Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers
Abstract Background Direct primary care provision of first-trimester medical abortion could potentially address inequitable abortion access in Canada. However, when Health Canada approved the combination medication Mifegymiso® (mifepristone 200 mg/misoprostol 800 mcg) for medical abortion in July 20...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-11-01
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| Series: | Pilot and Feasibility Studies |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40814-019-0520-8 |
| _version_ | 1818317738104324096 |
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| author | Courtney Devane Regina M. Renner Sarah Munro Édith Guilbert Sheila Dunn Marie-Soleil Wagner Wendy V. Norman |
| author_facet | Courtney Devane Regina M. Renner Sarah Munro Édith Guilbert Sheila Dunn Marie-Soleil Wagner Wendy V. Norman |
| author_sort | Courtney Devane |
| collection | DOAJ |
| description | Abstract Background Direct primary care provision of first-trimester medical abortion could potentially address inequitable abortion access in Canada. However, when Health Canada approved the combination medication Mifegymiso® (mifepristone 200 mg/misoprostol 800 mcg) for medical abortion in July 2015, we hypothesized that the restrictions to distribution, prescribing, and dispensing would impede the uptake of this evidence-based innovation in primary care. We developed and pilot-tested a survey related to policy and practice facilitators and barriers to assess successful initiation and ongoing clinical provision of medical abortion service by physicians undertaking mifepristone training. Additionally, we explored expert, stakeholder, and physician perceptions of the impact of facilitators and barriers on abortion services throughout Canada. Methods In phase 1, we developed a survey using 2 theoretical frameworks: Greenhalgh’s conceptual model for the Diffusion of Innovations in health service organizations (which we operationalized) and Godin’s framework to assess the impact of professional development on the uptake of new practices operationalized in Légaré’s validated questionnaire. We finalized questions in phase 2 using the modified Delphi methodology. The survey was then tested by an expert panel of 25 nationally representative physician participants and 4 clinical content experts. Qualitative analysis of transcripts enriched and validated the content by identifying these potential barriers: physicians dispensing the medication, mandatory training to become a prescriber, burdens for patients, lack of remuneration for mifepristone provision, and services available in my community. To assess the usability and reliability of the online survey, in phase 3, we pilot-tested the survey for feasibility. Results We developed and tested a 61-item Mifepristone Implementation Survey suitable to study the facilitators and barriers to implementation of mifepristone first-trimester medical abortion practice by physicians in Canada. Conclusions Our team operationalized Greenhalgh’s theoretical framework for Diffusion of Innovations in health systems to explore factors influencing the implementation of first-trimester medical abortion provision. This process may be useful for those evaluating other health system innovations. Identification of facilitators and barriers to implementation of mifepristone practice in Canada and knowledge translation has the potential to inform regulatory and health system changes to support and scale up facilitators and mitigate barriers to equitable medical abortion provision. |
| first_indexed | 2024-12-13T09:42:05Z |
| format | Article |
| id | doaj.art-a209ee73922c4a49be85df44475ef332 |
| institution | Directory Open Access Journal |
| issn | 2055-5784 |
| language | English |
| last_indexed | 2024-12-13T09:42:05Z |
| publishDate | 2019-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Pilot and Feasibility Studies |
| spelling | doaj.art-a209ee73922c4a49be85df44475ef3322022-12-21T23:52:10ZengBMCPilot and Feasibility Studies2055-57842019-11-015111410.1186/s40814-019-0520-8Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriersCourtney Devane0Regina M. Renner1Sarah Munro2Édith Guilbert3Sheila Dunn4Marie-Soleil Wagner5Wendy V. Norman6Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health CenterContraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health CenterContraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health CenterContraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health CenterContraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health CenterContraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health CenterContraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health CenterAbstract Background Direct primary care provision of first-trimester medical abortion could potentially address inequitable abortion access in Canada. However, when Health Canada approved the combination medication Mifegymiso® (mifepristone 200 mg/misoprostol 800 mcg) for medical abortion in July 2015, we hypothesized that the restrictions to distribution, prescribing, and dispensing would impede the uptake of this evidence-based innovation in primary care. We developed and pilot-tested a survey related to policy and practice facilitators and barriers to assess successful initiation and ongoing clinical provision of medical abortion service by physicians undertaking mifepristone training. Additionally, we explored expert, stakeholder, and physician perceptions of the impact of facilitators and barriers on abortion services throughout Canada. Methods In phase 1, we developed a survey using 2 theoretical frameworks: Greenhalgh’s conceptual model for the Diffusion of Innovations in health service organizations (which we operationalized) and Godin’s framework to assess the impact of professional development on the uptake of new practices operationalized in Légaré’s validated questionnaire. We finalized questions in phase 2 using the modified Delphi methodology. The survey was then tested by an expert panel of 25 nationally representative physician participants and 4 clinical content experts. Qualitative analysis of transcripts enriched and validated the content by identifying these potential barriers: physicians dispensing the medication, mandatory training to become a prescriber, burdens for patients, lack of remuneration for mifepristone provision, and services available in my community. To assess the usability and reliability of the online survey, in phase 3, we pilot-tested the survey for feasibility. Results We developed and tested a 61-item Mifepristone Implementation Survey suitable to study the facilitators and barriers to implementation of mifepristone first-trimester medical abortion practice by physicians in Canada. Conclusions Our team operationalized Greenhalgh’s theoretical framework for Diffusion of Innovations in health systems to explore factors influencing the implementation of first-trimester medical abortion provision. This process may be useful for those evaluating other health system innovations. Identification of facilitators and barriers to implementation of mifepristone practice in Canada and knowledge translation has the potential to inform regulatory and health system changes to support and scale up facilitators and mitigate barriers to equitable medical abortion provision.http://link.springer.com/article/10.1186/s40814-019-0520-8MifepristoneCanadaAbortionSurveyFamily planningFamily physician |
| spellingShingle | Courtney Devane Regina M. Renner Sarah Munro Édith Guilbert Sheila Dunn Marie-Soleil Wagner Wendy V. Norman Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers Pilot and Feasibility Studies Mifepristone Canada Abortion Survey Family planning Family physician |
| title | Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers |
| title_full | Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers |
| title_fullStr | Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers |
| title_full_unstemmed | Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers |
| title_short | Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers |
| title_sort | implementation of mifepristone medical abortion in canada pilot and feasibility testing of a survey to assess facilitators and barriers |
| topic | Mifepristone Canada Abortion Survey Family planning Family physician |
| url | http://link.springer.com/article/10.1186/s40814-019-0520-8 |
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