A qualitative evidence synthesis to explore the barriers and enablers to providing sexual and reproductive healthcare in general practice.

Problem

General practice has a key role in address inequalities in sexual and reproductive health across the UK. Unsafe sex is a matter of life and death: in poor countries it is the second most important risk factor leading to disability and death and in developed countries it is 9th most important risk factor. The Royal College of General Practitioners have recently named Sexual and Reproductive Health (SRH) a priority area for improvement - SRH Time to Act. This was in response to the imminent crisis caused by reduction in SRH services in the context of increasing rates of sexually transmitted infections, high unplanned pregnancies and abortion rates compared to other developed countries.

Approach

A variety of qualitative and quantitative studies have been undertaken to understand barriers to access and uptake of sexual and reproductive health. This review aims to find concurrent themes across different areas of provision in general practice with a focus on qualitative research.We searched the following electronic databases: MEDLINE, EMBASE, PUMED and Web of Science. The searches were limited to studies published in English within the last 20 years. Quantitative studies, case reports, reviews and conference abstracts will be excluded. All countries who have a similar provision of general practice were including in the search, this included Australia, New Zealand, North America, France and Netherlands.The title of studies retrieved using the search strategy were screened independently by two reviewers to identify studies that potentially meet the inclusion criteria. Two members of the team independently screen abstracts before moving to full text review. We used the Covidence platform to facilitate this and Nvivo was used as a management system to enable thematic analysis.

Findings

2898 titles were identified in the search, these were screened by two independent reviewers and 93 articles were selected for full article review which is currently in progress. We are currently screening and extracting data and expect that by the time of the conference to have developed detailed themes. We do not have detailed thematic analysis at present, but preliminary results reflect a variety of barriers and enablers. The healthcare professional, the patient and the system have positive and negative roles within the negotiation from need to healthcare. Themes around knowledge, stigma, embarrassment, fear of intrusion and confidentiality can be seen throughout the studies. These topics will be presented at conference in further detail.

Consequences

We aim explore themes around provision of SRH in general practice so that we can develop an intervention which will help readdress inequalities in access. A better understanding of the interaction between patient/pubic, healthcare professionals and the system will help clarify how best for policy makers to expand SRH in general practice.