Understanding access to sexual and reproductive health in general practice using an adapted Candidacy Framework: a systematic review and qualitative evidence synthesis.

Abstract

Background: General practice has a key role in reducing inequity in access to care relating to sexual and reproductive health (SRH). Unplanned pregnancy, abortion, and sexually transmitted infections are increasing and disproportionately affect deprived communities and minoritised ethnic groups. The Candidacy Framework is a practical and theoretical framework for understanding the complex interactional processes of access to SRH care in general practice.

Aim: To use the Candidacy Framework to explore access to SRH care in general practice. The seven interaction stages are: identification of need; navigation of services; permeability of services; appearing and asserting need; adjudication by healthcare professional (HCP); offers or resistance of offer; and the local operating conditions or local production of candidacy.

Design and setting: Systematic review with qualitative evidence synthesis using a framework approach.

Method: A systematic search of MEDLINE, Embase, PubMed, and the Web of Science was conducted to identify primary qualitative research studies exploring access to SRH care in general practice from practitioner, public, and patient perspectives in countries with universal health care. The Candidacy Framework was used to synthesise the findings.

Results: Analysis of 42 studies revealed the impact of stigma, shame, and embarrassment among individuals, communities, and HCPs. Findings showed limited inclusion of demographics, such as ethnicity and socioeconomic status. Barriers to access were more evident for those from lower socioeconomic communities, minoritised ethnic groups, and the LGBTQ+ community. There are multiple barriers, which include the behaviours of HCPs, who have a crucial role in recognising an individual's SRH need.

Conclusion: General practice offers a cradle-to-grave healthcare service that should have SRH as a priority area of provision. Further understanding is needed about the impact of historic harms by medicine and health care on racialised individuals and minoritised genders.