Process evaluation of a task-shifting strategy in hormonal contraception: does training translate into practice?

OBJECTIVES Since 2000, the Province of Quebec has experienced a shortage of physicians and a decrease in access to prescription contraceptives. A task-shifting strategy was launched in 2007 to allow trained nurses, in collaboration with community pharmacists, to start healthy women on hormonal contraception for a six-month period without a medical consultation. This study examined the proportion of trained nurses effectively involved in this innovative practice to determine which factors are associated with it. METHODS We performed a cross-sectional study in which all nurses who had been trained in hormonal contraception since 2007, who were registered with the College of Nurses of Quebec, and who were employed as nurses in the Quebec Health System were asked to respond to a postal or electronic survey. RESULTS A total of 3043 nurses were invited to participate in the study. Fifty-seven percent (57.3%) of 745 respondents were involved in this new practice. The major determinant was the adoption of the Collaborative Agreement in Hormonal Contraception by health organizations. The other influential factors were having been trained before 2011, being a permanent employee, working in a youth clinic of a centre for health and social services, and working in a rural or remote area. CONCLUSION Despite a modest response rate, this study provides support for formalizing the training of nurses in hormonal contraception by integrating it into nursing education at all levels, and for implementing it in other health organizations such as family medicine groups, which are widespread in Quebec.