Identifying barriers and facilitators of full service nurse-led early medication abortion provision: qualitative findings from a Delphi study

Abstract

Objective: To explore factors that can influence implementation of a nurse-led model of care for early medication abortion provision in the primary healthcare setting of regional and rural Victoria, Australia.Background: Global research indicates that an increased involvement of primary healthcare nurses in the delivery of early medication abortion provision has the potential to improve abortion access. In Victoria, access in regional and rural areas is restricted despite abortion being legal. A nurse-led early medication abortion provision model is feasible and can potentially improve the current situation.Study design and methods: An online threeround classic Delphi method was used. This paper reports the qualitative findings. Non-probability sampling techniques were used to recruit a panel of professional experts. Data from the three questionnaires were collected and analysed using thematic analysis. Factors influencing model implementation were categorised into the Capability, Opportunity, Motivation-Behaviour framework.Results: A total of 24 medical and other health professionals participated. They identified a range of factors that can hinder model implementation, including a lack of affordable medication abortion education, no remuneration for nurse-led early medication abortion provision, and concerns related to stigma and support. Discussion and conclusion:Understanding and addressing barriers to model implementation may enable the development of primary healthcare nurses' role in the delivery of early medication abortion provision to improve abortion access. Impact: To improve abortion access in Victoria's under-served regions, the potential of nurse-led early medication abortion provision was explored. Barriers to model implementation relate to a lack of medication abortion education and funding, professional support and stigma concerns. The study identified a range of support elements that would enable primary healthcare nurses to develop new roles and responsibilities in the delivery of medication abortion services.

Views and practice of abortion among Queensland midwives and sexual health nurses

“…There would also appear to be a role for increasing nurse and midwife‐led involvement in the provision of pre‐and post‐abortion care for Queensland women. Recent Victorian‐based research by de Moel‐Mandel et al suggests that a lack of training, funding and support as well as associated stigma may be significant barriers to nurse‐led initiation of EMA 26 . The findings of our study suggest there is likely to be support toward addressing such barriers.…”

“…Recent Victorian-based research by de Moel-Mandel et al suggests that a lack of training, funding and support as well as associated stigma may be significant barriers to nurse-led initiation of EMA. 26 The findings of our study suggest there is likely to be support toward addressing such barriers.…”

“Almost like it was really underground”: a qualitative study of women’s experiences locating services for unintended pregnancy in a rural Australian health system

“…Already in an exploratory phase in Australia is the development of nurse-led models of abortion care designed to alleviate demand on GPs and enable greater access for rural women. 50 , 51 However, improvements to rural women’s reproductive health including abortion are not the responsibility of individual rurally based primary care practitioners, nurses or GPs. Rather, the findings in this study point to an urgent need for systemic repositioning of unintended pregnancy and abortion, out of the shadows of the health system and into the mainstream.…”