Enabling women to access preferred methods of contraception : a rapid review and behavioural analysis

Background: Many pregnancies in the UK are either unplanned or ambivalent. This review aimed to (i) explore barriers and facilitators to women choosing and accessing a preferred method of contraception in the United Kingdom, and (ii) identify opportunities for behavioural interventions based on examination of interventions that are currently available nationally. Methods: Three databases were searched, and experts contacted to identify grey literature for studies presenting barriers and facilitators to women choosing and accessing a preferred method of contraception, conducted in the UK and published between 2009 and October 2019. Information on barriers and facilitators were coded into overarching themes, which were then coded into Mechanisms of Actions (MoAs) as listed in the Theory and Techniques Tool. National interventions were identified by consulting stakeholders and coded into the Behaviour Change Wheel. The match between barriers/facilitators and intervention content was assessed using the Behaviour Change Wheel. Results: We included 32 studies and identified 46 barrier and facilitator themes. The most cited MoA was Environmental Context and Resources, which primarily related to the services women had access to and care they received. Social Influences, Beliefs about Consequences (e.g., side effects) and Knowledge were also key. The behavioural analysis highlighted four priority intervention functions (Modelling, Enablement, Education and Environmental Restructuring) that can be targeted to support women to choose and access their preferred method of contraception. Relevant policy categories and behaviour change techniques are also highlighted. Conclusions: This review highlights factors that influence women’s choices and access to contraception and recommends opportunities that may be targeted for future interventions in order to support women to access preferred contraception. Registration Protocol was registered with PROSPERO (an international database of prospectively registered systematic reviews in health and social care) in December 2019, CRD42019161156

“I believe once I’m happy within myself I won’t need to Smoke”: An exploration of Women Smokers’ Views on Smoking, Tobacco Control and Cessation.

Women’s smoking is emerging as a significant global public health issue and has been acknowledged as an epidemic unlikely to reach its peak until well into the 21st century. Within developed countries, including New Zealand, smoking is increasingly patterned according to social disadvantage and inequality, and is therefore a particularly significant issue for women already marginalised due to their ethnicity or socioeconomic position. These women not only suffer from disproportionate rates of smoking and the associated health outcomes, they have also become further marginalised in society as a result of smoker-stigmatisation. Previous literature has indicated the importance of examining the unintended burdens that tobacco de-normalisation strategies may impose on vulnerable smokers and that examining contextual factors that influence smoking inequalities may be the key to eliminating them. Therefore, the aim of this exploratory study was to examine women smokers’ views and perceptions of smoking, tobacco control and cessation within a context in which tobacco de-normalisation is high on the social and political agenda. In-depth qualitative interviews were conducted with twelve adult female smokers living in Hornby, Christchurch. A thematic analysis revealed that smoking was intrinsically linked to the lived circumstances of the women, determined by wider social structures that undermined their adaptive capacity to quit. Within this context smoking was valued and relied on as a companion, a coping mechanism and an activity to deal with feelings of stress, loneliness and boredom. For these women, tobacco de-normalisation and smoker-stigmatisation appeared to foster resistance and opposition to the intensification of tobacco control, which was often viewed as a threat to their autonomy. Resistant responses to smoker-stigmatisation also influenced the women’s attitudes towards utilising and accessing cessation resources, reflected in their rejection of the influence of external pressures to quit smoking, their emphasis of the importance of will power and their preference for autonomous and self-directed methods of cessation

“I believe once I’m happy within myself I won’t need to Smoke”: An exploration of Women Smokers’ Views on Smoking, Tobacco Control and Cessation.

Women’s smoking is emerging as a significant global public health issue and has been acknowledged as an epidemic unlikely to reach its peak until well into the 21st century. Within developed countries, including New Zealand, smoking is increasingly patterned according to social disadvantage and inequality, and is therefore a particularly significant issue for women already marginalised due to their ethnicity or socioeconomic position. These women not only suffer from disproportionate rates of smoking and the associated health outcomes, they have also become further marginalised in society as a result of smoker-stigmatisation. Previous literature has indicated the importance of examining the unintended burdens that tobacco de-normalisation strategies may impose on vulnerable smokers and that examining contextual factors that influence smoking inequalities may be the key to eliminating them. Therefore, the aim of this exploratory study was to examine women smokers’ views and perceptions of smoking, tobacco control and cessation within a context in which tobacco de-normalisation is high on the social and political agenda. In-depth qualitative interviews were conducted with twelve adult female smokers living in Hornby, Christchurch. A thematic analysis revealed that smoking was intrinsically linked to the lived circumstances of the women, determined by wider social structures that undermined their adaptive capacity to quit. Within this context smoking was valued and relied on as a companion, a coping mechanism and an activity to deal with feelings of stress, loneliness and boredom. For these women, tobacco de-normalisation and smoker-stigmatisation appeared to foster resistance and opposition to the intensification of tobacco control, which was often viewed as a threat to their autonomy. Resistant responses to smoker-stigmatisation also influenced the women’s attitudes towards utilising and accessing cessation resources, reflected in their rejection of the influence of external pressures to quit smoking, their emphasis of the importance of will power and their preference for autonomous and self-directed methods of cessation