RESUMEN
Objectives: The oral contraceptive pill (OCP) is the most used contraceptive worldwide; nevertheless, discontinuation rates are relatively high. While advantages of the OCP, like pregnancy prevention and planned parenthood, result in autonomy and independence, side effects and other aspects play a role in the decision to (dis)continue usage. Informed and deliberate decision-making is of importance to prevent adverse effects in health and quality of life. Therefore, the present study aimed to explore how women in the Netherlands decide to (dis)continue the OCP. Study design: This paper reports a qualitative study using four focus groups, conducted online or face-to-face, with 20 women of different educational background aged between 18 and 23. The topic guide was based on relevant theory and literature, and focused on personal beliefs, experiences and social interactions about the OCP. The study is reported according to SRQR guidelines. Results: The main themes that were found the influence decision-making were effects, side effects, towards alternatives, interpersonal communication with peers, interpersonal communication with the general practitioner, and online information seeking. Feeling responsible emerged as a relevant additional theme, embedded in the decision-making process, and influencing other themes. Some educational differences emerged. Conclusions: The decision to start the OCP is a highly normalized process in the Netherlands. However, women who feel a strong sense of responsibility for pregnancy prevention may be less open to considering alternative contraception methods. Results imply that women can be better supported in the decision-making process by providing balanced information on effects and side effects of a wide range of contraceptives, as well as restoring the balance in both sexual partner's responsibility for contraception. Implications for practice and suggestions for further research on the concept of responsibility, its influence, and underlying mechanisms are provided.
RESUMEN
OBJECTIVE: There has been an increase in testing of vitamins in patients in general practice, often based on irrational indications or for non-specific symptoms, causing increasing healthcare expenditures and medicalisation of patients. So far, there is little evidence of effective strategies to reduce this overtesting in general practice. Therefore, the aim of this qualitative study was to explore the barriers and facilitators for reducing the number of (unnecessary) vitamin D and B12 laboratory tests ordered. DESIGN AND SETTING: This qualitative study, based on a grounded theory design, used semistructured interviews among general practitioners (GPs) and patients from two primary care networks (147 GPs, 195 000 patients). These networks participated in the Reducing Vitamin Testing in Primary Care Practice (REVERT) study, a clustered randomized trial comparing two de-implementation strategies to reduce test ordering in primary care in the Netherlands. PARTICIPANTS: Twenty-one GPs, with a maximum of 1 GP per practice who took part in the REVERT study, and 22 patients (who were invited by their GP during vitamin-related consultations) were recruited, from which 20 GPs and 19 patients agreed to participate in this study. RESULTS: The most important factor hampering vitamin-test reduction programmes is the mismatch between patients and medical professionals regarding the presumed appropriate indications for testing for vitamin D and B12. In contrast, the most important facilitator for vitamin-test reduction may be updating GPs' knowledge about test indications and their awareness of their own testing behaviour. CONCLUSION: To achieve a sustainable reduction in vitamin testing, guidelines with clear and uniform recommendations on evidence-based indications for vitamin testing, combined with regular (individual) feedback on test-ordering behaviour, are needed. Moreover, the general public needs access to clear and reliable information on vitamin testing. Further research is required to measure the effect of these strategies on the number of vitamin test requests. TRIAL REGISTRATION NUMBER: WAG/mb/16/039555.
