Translating policy to practice: theory-based formative research to improve messaging and over-the-counter access to emergency contraception in Florence, Italy

Abstract

Objectives

Italy’s 2015 emergency contraception (EC) policy made EC available without prescription for individuals aged 18 years and older; however, women living in Italy continue to face barriers to accessing EC. The purposes of this study were to understand EC knowledge, attitudes and behaviours among women living in Italy and explore the impact of the 2015 policy.

Methods

Researchers conducted 30 interviews with women living in Florence, Italy, aged 18–50 years and using the Italian health care system. Researchers used an expanded grounded theory approach to understand women’s EC experiences, with diffusion of innovations (DOI) serving as a conceptual lens. Researchers completed open and axial coding to identify emerging themes.

Results

Participants had low awareness of the 2015 EC policy and suggested increased messaging in strategic locations to overcome this barrier. They held positive and negative attitudes towards EC: while some perceived the advantage of EC compared with unintended pregnancy, others expressed concerns about irresponsible behaviour and safety. Finally, conscientious objection impacted access, despite women’s desire for autonomous EC decision making.

Conclusion

The findings offer practical recommendations to guide EC messaging in Italy to increase women’s access to EC. Recommendations include using theory- and audience-based methods to overcome gaps in policy knowledge and real and perceived barriers to EC access. Incorporating DOI as a theoretical framework with women’s voices presents a novel opportunity to enhance policy and EC dissemination.

摘要

目的：意大利2015年的紧急避孕(EC)政策使18岁及以上者无需处方即可获得EC；然而, 意大利妇女获取EC时仍有障碍。这项研究旨在了解居住在意大利的妇女关于EC的认识、态度和行为, 并探讨2015年政策的影响。

方法：研究者对居住在意大利佛罗伦萨、年龄在18-50岁、使用意大利医疗保健系统的妇女进行了30次采访。研究者利用扎根理论来理解女性的EC经历, 以创新扩散作为概念镜头。研究者完成了开放式编码和轴心式编码来确认新兴主题。

结果：参与者对2015EC政策知之甚少, 建议增加战略性宣传来克服这个问题。她们对EC持积极和消极的态度：一些人认为EC胜过意外怀孕, 但另一些人对不负责任行为和安全性表示担忧。最后, 内心的抗拒影响了EC获取, 尽管女性渴望进行自主EC决策。

结论：研究结果提供了切实可行的建议以指导意大利EC信息传递, 以增加女性获取EC的机会。建议包括使用以理论和受众为基础的方法来克服政策知识方面的差距, 以及对获取EC的实际和认知障碍。将DOI和女性声音作为理论框架, 为加强政策和EC宣传提供了一个新的机会。

Keywords:

• Diffusion of innovations
• emergency contraception
• Italy
• messaging strategy
• qualitative methods

Acknowledgements

The authors would like to thank students who participated in the summer 2018 Purdue University Investigating Women’s Reproductive and Sexual Health Issues in Florence, Italy, study abroad programme, for their support in data collection and transcription and overall collaboration on the project. We would also like to thank Florence University of the Arts for its partnership and project support.

Disclosure statement

The authors report no conflicts of interest.

Data availability statement

Data are available upon request.

Additional information

Funding

This research was partially funded by the Purdue University Office of Programmes for Study Abroad, International Programmes (Study Abroad and International Learning Grant and Intercultural Pedagogy Grant).