Wednesday, 6 April 2016

A qualitative study of the barriers and enablers to fertility-awareness education in general practice

Kerry D. Hampton
Jennifer M. Newton
Rhian Parker
Danielle Mazza

A qualitative study of the barriers and enablers to fertility-awareness education in general practice

Infertility is a global public health issue that affects 9% of couples worldwide (Boivin et al. 2009). A plethora of published research exists on assisted reproductive technology (ART) treatment. Similarly, the growth of available ART clinics worldwide providing care services for infertile people has been exponential (Kamphuis et al. 2014).

However, concern is mounting about the rising trend in increasing use of ART treatment. This stems from the increased risks associated with ART-conceived children compared with naturally-conceived children, including higher overall healthcare costs and increases in morbidity and mortality for both mothers and children (Kamphuis et al. 2014).

There is a substantial literature on fertility-awareness (a woman’s ability to identify the fertile period of the menstrual cycle) as one way of reducing infertility (Stanford et al. 2008, Tham et al. 2012). However, to date, no primary care model in fertility-awareness has been described.

In this study published in JAN, titled: ‘A qualitative study of the barriers and enablers to fertility-awareness education in general practice’, the authors report the views of general practitioners’ (GPs) and practice nurses’ (PNs) on the barriers and enablers, and how general practitioners and practice nurses can best work together to improve the delivery of fertility-awareness education for women who first report trouble conceiving (Hampton et al. 2016).

Our previous work established that poor levels of fertility-awareness exist in women, and that most women would like to receive this type of education before they are referred to ART clinics (Hampton et al. 2013, Hampton and Mazza 2015). Similarly, most GPs and PNs are aware of women’s overall poor understanding of fertility-awareness. They nominated PNs (nurses and midwives) as the most appropriate health practitioner in general practice to enhance women’s fertility-awareness in the belief that the knowledge may assist some infertile women to conceive (Hampton 2014).

The biggest barriers to fertility-awareness education in general practice were short consultations and time constraints faced by general practitioners together with a lack of patient educational materials and remuneration to support its delivery. The main enablers were a greater use of nurses and midwives trained in fertility-awareness who work in a collaborative team care arrangement with GPs.

The authors conclude that a primary care model in fertility-awareness would fill an important gap in the initial care of infertile women, and build capacity in general practice to reduce infertility through women’s enhanced fertility-awareness.


Boivin, J., Bunting, L., Collins, J. A. & Nygren, K. G. (2009). Reply: International estimates on infertility prevalence and treatment seeking: potential need and demand for medical care. Human Reproduction, 24(9), 2380-2383. doi:10.1093/humrep/dep218

Hampton, K. D. (2014) Informing the development of a new model of care to improve the fertility-awareness of sub-fertile women in primary health care. PhD Monash University

Hampton, K. D. & Mazza, D. (2015). Fertility-awareness knowledge, attitudes and practices of women attending general practice. Australian Family Physician, 44(11), 840-845.

Hampton, K. D., Mazza, D. & Newton, J. M. (2013). Fertility-awareness knowledge, attitudes and practices of women seeking fertility assistance. Journal of Advanced Nursing, 69(5), 1076-1084. doi:10.1111/j.1365-2648.2012.06095.x.

Hampton, K. D., Newton, J. M., Parker, R. & Mazza, D. (2016). An examination of the barriers and enablers to fertility-awareness education in general practice: a qualitative study. Journal of Advanced Nursing. Kamphuis, E. I., Bhattacharya, S., Van Der Veen, F., Mol, B. W. J. & Templeton, A. (2014). Are we overusing IVF? British Medical Journal, 348(g252). doi:10.1136/bmj.g252

Stanford, J. B., Parnell, T. A. & Boyle, P. C. (2008). Outcomes from treatment of infertility with natural procreative technology in an Irish general practice.  Journal of the American Board of Family Medicine, 21(5), 375-384.

Tham, E., Schliep, K. & Stanford, J. B. (2012). Natural procreative technology for infertility and recurrent miscarriage: Outcomes in a Canadian family practice. Canadian Family Physician, 58(May), e267-e274.

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