Title: A mixed methods evaluation of online provision of oral contraceptives to measure: validity of self-reported biometric data; essential information transfer and user experience of self measurement and submission of biometric data.
Funder: Department of Health and Social Care

Abstract: Background One in six pregnancies in Britain are unplanned costing the NHS &pound;193,200,000 in 2010. Unintended pregnancy is associated with poor pregnancy outcomes. Improved access to contraceptive services can reduce unintended pregnancy and online contraception, available 24 hours per day from mobile phones, can increase access to contraception. The combined oral contraceptive (COC) is the most popular prescription contraceptive in the UK, used by 16% of all women aged 16-45 in the UK. Online prescription of the COC requires accurate data on height, weight, blood pressure and medical history. Safe online prescribing assumes accurate reporting of this data. To date there has been no research to verify this. The lack of this research is an important barrier to the provision of online contraception. Aims The study aims to describe the agreement between online and face-to-face assessment of eligibility for the COC and the effectiveness of online and clinic based transfer of essential information about COC use. In addition it will explore user experience of measurement and submission of biometric data and attitudes towards the relationship between biometric data and contraception, risk associated with submission of incorrect data and trust in relation to online services. Questions to be addressed The agreement between online and face-to-face assessment of eligibility for the COC as specified by the UK Medical Eligibility Criteria (UKMEC) for blood pressure and body mass index (BMI). The sensitivity and specificity of online, self-reported blood pressure, BMI and smoking status. The effectiveness of online and clinic based transfer of essential information about COCs. User experience of the online contraceptive service focusing on: experience of measuring and submitting biometric data; ideas about the relationship between the biometric data and contraception; views on the risk associated with submission of incorrect data and trust within relationships with online services. Plan for the investigation We will recruit 365 users of the online contraceptive service and document data on demographics, health literacy, patient activation and knowledge of essential information on the COC via an online questionnaire. We will extract the data submitted on height, weight, blood pressure and smoking from the online clinical record and complete a research visit with each participant who used the online service within 28 days of recruitment to measure blood pressure, height and weight and evidence of recent smoking. We will recruit 365 users who were prescribed the COC in clinics and record their knowledge of essential information on the COC via an online questionnaire. We will purposively sample, for maximum variabiity, based on their baseline data, 20 users of online services to document their experience of the service through semi-structured qualitative interviews. The interviews will focus on attitudes to and experience of biometric data measurement and submission within an online contraceptive service. We are particularly interested in understanding of risk in relation to the COC, strategies to measure biometric data and ideas about trust in relation to online services. We will analyse the data using the framework approach, a matrix based analytic method that classifies and organises data according to key themes, sub themes and emergent categories (Ritchie et al, 2003). Summary of the benefits to patients and the NHS Concern about the reliability of biometric data reported online prior to prescription of the combined oral contraceptive is the most important barrier to widespread, NHS, online contraceptive provision. Without an answer to this question, online contraceptive services are unlikely to be widely commissioned and women will continue to suffer long waiting times in clinics, poor access to appointments in general practice and fear of judgmental attitudes. Suboptimal access to services will continue to be associated with unintended pregnancy.

Lay abstract: One in six pregnancies in Britain are unplanned costing the NHS &pound;193,200,000 in 2010. Unintended pregnancy is associated with poor pregnancy outcomes including late access to pregnancy care and post-natal depression. Lambeth and Southwark have high rates of unintended pregnancy with abortion rates of 25/1000 women aged 15-44 (national average 16/1000). Quality contraceptive services can reduce unintended pregnancy but research locally and nationally shows that poor access and judgemental attitudes from staff can prevent use. Waiting times in clinics are long and general practice appointments may be inflexible and require advanced booking. Online contraception, available 24 hours from mobile phones, and delivered in the post increases convenience and anonymity and may improve access and reduce unintended pregnancy. The first free online contraceptive service in the UK is being piloted in Lambeth and Southwark where 15,000 prescriptions for the oral contraceptive pill (COC) are written every quarter. This could free up NHS capacity. Prescribing the COC requires accurate information on smoking history, blood pressure, height and weight. Online services ask women to measure their height and weight, complete a blood pressure check at a local pharmacy (or GP) and input this data. We know that sexual histories are accurately provided online but user completed weight and blood pressure has never been tested and there are concerns that the data provided will be inaccurate. This concern remains a barrier to widespread provision of NHS, online, contraception. Our study tests whether self-recorded blood pressure, height, weight and smoking is similar to that recorded face-to-face. It checks whether essential information on COC use is better retained when provided online or face-to-face. It documents user experience of and attitudes to measuring and submitting biometric data. Our findings will be published in peer review journals, shared with sexual health commissioners and service providers in the UK.

Research activity codes: 3.3 NUTRITION AND CHEMOPREVENTION
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH