Early telemedical abortion, safeguarding, and under 18s: a qualitative study with care providers in England and Wales.

IF 3.4 3区医学 Q1 FAMILY STUDIES

BMJ Sexual & Reproductive Health Pub Date : 2023-10-01 Epub Date: 2023-01-27 DOI:10.1136/bmjsrh-2022-201762

Elizabeth Chloe Romanis, Jordan A Parsons

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引用次数: 1

Abstract

Background: Telemedical early medical abortion (TEMA) was introduced in England and Wales as a temporary measure in 2020 and was made permanent in 2022. While there are considerable data showing the safety, efficacy, and acceptability of TEMA for patients, there have been objections raised to TEMA based on safeguarding-particularly for people under 18 years of age. Little is known about abortion care providers' views and experiences of carrying out their safeguarding duties with people aged under 18 in the shift to TEMA.

Methods: This is a qualitative study involving online semi-structured interviews and reflexive thematic analysis. Audio-recorded, semi-structured interviews with abortion providers in England and Wales (n=20) generated data about their views and experiences of safeguarding in telemedical abortion care. Recordings were transcribed verbatim and then subject to reflexive thematic analysis to construct themes.

Results: While the study was designed with adult safeguarding in mind, the safeguarding of under 18s became a key area of discussion. Three major themes were constructed in relation to under 18s: (1) age as a risk factor in safeguarding; (2) telemedicine as improving access to care; and (3) telemedicine as enhancing communication.

Conclusion: Care providers believe TEMA has benefitted the under 18s. There was a strong feeling both that TEMA had improved access (which, in turn, improved safeguarding) and that under 18s were comfortable communicating using remote means. Providers believe safeguarding proformas must account for the different nature of risks where service users are under 18, but that it is disproportionate to assume that TEMA is unsuitable for all under 18s or groups of under 18s.

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早期远程医疗堕胎、保护和18岁以下儿童：一项针对英格兰和威尔士护理提供者的定性研究。

背景：远程医疗早期药物流产（TEMA）于2020年在英格兰和威尔士作为一项临时措施引入，并于2022年永久化。虽然有相当多的数据表明TEMA对患者的安全性、有效性和可接受性，但也有人反对TEMA，尤其是针对18岁以下的人。人们对堕胎护理提供者在向TEMA过渡期间对18岁以下人群履行保护职责的看法和经历知之甚少。方法：这是一项定性研究，涉及在线半结构化访谈和反射性主题分析。对英格兰和威尔士堕胎服务提供者（n=20）进行的录音、半结构化采访产生了关于他们在远程医疗堕胎护理中的观点和经验的数据。录音被逐字转录，然后进行反身主题分析以构建主题。结果：虽然这项研究的设计考虑到了成年人的保护，但18岁以下儿童的保护成为了一个关键的讨论领域。针对18岁以下儿童构建了三个主要主题：（1）年龄是保障的风险因素；（2）远程医疗作为改善获得护理的途径；以及（3）远程医疗作为加强交流的手段。结论：护理人员认为TEMA使18岁以下的人受益。有一种强烈的感觉，TEMA改善了访问（这反过来又改善了安全保障），18岁以下的人也可以放心地使用远程方式进行通信。提供商认为，在服务用户未满18岁的情况下，保障形式必须考虑到不同性质的风险，但认为TEMA不适合所有18岁以下或18岁以下人群是不相称的。

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来源期刊

BMJ Sexual & Reproductive Health Medicine-Reproductive Medicine

CiteScore

5.10

自引率

6.10%

发文量

期刊介绍： BMJ Sexual & Reproductive Health is a multiprofessional journal that promotes sexual and reproductive health and wellbeing, and best contraceptive practice, worldwide. It publishes research, debate and comment to inform policy and practice, and recognises the importance of professional-patient partnership.