Contraception to your door

Just in time for Christmas US company, Nurx, launched an app dubbed the ‘Uber of contraception’ (or birth control, as they call it over there). In a country where womens’ reproductive health services have been somewhat under attack, the app has been heralded as a cost-effective solution to the lengthy process of getting contraception in the States. Here in the UK we're developing our very own online contraception service.

In Autumn 2015 we started developing an emergency hormonal contraception (EHC) service. We ran focus groups and costed up the service based on numbers we predicted we could shift from clinics, pharmacies and GPs to our online service. Working closely with commissioners throughout this highlighted that the business case for developing oral contraception services ahead of EHC was stronger. Southwark and Lambeth have high pregnancy termination rates compared to the rest of London and England - improving access to contraception could improve these figures.

So we pivoted, bringing forward the supply of oral contraceptive (OC) pills online (the combined pill and progestogen only pill) - something we’d planned for later in 2016. We know we can deliver a saving on this service. Having an agile team and business structure means we can quickly go in another direction if we need to. The impacts of budget cuts on access to long acting reversible contraception have been widely speculated; by offering oral contraceptives by post, we can free up capacity in clinics and GP surgeries.

Early feedback

Having initially mapped what would be needed for EHC, we have applied and adapted this to create starting assumptions on the OC user journeys and prototype an OC order form.

Last Monday we hosted 9 women at SH:24 HQ to test and challenge these assumptions. We have more focus groups to run and then will test our alpha OC service but for now, here are 3 insights from the group (we’ll keep you posted about further developments):

1. Our prototype order form undersold the support available from our SH:24 sexual health nurse during the ordering process

On the prototyped order form people are offered the opportunity to get support via a button at the bottom of the page that says ‘Need help now?’. We discussed what the group assumed that would do, in general some static support was expected, perhaps FAQs or a phone number that they could call.

One of our group said: "I would never use this unless I had been to the doctors already and talked through all the medical stuff"

It became very clear that the button in it’s current form, was underselling the 1:1 support from our lead sexual health nurse, Sarah Cox who would respond to requests from that button. Sarah would offer users support by webchat, call back request or talk-by-text. If users can’t understand the support available, we’re not supporting them in the way we’d want to.

It is much easier than getting a GP appointment

After clarifying what the button did, the woman who said she wouldn’t use the service without speaking to a doctor decided speaking to our nurse before ordering would change her mind.

2. Our assumption that users would need some clarification around health screening questions was correct

From our experience in focus groups for EHC, people were keen to know why they were being asked certain questions and we made the assumption this would apply with OC too. During our OC workshop,it was clear some of the screening questions were less straight-forward than others and that there were opportunities to reassure users around certain questions; either by giving more information or context, explain why we need that answer, or what the result would be if they tick one way or another.

Additionally, when the group felt like they couldn’t be 100% certain about a Yes or No answer - there was a suggestion to front the sentence with ‘To your knowledge… do you have a family history of X?’. Thus avoiding the “guilty feeling” of answering ‘incorrectly’. This highlighted the need again to communicate the opportunity to ask for support at any stage.

3. There was genuine excitement about this service becoming available (and not just ours)

This could make life so much easier for women!
I’d use this definitely, it’s so good. It is so much effort to get an appointment even with a nurse at my GP
When will you be in Croydon?!
When this happens SH:24 will be my homepage

Delivering contraception safely

We’re glad there is a strong appetite for this service among people who might use it, and our screening questions are being to designed to ensure it will be delivered safely. Contraception however, does have some risks; recent news coverage of death caused by blood clotting linked to taking the combined pill underlines that we need to ensure people who use our services know the importance of always sharing with medical professionals that they are taking the pill and what risks and signs to look out for. The combination of our static oral contraception information pages, information during the order process and the support and oversight of each order by our sexual health nurse will assist users as they consider whether contraception is right for them.