Barriers and facilitators to the delivery and uptake of long-acting reversible contraception: What are the views of GPs?

Problem

The use of long-acting reversible contraception (LARCs) remains low in Australia, despite their high efficacy. We aimed to identify barriers and facilitators to the uptake of LARCs in general practice.

Approach

We used a qualitative approach. Semi-structured telephone interviews were conducted with 20 GPs in Australia. The interview schedule was informed by the Theoretical Domains Framework. Interviews explored the barriers and facilitators to LARC uptake, and were audio-recorded and transcribed verbatim, and the data were coded into themes using a deductive process of thematic analysis.

Findings

Five key domains were identified, as illustrated by the following: 1) Some GPs were unaware of the efficacy and suitability of LARCs and acknowledged that educational opportunities would improve their knowledge (Knowledge); 2) Incentives were believed to be a valuable motivator for GPs to discuss LARCs (Behavioural Regulation); 3) GPs reported not discussing LARCs with pregnant patients and patients who expressed satisfaction with their current contraception (Memory, Attention and Decision Processes); 4) The perceived cost of medical indemnity insurance deterred GPs from providing IUD insertion (Environmental Context and Resources); and 5) GPs believed patients had negative perceptions about LARCs based on the experiences of their peers and were therefore reluctant to choose LARCs (Social Influences).

Consequences

Our findings will inform the development of interventions aimed at increasing LARC uptake among Australian women, with potential public health benefits for women and reduced costs to the health care system.