The ‘Co-designing abortion care in Melbourne’s North’ research team
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Equitable access to contraception and abortion are fundamental components of sexual and reproductive health. Due to the sensitive nature of abortion care and vulnerability of the women who access these services, it is important that the needs of women are understood and prioritised to promote empowerment and optimize patient experience. There has been very little research partnering with women in this space. We are a collaborative multidisciplinary research team that aims to address this gap in the literature and add to the growing body of evidence on the use of co-design in developing tailored health services to improve patient experience.
Objective: This project aims to improve the current model of comprehensive abortion care at Northern Health by partnering with women and community stakeholders to co-design a flexible reproductive and abortion health service that is tailored to their needs and promotes equitable access.
Target population: Women and gender diverse people aged 18-49 residing in Melbourne’s north who have ever accessed a sexual and reproductive health care service.
Methodology:Our core research methodology is underpinned by participatory design and will utilise an experience-based co-design approach. This study will be a mixed-methods, multiphase design, enabling us to draw on the strength of both qualitative and quantitative methods. We will synthesize data obtained from key informant interviews, target group surveys and semi-structured interviews to deepen our understanding and inform the development of content for co-design working groups with consumers and health service stakeholders. These working groups will co-design a model of care that we will then seek to implement and evaluate in the future.
2021-2022: Stage 1- Collect baseline data Audit the service and conduct an anonymous patient survey to understand the demographic characteristics of consumers, assess baseline patient experience, and ask for feedback about the service. - COMPLETE
2022: Stage 2- Key informant interviews Conduct semi-structured interviews of relevant internal staff and external stakeholders to gain an understanding of their perspectives, identify barriers to care provision and gather ideas for improvement. -COMPLETE
2023: Stage 3- Target Group online survey Build and conduct an anonymous online survey for the target group to understand their experiences, needs and ideas. – ACTIVE
2023: Stage 4- Target Group semi-structured interviews Participants who want to contribute further but do not have the time or capacity to engage in group workshops may provide additional input through individual semi-structured interviews. -ACTIVE
2023: Stage 5- Co-design workshops Invite a diverse group of consumers, staff and other relevant stakeholders to participate in approximately 4 x 2 hour group workshops with ~8 participants to develop a model of care collaboratively. -UPCOMING
Each stage will inform the development of the content for the subsequent stages, in conjunction with published literature and expert opinion.
Expected outcomes: Whilst the current gynaecologist-led surgical service has high acceptability among women seeking abortion, our audit and the published literature suggests potential improvements including: expanding the role of the midwife through midwife-led early medical abortion (also known as EMA or MTOP); offering telehealth services for early medical abortion; improving patient resources and providing information in a range of formats, increasing access to long acting reversible contraception post early medical abortion; engaging with stakeholders to enhance cultural safety; and streamlining referral pathways with general gynaecology, mental health and social work services. We will explore the acceptability and desirability of a range of care options, including a potential midwife-led early medical abortion telehealth service.
Innovation and/or significance: There is strong evidence that patient experience has a profound impact on healthcare outcomes, with a growing body of evidence supporting the use of co-design to develop health care services and procedures tailored to the needs of a target population and improve patient experience. A positive experience of sexual and reproductive health care has the potential to reduce stigma, emotional distress and morbidity, particularly for patients accessing abortion services.
The resulting proposed model for the family planning service would be the first multidisciplinary co-designed sexual health and abortion care service in Victoria, and would demonstrate the ability of health services to create innovative solutions through patient and professional partnerships.
Expanding the existing service to include midwifery-led telehealth outpatient early medical abortion has significant advantages for accessibility, flexibility, privacy, hospital admissions and costs (both to the hospital and the patient). Task-shifting and utilising all members of the multidisciplinary team to their full capacity will enhance the flexibility and resilience of this service. This will in turn improve the ability of the team to manage changes in demand and/or health service capacity (such as that induced by the COVID-19 pandemic) and thereby future-proof an essential reproductive health service. This model of care could be scalable and adopted by other health services, thus spreading the impact of this research beyond an individual clinic.
Kate Chaouki, Clinical Midwife Consultant & Northern Health Family Planning Clinic co-ordinator
Eleanor Johnson, Northern Health Research Midwife & MACH Health Service Research Fellow
Associate Professor Lisa Hui, Northern Health Maternal Fetal Medicine Specialist & Associate Professor Dept of O&G at University of Melbourne
Professor Cathy Vaughan , Head of Gender and Women’s Health Unit in the Centre for Health Equity at Melbourne School of Population and Global Health
Dr Jeanie Henderson, Obstetrician & Gynaecologist, Northern Health Family Planning Clinic Medical Lead
Professor Bodil Rasmussen, Chair in Nursing in the partnership with Deakin University and Western Health
We have secured over $75,000 funding from the Victorian Nursing and Midwifery Trust Major Grants and the University of Melbourne Department of Obstetrics and Gynaecology Innovation Grant schemes to fund Phases 1 & 2 of our project.Eleanor Johnson has also secured a Melbourne Academic Centre for Health (MACH) Health Service Research Future Leaders Fellowship to develop this research with 0.2FTE being funded by Northern Health for 1 year. We have the support of Northern Health to see this project through to implementation and evaluation (Phase 3).
For further information about this research, please contact Eleanor Johnson
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