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The service-users of online contraception: a cohort study
Meeting Abstracts
The service-users of online contraception: a cohort study Emma Rezel-Potts, Melissa J Palmer, Caroline Free, Paula Baraitser
Abstract Published Online November 29, 2019 School of Population Health & Environmental Sciences, King’s College London, London, UK (E Rezel-Potts PhD, P Baraitser MD); and Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK (M J Palmer PhD, Prof C Free PhD) Correspondence to: Dr Emma Rezel-Potts, School of Population Health & Environmental Sciences, King’s College London, London SE1 1UL, UK [email protected]
Background In January, 2017, the first free service offering 3 or 6 months’ supplies of oral contraceptive pills (OCPs) ordered online and posted home became available in the London boroughs of Lambeth and Southwark—an ethnically and socioeconomically diverse area with high rates of unplanned pregnancy. There are concerns that online services may only benefit more advantaged groups; therefore, we aimed to describe service users according to age, ethnicity, and index of multiple deprivation (IMD) quintile of area of residence, and determine whether these factors were associated with repeat use of the service. Methods We analysed routinely collected data from all 1186 requests for OCPs from January, 2017, to April, 2018, describing service users and their patterns of use. The primary outcome was two or more orders of OCPs from the online service during these 15 months, excluding those whose index prescription had not expired. Logistic regression analysis examined factors associated with this outcome at the bivariate and multivariable level, adjusting for age, IMD quintile, and ethnic group. Ethics approval was granted by The Proportionate Review Sub-Committee of the National Research Ethics Service (NRES) Committees – North of Scotland. Findings The online service was accessed by 726 individuals, 526 (72%) of whom were aged between 20 and 29 years and 427 (59%) of whom were of white ethnic group. 575 (79%) were residents of the first and second most deprived IMD quintiles. Compared with service users reported as being of white ethnic group, those of black ethnic group were significantly less likely to make repeat orders (adjusted odds ratio 0·52, 95% CI 0·31–0·89; p=0·016), as were those of Asian (0·39, 0·20–0·77; p=0·007) and mixed ethnic groups (0·37, 0·20–0·70; p=0·002). Interpretation These are the first findings on free, online contraception and suggest that early users reflect the population of the local area in terms of ethnic diversity and socioeconomic deprivation. Black and minority ethnic groups had lower odds of repeat use than did those of the white ethnic group, reflecting broader disparities in contraceptive continuation across services. Online service development should prioritise the identification and removal of barriers that might inhibit repeat online use for black and minority ethnic groups. Funding Guy’s and St Thomas’ Charity. Contributors PB conceived of the project and is the principle investigator. PB and CF are joint PhD supervisors for ER-P. ER-P designed the study protocol as part of her PhD with input from CF and PB. MJP assisted ER-P in the analysis plan. ER-P and MJP did all data cleaning, derivation of variables for analysis, and all analysis. CF checked the analysis and do-files. ER-P led the abstract writing with contributions from PB. All authors were involved in interpretation of the results, and read and commented on all drafts, giving final approval of the submitted version. Declaration of interests ER-P reports receiving a PhD studentship from Guy’s and St Thomas’ charity via SH:24, a not-for-profit community interest company. PB reports grants from Guy’s and St Thomas’ charity via SH:24 during the conduct of the study, and is a director of SH:24. CF reports receiving funding for her time from Guy’s and St Thomas’ Charity paid via SH:24. MJP declares no competing interests.
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The service-users of online contraception: a cohort study Emma Rezel-Potts, Melissa J Palmer, Caroline Free, Paula Baraitser
Abstract Published Online November 29, 2019 School of Population Health & Environmental Sciences, King’s College London, London, UK (E Rezel-Potts PhD, P Baraitser MD); and Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK (M J Palmer PhD, Prof C Free PhD) Correspondence to: Dr Emma Rezel-Potts, School of Population Health & Environmental Sciences, King’s College London, London SE1 1UL, UK [email protected]
Background In January, 2017, the first free service offering 3 or 6 months’ supplies of oral contraceptive pills (OCPs) ordered online and posted home became available in the London boroughs of Lambeth and Southwark—an ethnically and socioeconomically diverse area with high rates of unplanned pregnancy. There are concerns that online services may only benefit more advantaged groups; therefore, we aimed to describe service users according to age, ethnicity, and index of multiple deprivation (IMD) quintile of area of residence, and determine whether these factors were associated with repeat use of the service. Methods We analysed routinely collected data from all 1186 requests for OCPs from January, 2017, to April, 2018, describing service users and their patterns of use. The primary outcome was two or more orders of OCPs from the online service during these 15 months, excluding those whose index prescription had not expired. Logistic regression analysis examined factors associated with this outcome at the bivariate and multivariable level, adjusting for age, IMD quintile, and ethnic group. Ethics approval was granted by The Proportionate Review Sub-Committee of the National Research Ethics Service (NRES) Committees – North of Scotland. Findings The online service was accessed by 726 individuals, 526 (72%) of whom were aged between 20 and 29 years and 427 (59%) of whom were of white ethnic group. 575 (79%) were residents of the first and second most deprived IMD quintiles. Compared with service users reported as being of white ethnic group, those of black ethnic group were significantly less likely to make repeat orders (adjusted odds ratio 0·52, 95% CI 0·31–0·89; p=0·016), as were those of Asian (0·39, 0·20–0·77; p=0·007) and mixed ethnic groups (0·37, 0·20–0·70; p=0·002). Interpretation These are the first findings on free, online contraception and suggest that early users reflect the population of the local area in terms of ethnic diversity and socioeconomic deprivation. Black and minority ethnic groups had lower odds of repeat use than did those of the white ethnic group, reflecting broader disparities in contraceptive continuation across services. Online service development should prioritise the identification and removal of barriers that might inhibit repeat online use for black and minority ethnic groups. Funding Guy’s and St Thomas’ Charity. Contributors PB conceived of the project and is the principle investigator. PB and CF are joint PhD supervisors for ER-P. ER-P designed the study protocol as part of her PhD with input from CF and PB. MJP assisted ER-P in the analysis plan. ER-P and MJP did all data cleaning, derivation of variables for analysis, and all analysis. CF checked the analysis and do-files. ER-P led the abstract writing with contributions from PB. All authors were involved in interpretation of the results, and read and commented on all drafts, giving final approval of the submitted version. Declaration of interests ER-P reports receiving a PhD studentship from Guy’s and St Thomas’ charity via SH:24, a not-for-profit community interest company. PB reports grants from Guy’s and St Thomas’ charity via SH:24 during the conduct of the study, and is a director of SH:24. CF reports receiving funding for her time from Guy’s and St Thomas’ Charity paid via SH:24. MJP declares no competing interests.
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