participants
left non-pregnant
SRH.11
Natsal-COVID |
| Extracted PMC Text Content in Record:
|
First 5000 Characters:Responding to rising COVID-19 cases, the UK announced a national lockdown in March 2020, imposing stay-at-home orders and discouraging non-essential contact including between healthcare workers and patients. To minimise SARS-CoV-2 transmission, providers rapidly adjusted how they delivered sexual and reproductive health (SRH) services through new protocols, staff redeployment and site closures.1 2 Early abortion care via telemedicine was an example of successful adaptability, reducing waiting times and barriers to access3 and increasing satisfaction.4–6 However, other essential SRH services such as long-acting reversible contraception (LARC) provision or asymptomatic sexually transmitted infection (STI) screening were halted or reduced.1 7 Providers tried to prioritise those with most need who could not be managed remotely for in-person care.8
Access to SRH services remains imperative even during a pandemic.9 People have a right to sexual expression, reproductive autonomy, safe childbirth and a life free from infection.10 The population need for services such as routine and emergency contraception, STI testing and treatment, sexual problems advice or antenatal care is continual. Disruptions to these services can have significant repercussions including unplanned pregnancy, undiagnosed STIs and sexual dysfunction.
The Natsal-COVID study sought to understand the initial impact of service reduction and reconfiguration in Britain (consisting of England, Scotland and Wales).11 SRH services in Britain are delivered by a range of providers including general practitioners (GPs), specialist integrated sexual health services and screening programmes (e.g., chlamydia or cervical cancer screening). Natsal-COVID Wave 1, undertaken in July–August 2020, is a quasi-representative web-panel survey designed to understand the early impact of the pandemic on SRH. The study highlighted unmet need for SRH services, with one in 10 survey participants reporting unsuccessful attempts to access SRH services and one in five men needing but being unable to access condoms.12 Other UK studies found that men who have sex with men and young people experienced an unmet need for STI testing, contraception and condom access.13–15 This paper describes the results from qualitative follow-up interviews with Natsal-COVID participants exploring the experiences of unmet or delayed SRH need in the general population. Learning from patient perspectives is crucial to inform recovery and rebuilding efforts during and after COVID-19.8
The study aimed to explore: (1) what challenges arose for patients attempting to access and navigate SRH services during the pandemic, and (2) how COVID-19 protocols and reduced staffing affected patient perceptions of service quality.
Natsal-COVID is a mixed-method study exploring the impact of the COVID-19 pandemic on sexual behaviour, relationships and SRH.11 Following the Wave 1 web-panel survey, follow-up qualitative interviews were carried out to explore sexuality-related topics relevant during the pandemic. This paper draws on interviews with 20 of the 311 participants who, in the survey, reported unmet SRH access since lockdown and agreed to recontact. Quotas were applied to ensure variation by age, gender, ethnicity and region. We sought to include a minimum number of participants living in Scotland and Wales, and to oversample women to reflect their higher use of SRH services. Ethical approval was obtained from the University of Glasgow MVLS College Ethics Committee (20019174) and LSHTM Research Ethics Committee (22565).
The research team telephoned individuals who agreed to recontact, fell within the pre-specified quotas and provided valid contact details. An introductory call explained the study and confirmed eligibility. Those interested were emailed a study information sheet and given the opportunity to ask questions. Informed consent to participate was sought and recorded prior to interview. Interviews were conducted by three trained qualitative interviewers (DR, KJM and RBP) between 2 October 2020 and 16 November 2020. All interviews were conducted by telephone, lasting 45–90 min. The interview guide explored the context of help-seeking, experiences of attempting to access SRH services, impact of unmet or delayed need, and attitudes and experiences with telemedicine (see online supplemental material). Fieldnotes (summaries and reflections) were recorded after each interview. Participants were offered a £30 e-voucher for their time and contributions.
Audio recordings were professionally transcribed verbatim. Transcripts were reviewed by DR, KJM and RBP for accuracy and familiarity. Identifying details were removed. Data were thematically analysed16 to inductively identify themes pertinent to policy and practice. Participants' partners' experiences were occasionally related and were included in the analysis. Analysis was aided by NVivo 12 (QSR International), a CAQDAS software. DR open coded five transcripts |
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