‘I didn’t want to visit a doctor unless it was extremely necessary’: perspectives on delaying access to sexual and reproductive health care during the COVID-19 pandemic in Australia from an online survey
Helen Bittleston A C , Jane L. Goller A , Meredith Temple-Smith B , Jane S. Hocking A and Jacqueline Coombe AA Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3053, Australia.
B Department of General Practice, The University of Melbourne, Melbourne, Vic. 3010, Australia.
C Corresponding author. Email: helen.bittleston@unimelb.edu.au
Australian Journal of Primary Health 28(2) 131-136 https://doi.org/10.1071/PY21239
Submitted: 11 October 2021 Accepted: 16 December 2021 Published: 3 February 2022
Journal Compilation © La Trobe University 2022 Open Access CC BY
Abstract
Australians were subject to a series of COVID-19 lockdown restrictions throughout 2020. Although accessing medical care was allowable, concerns were raised that people were avoiding healthcare services. We explored young Australians’ reasons for delaying seeking sexual and reproductive health (SRH) care during the pandemic, using data from two cross-sectional surveys. The surveys included a question asking whether respondents had delayed accessing care during the pandemic. Free-text responses from young Australians (aged 18–29 years) were analysed using conventional content analysis. In all, 1058 under-30s completed a survey, with 262 (24.8%) reporting they had delayed seeking SRH care. Of these, 228 (87.0%) respondents provided a free-text comment. Participants who commented were predominantly female (86.4%) and had a median age of 23 years (interquartile range 20–26 years). Most commonly, respondents delayed testing for sexually transmissible infections, cervical cancer screening, and contraceptive care. Some delayed accessing care despite experiencing symptoms. Participants avoided seeking care due to concerns about contracting COVID-19, uncertainty about accessing care during restrictions and anxiety relating to accessing SRH care. Although some reported a reduced need for SRH care, others required but did not access care. Young people should be reassured that SRH issues are a valid reason to access services, especially when experiencing symptoms.
Keywords: COVID-19, health services: accessibility, primary health care, reproductive health services.
References
Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) (2020) Sexual health services in Australia and New Zealand during the COVID-19 pandemic: ASHM COVID-19 taskforce report. ASHM.Australian Institute of Health and Welfare (AIHW) (2021a) Cancer screening and COVID-19 in Australia. Catalogue no. CAN 137. (AIHW: Canberra, Australia) Available at https://www.aihw.gov.au/reports/cancer-screening/cancer-screening-and-covid-19-in-australia/contents/how-has-covid-19-affected-australias-cancer-screening-programs [Verified 20 January 2022]
Australian Institute of Health and Welfare (QIHW) (2021b) COVID-19: looking back on health in 2020. (AIHW: Canberra, Australia) Available at https://www.aihw.gov.au/reports-data/australias-health-performance/covid-19-and-looking-back-on-health-in-2020 [Verified 25 June 2021]
Australian Medical Association (2020) AMA COVIDSafe Practice Guide. Australian Medical Association, ACT, Australia.
Australian Sexual Health Alliance (2018) Australian STI Management Guidelines for use in Primary Care. ASHM. Available at http://www.sti.guidelines.org.au/syndromes/pid-pelvic-inflammatory-disease
Ayhan CHB, Bilgin H, Uluman OT, Sukut O, Yilmaz S, Buzlu S (2020) A systematic review of the discrimination against sexual and gender minority in health care settings. International Journal of Health Services 50, 44–61.
| A systematic review of the discrimination against sexual and gender minority in health care settings.Crossref | GoogleScholarGoogle Scholar | 31684808PubMed |
Barney A, Buckelew S, Mesheriakova V, Raymond-Flesch M (2020) The COVID-19 pandemic and rapid implementation of adolescent and young adult telemedicine: challenges and opportunities for innovation. Journal of Adolescent Health 67, 164–171.
| The COVID-19 pandemic and rapid implementation of adolescent and young adult telemedicine: challenges and opportunities for innovation.Crossref | GoogleScholarGoogle Scholar |
Cheng Y, Boerma C, Peck L, Botfield JR, Estoesta J, Mcgeechan K (2021) Telehealth sexual and reproductive health care during the COVID-19 pandemic. The Medical Journal of Australia 215, 371–372.
| Telehealth sexual and reproductive health care during the COVID-19 pandemic.Crossref | GoogleScholarGoogle Scholar | 34374090PubMed |
Chow EPF, Hocking JS, Ong JJ, Phillips TR, Fairley CK (2021) Sexually transmitted infection diagnoses and access to a sexual health service before and after the national lockdown for COVID-19 in Melbourne, Australia. Open Forum Infectious Diseases 8, ofaa536
| Sexually transmitted infection diagnoses and access to a sexual health service before and after the national lockdown for COVID-19 in Melbourne, Australia.Crossref | GoogleScholarGoogle Scholar | 33506064PubMed |
Continuity of Care Collaboration (2020) Australians are delaying healthcare appointments and tests during COVID-19. (Allied Health Professions Australia) Available at https://ahpa.com.au/advocacy/australians-are-delaying-healthcare-appointments-and-tests-during-covid-19/ [Verified 20 January 2022]
Coombe J, Kong FYS, Bittleston H, Williams H, Tomnay J, Vaisey A, Malta S, Goller JL, Temple-Smith M, Bourchier L, Lau A, Chow EPF, Hocking JS (2020) Love during lockdown: findings from an online survey examining the impact of COVID-19 on the sexual health of people living in Australia. Sexually Transmitted Infections 97, 357–362.
Department of Health (2018) Fourth National Sexually Transmissible Infections Strategy. Australian Government, Canberra.
Dixon SC, Herbert DL, Loxton D, Lucke JC (2014) ‘As many options as there are, there are just not enough for me’: Contraceptive use and barriers to access among Australian women. The European Journal of Contraception & Reproductive Health Care 19, 340–351.
| ‘As many options as there are, there are just not enough for me’: Contraceptive use and barriers to access among Australian women.Crossref | GoogleScholarGoogle Scholar |
Findling MG, Blendon RJ, Benson JM (2020) Delayed care with harmful health consequences—reported experiences from national surveys during Coronavirus disease 2019. JAMA Health Forum 1, e201463
| Delayed care with harmful health consequences—reported experiences from national surveys during Coronavirus disease 2019.Crossref | GoogleScholarGoogle Scholar |
Hsieh H-F, Shannon SE (2005) Three approaches to qualitative content analysis. Qualitative Health Research 15, 1277–1288.
| Three approaches to qualitative content analysis.Crossref | GoogleScholarGoogle Scholar | 16204405PubMed |
Hunt G, Kidd M (2020) COVID-19: Whole of population telehealth for patients, general practice, primary care and other medical services. (Department of Health) Available at https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/covid-19-whole-of-population-telehealth-for-patients-general-practice-primary-care-and-other-medical-services [Verified 20 January 2022]
Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G (2020) Delayed access or provision of care in Italy resulting from fear of COVID-19. The Lancet. Child & Adolescent Health 4, e10–e11.
| Delayed access or provision of care in Italy resulting from fear of COVID-19.Crossref | GoogleScholarGoogle Scholar |
Lewis R, Blake C, Shimonovich M, Coia N, Duffy J, Kerr Y, Wilson J, Graham CA, Mitchell KR (2021) Disrupted prevention: condom and contraception access and use among young adults during the initial months of the COVID-19 pandemic. An online survey. BMJ Sexual & Reproductive Health 47, 269–276.
| Disrupted prevention: condom and contraception access and use among young adults during the initial months of the COVID-19 pandemic. An online survey.Crossref | GoogleScholarGoogle Scholar |
Lim MS, Bowring A, Gold J, Hellard ME (2011) What’s your “porn star” name? A novel method of identifying research participants. Sexually Transmitted Diseases 38, 150–151.
| What’s your “porn star” name? A novel method of identifying research participants.Crossref | GoogleScholarGoogle Scholar | 21209598PubMed |
North Western Melbourne PHN (2021) It’s OK to see your GP. Available at https://nwmphn.org.au/for-community/campaigns/its-ok-to-see-your-gp/ [Verified 2 February 2022]
Prime Minister of Australia (2020) National Cabinet Statement. Available at https://www.pm.gov.au/media/national-cabinet-statement [Verified 20 January 2022]
RACGP (2020) RACGP launches nationwide campaign to stop people neglecting their health due to COVID-19. (RACGP) Available at https://www.racgp.org.au/gp-news/media-releases/2020-media-releases/april-2020/racgp-launches-nationwide-campaign-to-stop-people [Verified 20 January 2022]
Reyniers T, Rotsaert A, Thunissen E, Buffel V, Masquillier C, Van Landeghem E, Vanhamel J, Nöstlinger C, Wouters E, Laga M, Vuylsteke B (2021) Reduced sexual contacts with non-steady partners and less PrEP use among MSM in Belgium during the first weeks of the COVID-19 lockdown: results of an online survey. Sexually Transmitted Infections 97, 414–419.
| Reduced sexual contacts with non-steady partners and less PrEP use among MSM in Belgium during the first weeks of the COVID-19 lockdown: results of an online survey.Crossref | GoogleScholarGoogle Scholar | 33172917PubMed |
Rich JL, Chojenta C, Loxton D (2013) Quality, rigour and usefulness of free-text comments collected by a large population based longitudinal study – ALSWH. PLoS One 8, e68832
| Quality, rigour and usefulness of free-text comments collected by a large population based longitudinal study – ALSWH.Crossref | GoogleScholarGoogle Scholar | 23874784PubMed |