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
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Abstract
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 quotas. 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.
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SciScore for 10.1101/2021.10.22.21264941: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethical approval was obtained from University of Glasgow MVLS College Ethics Committee (20019174) and LSHTM Research Ethics committee (22565).
Consent: Informed consent to participate was sought and recorded prior to interview.Sex as a biological variable Women were oversampled to reflect their higher use of SRH services. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing …SciScore for 10.1101/2021.10.22.21264941: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethical approval was obtained from University of Glasgow MVLS College Ethics Committee (20019174) and LSHTM Research Ethics committee (22565).
Consent: Informed consent to participate was sought and recorded prior to interview.Sex as a biological variable Women were oversampled to reflect their higher use of SRH services. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strength and limitations: We purposively interviewed participants who had tried but failed to access services. Quota-sampling from a quasi-representative population survey permitted us to include experiences from participants who varied by age, gender, ethnicity, and region. Although our enquiry followed a holistic framework of SRH, we were limited to issues experienced by our participants; services not covered included abortion and sexual assault services. Our study was unable to explore in depth the impacts of delayed access to specific services. Given the time between reporting of help-seeking and interview, we could not exclude potential for recall bias. This study aimed to highlight challenges, and participants were recruited accordingly. Thus, results likely underrepresent positive experiences, such as professional staff’s enormous efforts during this challenging time. Given participants’ digital recruitment, we may not have captured experiences of those without access to remote services, for example, due to language barriers, learning difficulties, or socio-economic factors. Finally, as with all qualitative research, our study draws on a small sample to capture a range of experiences of SRH access; it is not intended to be generalized or quantified.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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