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Collaboratively seeking to improve contraceptive counselling at the time of an abortion: A case study of quality improvement efforts in Sweden
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Obstetrics and Gynecology, Clinical and Experimental Medicine, Linköping, Sweden.
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Department of Obstetrics and Gyneacology, Norrköping, Region Ostergotland, Linköping, Sweden.
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2019 (English)In: BMJ Sexual and Reproductive Health, ISSN 2515-1991, Vol. 45, no 3, p. 190-199Article in journal (Refereed) Published
Abstract [en]

Background Many women find it difficult to choose and initiate a contraceptive method at the time of an abortion. There is a gap between regular clinical practice and existing evidence on motivational and person-centred counselling, as well as on use of long-acting reversible contraception (LARC). This study aims to describe and evaluate a Quality Improvement Collaborative (QIC) designed to enhance contraceptive services, with regard to changes in healthcare professionals' (HCPs') counselling in clinical practice, and in women's subsequent choice of, and access to, contraception. Methods Three multiprofessional teams working in abortion services from three hospitals in Sweden, and two women contributing with user experience, participated in a QIC during the period March-November 2017. Using a case study design, we collected and analysed both quantitative and qualitative data. Results Teams agreed on QIC goals, including that ≥50% of women would start LARC within 30 days post-abortion, and tested multiple evidence-based changes, aided by the two women's feedback. During the QIC, participating HCPs reported that they gained new knowledge and developed skills in contraceptive counselling at the time of an abortion. The teams welcomed the development of a performance feedback system regarding women's post-abortion contraception. While the majority of women counselled during the QIC chose LARC, only 20%-40% received it within 30 days post-abortion. Conclusion The QIC, incorporating user feedback, helped HCPs to develop capability in providing contraceptive services at the time of an abortion. Timely access to LARC remains a challenge in the present setting.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019. Vol. 45, no 3, p. 190-199
Keywords [en]
accessibility, long- acting reversible contraception, person-centred counselling, pregnancy termination, quality improvement collaboratives, user involvement
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:hj:diva-45494DOI: 10.1136/bmjsrh-2018-200299PubMedID: 31289100Scopus ID: 2-s2.0-85068865866OAI: oai:DiVA.org:hj-45494DiVA, id: diva2:1341247
Funder
Medical Research Council of Southeast Sweden (FORSS)Futurum - Academy for Health and Care, Jönköping County Council, SwedenAvailable from: 2019-08-08 Created: 2019-08-08 Last updated: 2019-08-08Bibliographically approved

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