The Reproductive Life Plan - a new paradigm in primary health care

Transcription

1 The Reproductive Life Plan - a new paradigm in primary health care Tanja Tydén and Jenny Stern

2 The Reproductive Life Plan (RLP) A tool for reproductive health promotion in a life cycle perspective, recommended by the CDC The aim is to find strategies for successful family planning, eg: have the wanted number of children avoid unwanted pregnancies avoid ill-health that may threaten reproduction Moos et al Johnson et al Dunlop et al 2010.

3 How it all began 1 st ECPHC, Brussels 2010 Merry-K Moos & Hani K. Atrash (US) presentation on the CDC recommendations Each woman, man, and couple should be encouraged to have a reproductive life plan. We started the PrePreg Network Jill Shawe UK Hanne Heegard DK Pierpaolo Mastrioacovo IT Ilse Delbaere BE

4 Family planning in Sweden Certified Nurse Midwives insert IUDs, implants and prescribe hormonal contraception CNM do ultrasound pre abortions and councelling post abortion Contraceptive and STI counselling free of charge Subsidised contraceptives Mandatory sexual health education

5 Reasons for an RLP study in Sweden Female university students wish to have: 2-3 children First at the age of 30 Last at the age of Impact of age on fecundity is underestimated Chance of successful IVF is overestimated Tydén et al Lampic et al Skoog Svanberg 2006

6 The RCT study on RLP Evaluate if RLP-based information in connection to contraceptive counseling 1. increases women s knowledge about reproduction* and folic acid 2. affects women s family planning 3. is appreciated by the women

7 * Knowledge of Reproduction Factors that can impair female fertility Healthy lifestyle during pregnancy planning including folic acid. How long an ovum and sperms live The age of which there is a marked decline in women s ability to become pregnant

8 Method, material and setting Randomised Controlled Trial Female university students (n=338) n=299, participation rate 88% A university clinic for contraceptive counselling

9 Intervention (RLP) Do you want (more) children in your life? No Contraceptives Yes, soon How to optimize life style Yes, sometime in the future How to preserve fertility, life style factors Information given - Verbally during the counseling - In a leaflet

10 Effects of the intervention Higher knowledge of reproduction Wished to have their last child earlier in life 90% thought midwives routinely should discuss RLP with their patients

11 Our experiences from this study 1. The staff must be interested and motivated 2. The staff need training, so they deliver what they are supposed to do 3. The staff need encouragement and incentive 4. The researchers need to support the staff and oversee the study carefully 5. The follow up with telephone call was time consuming Stern J, Larsson M, Kristiansson P, Tydén T. Introducing reproductive life plan-based information in contraceptive counselling: an RCT. Human Reproduction 2013 Vol.28, No.9. pp

12 Adoption Evaluate experiences of working with the RLP in contraceptive counseling Mixed methods, questionnaires and focus group interviews Obstacles and opportunities Pros and cons

13 What did we found 70% of midwives had used the RLP in their contraceptive counselling No one stated they did not like the idea 1.A predominantly positive experience 2.A health-promoting tool 3.Individual and societal factors influence the RLP counselling 4.Long term implementation comprises opportunities, risks and needs

14 Conclusions The use of RLP in contraceptive counselling appears a feasible way of promoting reproductive health It is a promising tool for health professionals involved in reproductive counselling, which deserves to be explored in other nations

15 Implementation Part of routine care in Uppsala county since fall 2015 Educational and skill training sessions Upcoming evaluation Questionnaires to midwives Questionnaires to women/patients Patient records

16 Our next steps

17 RLP in a general female population Ongoing Women aged (n = 2000) Contraceptive counseling Similar study design as the previous RCT study

18 What about the guys?

19 RLP for Men Ongoing Men aged (n = 300) Recruitment in connection to STI-testing or counseling An RCT study similar to the previous RCT study BUT difficulties in recruiting men

20 The final goal? Implementing the RLP in primary health care: contraceptive counseling interconception care cervical cancer screening STI testing

21 Thank you for your attention!