• Community pharmacists' views on providing a reproductive health service to women receiving opioid substitution treatment: a qualitative study using the TDF and COM-B

      Alhusein, Nour; Scott, Jenny; Neale, Jo; Chater, Angel M.; Family, Hannah; University of Bristol; University of Bath; King's College London; University of New South Wales; University of Bedfordshire (Elsevier, 2021-09-21)
      Background The absence of menstruation is common in women who use drugs. This can give a belief that conception is unlikely. When stabilised on Opioid Substitution Treatment (OST), fertility often returns, initially without realisation as ovulation precedes menstruation. This leaves women vulnerable to unplanned pregnancies. Community pharmacists (CPs) are frequently in contact with this patient group through the Supervised Consumption of OST service. This provides a timely opportunity to provide reproductive health (RH) advice. The aim of this study was to investigate pharmacists' views on providing a RH service to women receiving OST. Methods Twenty semi-structured interviews based on the Capability-Opportunity-Motivation to Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) were conducted between 2016 and 2017. Data analysis involved deductive coding using the TDF domains. The TDF domains were mapped onto the elements of the COM-B and used in the second step to create the framework and chart the data. The third step involved re-reading and clustering the codes, and inductive themes were generated to explain the data in depth. Results Nine of the 14 TDF domains, mapped into five elements of the COM-B, were identified. Five inductive themes were generated: 1) The pharmacists' experience and knowledge of reproductive health (RH) needs of women receiving OST, 2) The pharmacists' approach to providing advice, 3) The pharmacists' perception of the relationship with women receiving OST, 4) Social influences, and 5) Environmental factors. Community pharmacists feared causing offense to women receiving OST and described requiring cues as to when the service was needed. Pharmacists' highlighted a power imbalance in the relationship with women receiving OST. This could influence how receptive this patient group would be to pharmacy RH interventions. Conclusions CPs' concerns of providing RH service could hinder a proactive service provision. Supporting good rapport and providing a structured consultation would increase the accessibility of such a service.
    • Contraceptive choice and power amongst women receiving opioid replacement therapy: qualitative study

      Werthern, Helena; Alhusein, Nour; Chater, Angel M.; Scott, Jenny; Family, Hannah; Neale, Joanne; King’s College London; University of New South Wales; University of Bristol; University of Bedfordshire; et al. (Taylor & Francis, 2021-07-26)
      ABSTRACT Background: Women receiving treatment for opioid use disorder have low levels of contraception use and high rates of unintended pregnancies, abortion and children being adopted or fostered. This paper aims to understand the relationship between contraceptive choice and power amongst women receiving Opioid Replacement Therapy (ORT). Methods: During 2016/17, semi-structured interviews were undertaken with 40 women (aged 22–49 years) receiving ORT in the South of England. Data relating to the latent concept of power were inductively coded and analysed via Iterative Categorisation. Findings: The power manifested itself through six interconnected ‘fields’: i. ‘information about fertility and contraception’; ii. ‘access to contraception’; iii. ‘relationships with professionals and services’; iv. ‘relationships with male partners’; v. ‘relationships with sex work clients’; and vi. ‘life priorities and preferences’. Each field comprised examples of women’s powerlessness and empowerment. Even whenwomen appeared to have limited power or control, they sometimes managed to assert themselves. Conclusions: Power in relation to contraceptive choice is multi-faceted and multi-directional, operating at both individual and structural levels. Informed decision-making depends on the provision of clear, non-judgemental information and advice alongside easy access to contraceptive options. Additional strategies to empower women to make contraceptive choices and prevent unplanned pregnancies are recommended.