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Expanding choice through online contraception: a theory of change to inform service development and evaluation
  1. Emma Rezel-Potts1,
  2. Caroline Free2,
  3. Jonathan Syred1,
  4. Paula Baraitser1
  1. 1 School of Population Health & Environmental Sciences, King's College London, London, UK
  2. 2 Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Emma Rezel-Potts, School of Population Health & Environmental Sciences, Addison House, Guy's Campus, King's College London, London, SE1 1UL, UK; emma.c.rezel{at}


Background This study presents the theory of change underpinning an intervention to provide online contraceptive care in an inner London area with high rates of unplanned pregnancy. It aims to suggest attributes of an effective service and to identify key questions for its evaluation.

Methods Thematic analysis of an online sexual and reproductive health programme funding application and 21 semi-structured interviews with a purposive sample of stakeholders selected to provide expertise in contraception and online health.

Results A theory of change model summarised the positive processes of change which could be initiated through increased access to contraceptive supplies, online information and remote interaction and support. Stakeholders predicted that perceptions of convenience and anonymity of online access would vary across the target population. They stressed the importance of trusting service-users’ capabilities for autonomous contraceptive decision-making, but expressed concerns that online access could be detrimental for those requiring more complex care. Concerns were alleviated by the prospect of responsive support through text messaging and phone calls, and when the online service was positioned as part of a broader system of provision including physical services.

Conclusions This study has revealed priority areas for the ongoing development of an online contraception service and pertinent evaluation questions. Evaluative research should test assumptions within the theory of change model, exploring the characteristics and circumstances of those preferring online access over existing services and the value of convenience, anonymity, autonomous access and responsive support in executing effective contraceptive choices within a new landscape of contraceptive delivery.

  • online contraception
  • complex intervention
  • evaluation
  • theory of change

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  • Contributors PB conceived of the project. PB and CF are joint PhD supervisors for ER. ER designed the study protocol as part of her PhD with input from CF and PB. PB and JS constructed the topic guide and conducted the initial 14 interviews. ER and PB thematically analysed and generated process diagrams using the initial 14 interviews which were commented on by CF. ER generated the topic guide and conducted the interviews for the supplementary sample. ER carried out the final-stage analysis on the combined data. PB and CF verified the final codes and checked these against their own interpretations of the data. ER wrote the first draft of the manuscript with support from PB and CF. All authors edited the manuscript versions. All authors were involved in interpretation of the results, and read and commented on all drafts, giving final approval of the submitted version.

  • Funding This work was funded by Guy’s and St Thomas’ Charity via SH:24 (a not-for-profit community interest company).

  • Competing interests ER, the corresponding author, reports receiving a PhD studentship from Guy's and St Thomas' Charity via SH:24. PB and JS report grants from Guy’s and St Thomas’ Charity via SH:24 during the conduct of the study. CF reports receiving funding for her time from Guy’s and St Thomas’ Charity paid via SH:24. PB is also a director of SH:24.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from King’s College London research ethics committee (Ref: BDM/13/14-42). All participants were sent the approved participant information sheet and consent form prior to agreeing to be interviewed. All participants were interviewed in person by investigators. Written consents and permissions to record were obtained from the participants at the beginning of the interview.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.