Promotion of family planning services in practice leafletsBMJ 1994; 309 doi: http://dx.doi.org/10.1136/bmj.309.6959.927 (Published 08 October 1994) Cite this as: BMJ 1994;309:927
- M N Marshall,
- D J Pereira Gray,
- V Pearson,
- D R Phillips,
- M Owen
- Institute of General Practice, Postgraduate Medical School, University of Exeter, Exeter EX2 5DW Department of Public Health Medicine, Dean Clarke House, Southernhay East, Exeter EX1 1PQ Institute of Population Studies, University of Exeter, Hoopern House, Exeter EX4 6DT
- Correspondence to: Dr Marshall.
- Accepted 6 June 1994
General practitioners provide about three quarters of the family planning services in the United Kingdom, so potential users should be aware of the services offered by their practice. All general practices are now required to produce leaflets to describe the contraceptive services provided.1 As leaflets are generally well received by patients2 and influence patient behaviour,3 they could be a useful information source for many aspects of family planning. We analysed the information about family planning in practice leaflets.
Methods and results
The leaflets are held by the Devon Family Health Services Authority and were assessed by one of us (MNM). We used criteria representing quality indicators for assessment (table), allocating one equally weighted point for each of the criteria mentioned and adding them together to give a score for each practice. These scores were related to the number of partners, the presence of female partners, and whether the practice was approved to train general practitioners.
Overall, 175 (88%) practice leaflets from 198 practices in Devon were available for analysis. Of these, 50 (29%) were from training practices and 82 (47%) from practices with one or more female partners. For the 10 criteria the leaflets achieved a median score of 2. Large practices had higher scores than small ones. The most commonly mentioned criteria were reference to the service and encouragement to use it, mention of when and what services were available, and the offer of a choice of provider within the practice. Few practice leaflets referred to postcoital contraception, confidentiality, or other sexual health issues.
Large practices were significantly more likely than small ones to mention family planning (X2 for trend 5.94, P<0.02), to encourage the use of the service (16.74, P<0.001), and to advertise a range of services (5.98, P<0.02). Practices with female partners were significantly more likely to score above the median than all-male partnerships (X29.3, P<0.01). There was no significant difference between the scores for training and non-training practices.
The findings suggest that leaflets are not being best used to advertise the range and potential of family planning services, which are separately contracted but available within general practice. All practices in Devon offer contraceptive services, but one in 10 leaflets did not mention family planning. The lack of reference to postcoital contraception and information about services outside the practice for people who might not want to see their family doctor supports the need for more information for patients and corresponds with findings suggesting that patients attending their general practitioner were less knowledgeable than those attending family planning clinics.4
Group practices and those with female partners are most likely to give high priority to family planning issues in their leaflets. All practices could enhance their leaflets by encouraging members of the practice team to contribute and by working closely with other interested parties.
This study has limitations. Twenty three (12%) practices seemed to have submitted no leaflet to the family health services authority. These practices were informed of their omission; they were not significantly different from those that had submitted one in terms of size of partnership or health district. Our assessment criteria could be criticised as arbitrary and too detailed, and we did not rank their importance. Some issues, such as an explicit statement of confidentiality, might be more important to certain people, such as those under 16.
Leaflets are not the only or necessarily the best medium to advertise services, and some practices may be using other means. Certainly, low scores do not indicate a lack of service, but if the aims of the Health of the Nation5 are to be achieved general practitioners need to keep their patients informed using as many means as possible. The risk of information overload in long leaflets should be considered. Our findings should encourage practices to update their leaflets and review the health promotion information in them.
We thank the South West Regional Health Authority, the Devon Family Health Services Authority, and the Exeter, Plymouth, Torbay, and North Devon health authorities for their financial support with this study. We particularly thank staff of the family health services authority for their practical help.