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Abortion Task Shifting – Evidence Base

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Abortion Task Shifting – Evidence Base Health worker roles in providing safe abortion care and post-abortion contraception Web Supplement 3 Annexes 27–40: Evidence base for acceptability and feasibility WHO/RHR/15.11c © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Contents ANNEX 27. PERCEPTIONS OF AND EXPERIENCES WITH SELF-ADMINISTRATION OF MEDICAL ABORTION .. 2 ANNEX 28. BARRIERS AND FACILITATORS TO THE PROVISION OF ABORTION CARE SERVICES BY PHYSICIANS, MID-LEVEL PROVIDERS, PHARMACISTS AND LAY HEALTH WORKERS: A MULTICOUNTRY CASE STUDY SYNTHESIS .............................................................................................................................. 16 ANNEX 29. FACTORS AFFECTING THE IMPLEMENTATION OF TASK SHIFTING FOR ABORTION CARE: QUALITATIVE EVIDENCE SYNTHESIS ........................................................................................................... 35 ANNEX 30. A SYSTEMATIC REVIEW OF BARRIERS AND FACILITATORS TO THE EFFECTIVENESS AND IMPLEMENTATION OF DOCTOR–NURSE SUBSTITUTION PROGRAMMES (RASHIDIAN 2012) .................... 71 ANNEX 31. AN ANALYSIS OF LARGE-SCALE PROGRAMMES FOR SCALING UP HUMAN RESOURCES FOR HEALTH TO DELIVER CONTRACEPTIVES IN LOW- AND MIDDLE-INCOME COUNTRIES (POLUS 2012) ........ 79 ANNEX 32. THE EFFECTS, SAFETY AND ACCEPTABILITY OF COMPACT, PRE-FILLED, AUTODISABLE INJECTION DEVICES WHEN DELIVERED BY LAY HEALTH WORKERS (GLENTON, KHANNA 2013) ............... 81 ANNEX 33. BARRIERS AND FACILITATORS TO THE IMPLEMENTATION OF LAY HEALTH WORKER PROGRAMMES TO IMPROVE ACCESS TO MATERNAL AND CHILD HEALTH: QUALITATIVE EVIDENCE SYNTHESIS (GLENTON, COLVIN 2013) ......................................................................................................... 82 ANNEX 34. A SYSTEMATIC REVIEW OF QUALITATIVE EVIDENCE ON BARRIERS AND FACILITATORS TO THE IMPLEMENTATION OF TASK-SHIFTING IN MIDWIFERY SERVICES (COLVIN 2013) ...................................... 92 ANNEX 35. HOME-BASED ADMINISTRATION OF SAYANA® PRESS: REVIEW AND ASSESSMENT OF NEEDS IN LOW-RESOURCE SETTINGS (KEITH 2014) ............................................................................................... 98 ANNEX 36. UNTRAINED PHARMACY WORKER PRACTICES ......................................................................... 99 ANNEX 37. CERQUAL (CONFIDENCE IN THE EVIDENCE FROM REVIEWS OF QUALITATIVE RESEARCH) ... 101 ANNEX 38. SEARCH STRATEGY PERCEPTIONS OF AND EXPERIENCES WITH SELF-ADMINISTRATION OF MEDICAL ABORTION ................................................................................................................................. 102 ANNEX 39. SEARCH STRATEGY BARRIERS AND FACILITATORS TO THE PROVISION OF ABORTION CARE SERVICES BY PHYSICIANS, MID-LEVEL PROVIDERS, PHARMACISTS AND LAY HEALTH WORKERS: A COUNTRY CASE STUDY .............................................................................................................................. 103 ANNEX 40. SEARCH STRATEGTY FACTORS AFFECTING THE IMPLEMENTATION OF TASK SHIFTING FOR ABORTION CARE: QUALITATIVE EVIDENCE SYNTHESIS............................................................................. 105 This document is a supplement to the guideline which is available at: http://www.who.int/reproductivehealth/publications/unsafe_abortion/abortion-task-shifting/en/ 1 ANNEX 27. PERCEPTIONS OF AND EXPERIENCES WITH SELF-ADMINISTRATION OF MEDICAL ABORTION Colvin C, Wainwright M, Swartz A, Leon N. OBJECTIVE The review’s objective was to identify, appraise and synthesize qualitative research evidence on the factors affecting the self-administration of medical abortion during the first trimester of pregnancy. METHODS We searched the following electronic databases for eligible studies: Ovid MEDLINE In-Process & Other Non-Indexed Citations and Medline, CINAHL, Global Health (CAB), Popline, and WHO Global Health Library. When searching Medline and CINAHL, we made use of their filter for qualitative studies, choosing the “specificity” alternative for Medline and the “Qualitative – Best balance” alternative for CINAHL. We included any studies in English, Spanish, Portuguese, and French that met our inclusion criteria. Of studies that met our inclusion criteria, five are in Portuguese and the remainder are in English. In addition to the electronic searches, we contacted experts in our review Advisory Committee, searched reference lists of included studies, as well as key quantitative studies of self-administration, and searched websites for “grey literature”. When deciding whether or not to include a study in the review, we considered “task shifting” in this context to be the process of handing elements of decision-making, administration and management of the medical abortion process over to women themselves or to health professionals other than physicians. From the user perspective, this involves medical abortion at home for part or all of the procedure. From the health professional perspective, we were interested in their experiences of providing care in situations where women were responsible for self-administration of misoprostol, or their attitudes and opinions regarding the potential option for this in the future. From the partner/family member perspective, we were interested in the experience of accompanying the person throughout the process of medical abortion at home. Emergent inclusion criteria: 1. The research sought perspectives (users, providers, family members, etc.) and experiences concerning home administration of misoprostol, alternative forms of follow- up (either none, or phone, etc.), or alternative forms of counselling for home administration (e.g. from lay health workers, pharmacists). 2. Studies which follow the standard of care but which include data specifically relevant to the acceptability/feasibility of future home administration of misoprostol. 3. A less likely scenario, but which would also meet our criteria, would be home administration of mifepristone, or alternative forms of counselling for mifepristone– misoprostol abortions. 4. First trimester abortions. 5. The research methods include qualitative approaches and qualitative modes of reporting and analysis. This includes mixed-methods studies so long as they meet the above criteria. 2 6. Medical abortion in contexts of illegality can be included if they squarely meet criteria No. 1. These are considered indirect evidence and data extracted from them has to speak to the issue of home administration of misoprostol. 7. Ideally the research participants will be people who have experienced medical abortion with home administration but studies with prospective users (women/men of reproductive age) can also be included if relevant to home administration. All potential study abstracts were read and assessed independently by at least two authors. Disagreements about inclusion were resolved via discussion. We assessed the quality of included studies at the beginning of the review and then made use of the CERQual (Confidence in the Evidence from Review of Qualitative research) approach at the end to assess our confidence in each review finding. We developed a data extraction table initially informed by the SURE framework (The SURE Collaboration 2011). Our final data extraction framework focused on four topic areas related to the issues of feasibility and acceptability of self-administration of medical abortion. These were: (a) technical knowledge, comprehension and communication, (b) motivations for/acceptability of home use, (c) the process and pragmatics of home use, and (d) the experiences of and relationship contexts for home use. We analysed and synthesized our qualitative evidence using the framework thematic synthesis approach1 and summarized these findings in a Summary of Qualitative Findings table. STUDY SELECTION FLOW DIAGRAM TOTAL RECORDS POTENTIALLY ADDITIONAL STUDIES FROM DATABASE RELEVANT LITERATURE
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