Understanding access to Sexual and Reproductive Healthcare (SRH) in General Practice using the Candidacy Framework

Background: Deprived communities are more at risk of poor sexual and reproductive health outcomes, and access to SRH is more challenging in these populations. This is evident from significantly higher rates of unplanned pregnancies, abortions, teenage pregnancies, and a higher prevalence of sexually transmitted infection in deprived communities compared to affluent counterparts. This study aimed to identify and explore practitioner related barriers and facilitators to access of SRH in general practice using the candidacy framework. Method: A qualitative evidence synthesis (QES) was undertaken with a focus on SRH in general practice within healthcare systems like the NHS. Further exploration was done using semi-structured interviews conducted with 20 frontline healthcare practitioners from general practices serving deprived communities across Yorkshire. Thematic analysis was undertaken to identify factors in general practice which affected access. The candidacy framework guided the design and analysis of both the QES and interviews. Results: The data revealed the complexities of access to SRH service including the impact of stigma, shame, embarrassment among individuals, communities, and healthcare practitioners. Factors such as female disempowerment and gender-related barriers were identified. The candidacy framework was adapted to explain the complex interaction between the person accessing care and the healthcare practitioner, this developed the understanding of the interplay between appearing or asserting candidacy and the recognition or acceptance of this candidacy by the healthcare practitioner. Conclusion: To readdress SRH inequalities in deprived communities, there needs to be easily accessible and stigma-free services in general practice. This research highlights the importance of HCPs recognising and accepting the needs of their communities and having the funding to develop tailored and culturally congruent services specifically for their patients.