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The evaluation of a free-to-access online contraception service in Lambeth and Southwark

Student thesis: Doctoral ThesisDoctor of Philosophy

Unplanned pregnancy is associated with adverse health, economic, social and psychological outcomes for women and children. It can be addressed through improved contraceptive provision. This thesis aims to evaluate a free-to-access online contraception service which involves remote consultation, online information, text support and home-delivered oral contraceptive pills (OCPs), introduced in the London boroughs of Lambeth and Southwark. A theoretical framework used Bourdieusian sociological concepts to consider contraceptive practice as the product of habitus, which is an acquired system of dispositions reflecting past experiences, traditions and habits that engenders homogeneity in outcomes within social groups and is relationally bound with capital and field. This framed the online service as a new field of access which could attract users of a different habitus to users of existing, face-to-face services, altering capital exchange between patient and provider, such as the knowledge of how to effectively use a method. The overarching theory was integrated with a context-specific, theory of change conceptual model, generated through qualitative investigation of stakeholder views on the service, helping to surface key research questions. A quantitative study described the characteristics and patterns of use of online users in its first period of availability (n=726) and a cohort study collected objective and self-reported data to examine associations between OCP provider type and short-term continuation (n=227). Almost three quarters of online service-users were aged 20 to 29 years, most were of white ethnic group and the majority from socioeconomically deprived areas. Black, Asian and mixed ethnic groups had lower odds of repeat online orders compared to white ethnic group in bivariate and multivariable analyses. In the cohort study, short-term OCP continuation was more likely for the online group than the other services group and statistical significance was retained after adjusting for background variables. The online group rated their service more highly in terms of convenience, speed of access to OCPs and ease of communication with provider and had similar levels of basic OCP knowledge compared to those using other services. These are the first findings on free-to-access, online contraception. It may expand choice in access to OCPs to those of the habitus to benefit from its relative convenience and, despite the absence of face-to-face care, may not diminish the conveyance of capital in the form of basic OCP knowledge. Ongoing investment in both online and face-to-face provision is recommended to maximise contraceptive choice. Quantitative studies are needed to examine the effectiveness of online contraception long-term and qualitative work should explore ethnicity as habitus and its role in shaping contraceptive practice. This, and similar technological innovations are likely to proliferate in the current policy context, so it is vital for research to keep pace with change.
Original languageEnglish
Awarding Institution
Award date1 Jul 2019


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