The Hawke's Bay Condom Card Scheme: a qualitative study of the views of service providers on increased, discreet access for youth to free condoms

Staff and Users' Experiences of Pharmacy-Based Sexual and Reproductive Health Services: A Qualitative Interview Study from the UK

Since August 2015, a large range of sexual health and reproductive health services have been provided in more than 120 pharmacies across Birmingham (England). Our study aimed to explore how pharmacy staff and pharmacy users experience delivering or being provided with sexual health and reproductive health services. Between March and September 2019, semi-structured interviews were conducted with 15 pharmacy staff delivering sexual and reproductive health services and 15 people who had used a sexual and reproductive health service at the pharmacy. Interviews were analysed thematically. Pharmacy users found services convenient to use and were largely satisfied with pharmacy staff consultation skills. Staff were motivated to deliver the services, although some felt that they did not receive sufficient recognition for their work. Barriers to pharmacy-based sexual and reproductive health services were identified, including lack of privacy for users, lack of staff and user awareness of the services, lack of trained staff to deliver services and lack of capacity for copper coil insertions in females presenting for emergency contraception. The identification of barriers to effective service provision can be used to improve the delivery of sexual and reproductive health services in pharmacies and lead to a greater uptake.

Utilisation of pharmacy-based sexual and reproductive health services: a quantitative retrospective study

OBJECTIVES

To explore the utilisation of pharmacy-based sexual and reproductive health services (SRHS) in order to optimise delivery and identify barriers to access.

METHODS

The health provider Umbrella offers six SRHS from over 120 pharmacies in Birmingham (England). In this retrospective study, data collected between August 2015 and August 2018 were used to analyse uptake, user characteristics and attendance patterns according to day of the week.

RESULTS

A total of 60 498 requests for a pharmacy service were included in the analysis. Emergency contraception (50.4%), condoms (33.1%) and STI self-sampling kits (9.6%) accounted for more than 90% of all requests. A lower uptake of services was observed for the contraceptive injection (0.6%), oral contraception (5.4%) and chlamydia treatment (1.0%). Services were most likely to be requested by those self-identifying as female (85.6%), and those aged 16-24 years (53.8%). Based on available ethnicity data (n=54 668), most requests for a service were made by White/White British individuals (43.4%) and Asian/Asian British people (23.1%). The largest number of services were delivered on Mondays (20.9%) and the lowest on Sundays (5.0%). A high proportion of requests for services on Saturdays (57.0%), Sundays (67.6%) and Mondays (54.4%) were made by females presenting for emergency contraception.

CONCLUSION

The evaluation of healthcare utilisation is important to help refine and optimise the delivery of services. However, information relating to pharmacy-based SRHS is scarce and often limited to a single type of service provision. Overall, a wide range of pharmacy-based services were accessed by a diverse range of people, suggesting that pharmacies are a suitable provider of many SRHS. However, the routinely collected data analysed in the study had several limitations restricting the analysis. Sexual health providers should ensure they collect data which are as comprehensive as is possible in order to help understand the utilisation of services.

Systematic Review of Peer-Reviewed Literature on Global Condom Promotion Programs

Background: Globally, 1.7 million people were newly infected with HIV in 2018. Condoms are inexpensive, cost-effective, reduce HIV/STI incidence, morbidity, mortality, and unintended pregnancies, and result in health care cost savings. Given the rapid increase in at-risk adolescent and young adult (AYA) populations in countries with high HIV/STI prevalence as well as the reductions in donor support, promoting consistent condom use remains crucial. We synthesized all peer-reviewed literature on condom promotion programs with a focus on promotion in low and lower middle income (LMIC) countries and with AYA users. Methods: We systematically reviewed the published literature. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methods, we identified 99 articles published between 2000-2019. Results: Condom promotion programs were generally effective in changing attitudes, social norms, and beliefs in favor of condom use, and 85% demonstrated positive effects on multiple condom use measures. Programs targeting AYA were at least equally as effective as those targeting others and often showed greater use of best practices, such as mass media (66%) and audience segmentation (31%). We also saw differences between programs in the intervention strategies they used and found greater effects of marketing strategies on AYA compared to the overall sample. Conclusion: Condoms remain essential to prevention, and donor support must be maintained to combat the HIV/STI epidemic.

Health services for sexually transmitted infections: Where are we at in New Zealand? A narrative literature review

INTRODUCTION Sexually transmitted infection (STI) rates continue to rise in New Zealand. To effectively prevent, test and diagnose STIs in a timely manner to limit their health effects, health services must be appropriate and accessible for all. AIM The aim of this review was to identify and collate the existing literature and identify gaps in research relating to STI health service delivery in New Zealand. METHODS A critical narrative literature review was conducted. A keyword search of PubMed (2010 to October 2020), EMBASE (2010 to October 2020) and Google Scholar (2010 to October 2020) was conducted. The electronic search was supplemented with manual screening of references from identified articles. Eligible studies reported on STI service delivery in New Zealand. Articles not meeting these criteria were excluded. Articles solely reporting on the human papillomavirus vaccine or condom use statistics or perceptions were also excluded. Data extracted included study year, authors, aim, methods and outcome results. RESULTS A total of 179 articles were identified, including 16 that met study inclusion criteria. Nine studies focused on STI testing, five on health-seeking behaviours and two had other foci. The results reflected substantial gaps in the funding and delivery of best-practice STI management across all New Zealand. DISCUSSION New strategies are needed to improve access to low-cost or free services for sexual health care in general and clinic-wide systems implemented to enable routine delivery of advice about STI prevention and testing by clinicians to patients.

Pharmacy-based sexual health services: a systematic review of experiences and attitudes of pharmacy users and pharmacy staff

BACKGROUND

Pharmacies are increasingly providing services related to contraception and STIs. Identifying pharmacy staff' and users' experiences and attitudes relating to sexual health services is critical to understand users' needs and examining how pharmacy staff can most effectively contribute to patient-centred care. This systematic review aimed to examine pharmacy staff and pharmacy users' experiences and attitudes towards the delivery of a large range of sexual health services.

METHODS

Seven electronic databases and the reference lists of all included studies were searched in September 2018. Studies giving insight into pharmacy users' and pharmacy staff's experiences and attitudes towards the delivery of services related to contraception and STIs were included. The Mixed Methods Appraisal Tool was used to assess the quality of included studies and a narrative synthesis applied to analyse evidence.

RESULTS

Nineteen studies were included. Eleven studies looked at pharmacy staff, four at users and four at both groups. Users found services accessible and convenient and staff found service provision feasible. However, several barriers to service delivery were identified including lack of privacy for delivering services, lack of trained staff available to provide services and subjective judgements being made on who should be provided or offered a service.

DISCUSSION

Barriers to service delivery need to be addressed to allow pharmacies to deliver their full potential. Future research on pharmacy-based gonorrhoea and syphilis screening, and hepatitis B vaccination is needed.

PROSPERO REGISTRATION NUMBER

CRD42018106807.

Ensuring rigour and trustworthiness of qualitative research in clinical pharmacy

The use of qualitative research methodology is well established for data generation within healthcare research generally and clinical pharmacy research specifically. In the past, qualitative research methodology has been criticized for lacking rigour, transparency, justification of data collection and analysis methods being used, and hence the integrity of findings. Demonstrating rigour in qualitative studies is essential so that the research findings have the "integrity" to make an impact on practice, policy or both. Unlike other healthcare disciplines, the issue of "quality" of qualitative research has not been discussed much in the clinical pharmacy discipline. The aim of this paper is to highlight the importance of rigour in qualitative research, present different philosophical standpoints on the issue of quality in qualitative research and to discuss briefly strategies to ensure rigour in qualitative research. Finally, a mini review of recent research is presented to illustrate the strategies reported by clinical pharmacy researchers to ensure rigour in their qualitative research studies.