Research Highlights

Acceptability of the copper intrauterine device as emergency contraception

This project aimed to explore the knowledge and experiences of clients and clinicians in NSW, regarding the use of the copper intrauterine device (Cu-IUD) as a form of emergency contraception (EC). A cross-sectional convenience study was conducted by Family Planning NSW, which involved over 450 family planning clients and more than 50 NSW-practicing clinicians, who completed an anonymous online survey. Findings from the study suggested that many clients were unaware of the Cu-IUD as an option for EC, however nearly 50% would consider future use of this method. Cost and possible side-effects were identified as potential barriers. Clinicians were more likely to discuss the oral EC than the Cu-IUD, with time pressures reported as the main barrier. There is a need for increased education and promotion strategies for the Cu-IUD as EC in order to increase awareness of choice of options.

Dorney, E., Botfield, JR., Robertson, S., McGeechan, K., & Bateson, D., Acceptability of the copper intrauterine device as a form of emergency contraception in New South Wales, Australia. The European Journal of Contraception and Reproductive Health Care, 25(2), 114-119, Feb 2020

Optimising cervical cancer prevention amongst Aboriginal women in rural and remote New South Wales: A pilot study

Family Planning NSW, with Walgett Aboriginal Medical Service, implemented a pilot study which aimed to address the relatively high cervical cancer incidence and mortality amongst Aboriginal women, through utilising a combined screening approach with same-day treatment (if indicated and requested). A ‘same-day’ approach may benefit women who may otherwise be lost to follow up. An evaluation was undertaken by the University of Newcastle to explore the acceptability of this approach for Aboriginal and non-Aboriginal women and the relevant health workforce. Clients viewed the cervical screening program as acceptable, and the impact on the community appears to have been beneficial given the engagement of women overdue for screening or those that had never before been screened. Community engagement by Aboriginal Health Workers was critical for women’s participation. Several areas for improvement were highlighted, including continuing consultations with stakeholders, staggering the timing and availability of screening, and involving clinicians in community engagement and education.

Botfield, J., Estoesta, J., Brassil, A., Duggan, J., Corby, C., Walford, M., Loxton, D., & Townsend, N. (2019). Optimising cervical cancer prevention amongst Aboriginal women in rural and remote New South Wales: A pilot study Ashfield: Family Planning NSW.

Nurse-led implant insertions: Implications for clinical practice in Australia

Nurse-led contraceptive implant procedures are an accepted practice internationally; however this is not common practice in Australia. Family Planning NSW conducted a study to explore the effectiveness of contraceptive implant training on nurse-led insertions and removals, as well as its possible impact on clinical service delivery. Registered Nurses who participated in the Implanon NXT® Insertion and Removal Training Course, as well as their supervising clinicians, took part in the study. After training, all nurses were deemed competent in implant insertions and removals, and nurses felt positively about their increased scope of practice and ability to offer this procedure to patients. Supervising clinicians similarly felt that nurses could play a greater role in the provision of contraceptive implant procedures in Australia, although funding constraints were raised as a current limitation.

Botfield, JR., Wright, SM., Fenwick, SE., Cheng, Y. Training nurses in contraceptive implant procedures: Implications for practice in Australia. Collegian, available online, 7, Aug 2020

Nurse-led intrauterine device insertion training study

Family Planning NSW conducted a study to explore the attitudes of registered nurses (RNs) and medical officer (MO) mentors involved in intrauterine device (IUD) training for nurses, particularly regarding the addition of IUD insertions and removals to RNs scope of clinical practice in the family planning context. Most RNs viewed this as an opportunity to increase their critical thinking and procedural skills. Mentoring from MOs provided RNs with additional support to develop the required skills. MOs were supportive of RN-led IUD insertions and the expansion to their scope of practice.

Fleming, K., Cheng, Y., Botfield, J., Sousa, M., Bateson, D. Inclusion of intrauterine device insertion to registered nurses' scope of clinical practice., Collegian, Online, https://doi.org/10.1016/j.colegn.2017.12.002, Mar 2018

Cost-benefit analysis of long-acting reversible contraception (LARC) uptake in Australia

A cost-benefit analysis was undertaken to assess the impact of increasing the uptake of long acting reversible contraceptives (LARCs; i.e., contraceptive implants and intrauterine devices) in Australia. The analysis focused on three scenarios:

  • Scenario 1: Switching from an oral contraceptive pill (OCP) to a LARC.
  • Scenario 2: Initiating the use of a LARC for women not currently using any form of contraception.
  • Scenario 3: Impact of nurse-led LARC insertions.

Findings showed that an increase in LARC use would result in a net gain in economic benefits to Australia, due to reduced costs for women switching from an OCP to LARC, as well as a reduction in costs associated with unintended pregnancies for women not using contraception but wishing to avoid pregnancy. Enabling nurse-led LARC insertions would also facilitate access to LARC methods, and is a cost-effective way of increasing uptake. The creation of Medicare Benefits Schedule item numbers for RNs appropriately trained in LARC insertion would have benefits for both women and the Australian government.

The Centre for International Economics was commissioned by Family Planning NSW to conduct the economic modelling and analysis.

Concepcion, K., Lacey, S., McGeechan, K., Estoesta, J., Bateson, D., Botfield, JR., Cost–benefit analysis of enhancing the uptake of long-acting reversible contraception in Australia, Australian Health Review, available online, https://doi.org/10.1071/AH18190, Oct 2019

Botfield, JR., Lacey, S., Fleming, K., McGeechan, K., & Bateson, D. (2020) Increasing the accessibility of long-acting reversible contraceptives through nurse-led insertions: A cost-benefit analysis. Collegian, 27(1), 109-114.

Using supported accommodation settings for reaching women who are homeless and socio-economically disadvantaged to provide information, advocacy and referral to increase cervical screening

This collaborative project aimed to investigate knowledge of cervical cancer and screening, attitudes towards screening, prior experiences, and potential barriers and enablers for women experiencing homelessness or socioeconomic disadvantage in Sydney, NSW. Findings indicated that most women had a general understanding of reasons for screening; however, responses were varied regarding when a woman should begin and cease screening. Participants emphasised the importance of a female clinician in promoting a more positive screening experience, and health professionals were identified as their most trusted source of health information. Access to cervical screening by women experiencing disadvantage remains a challenge, and sustained multi-faceted health promotion efforts are needed to increase access.

This project was a collaboration between Family Planning NSW, Sydney Local Health District, Women’s Health Service, Leichhardt Women’s Community Health Centre and Domestic Violence NSW (formerly NSW Women’s Refuge Movement), and was funded by the NSW Cancer Institute.

Lovell, R., Botfield, JR., Cheng, W., Tilley, D., Fazio, A., & Estoesta, J., Promoting cervical screening among women experiencing homelessness and socioeconomic disadvantage in Sydney, Health Promotion Journal of Australia, 1-12, https://doi.org/10.1002/hpja.322, Jan 2020

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