A Qualitative Critique: Emergency Contraceptive Pills

The qualitative research article by Beaulieu, Kools, Kennedy, & Humphreys (2011) has a clearly identified phenomenon of interest. The author’s intent was to explore the phenomenon of young adult couples’ experiences with Emergency Contraceptive Pills (ECPs) and the potential reasons for its underuse. However, this specific article only presents the conclusions that related to couple consultations and decision-making processes about ECP use. It appears there is a significant need for this particular research study. Although millions of women become pregnant intentionally every year, a substantial additional number of women – around 87 million – become pregnant unintentionally (World Health Organization [WHO], 2005). Of the estimated 211 million pregnancies that occur each year, about 46 million end in induced abortion despite the wide availability of ECPs (WHO, 2005). There are great implications for women who have unintended pregnancy, including financial, health, psychosocial, and relationship consequences. Given the number of unintended pregnancies, their potential implications, and the underuse of ECPs, research is needed to help explore the reasons as to why ECP is under used (WHO, 2005). Literature Review/Conceptual Framework

Within the literature review the author’s present background research that indicates a need for their qualitative research and current research in support of their phenomenon. The author’s position maintains that although there is a decreasing trend in unwanted pregnancy, it continues to be a worldwide problem and presents research that has indicated ECP is a safe, and an effective form of contraception. Given the purported research included in the literature review, ECPs are widely available in most Western countries, but are underutilized (Beaulieu et al., 2011). Furthermore, background literature is reported in an organized manner that is subdivided into three additional categories; unintended pregnancy, ECPs, complexities of contraceptive decision making and developmental antecedents. This format allows the reader to easily understand the progression of the research and identify key issues surrounding unintended pregnancy and ECPs.

These research reports are significant because it aids in solidifying the need for the authors current research and also identifies gaps within the knowledge. Gaps identified include the reasons ECPs are underused, the limited research looking at the role of the male partner in the decision making process, study participants developmental levels (Beaulieu et al., 2011). After reading the literature review a person can clearly understand that unintended pregnancies, particularly in young women, are a global problem, ECPs are safe and effective, the decision making process is a complex progression, and that little research has been conducted with couples who are young and unmarried Beaulieu et al., 2011). The purpose of this study to explore the research gap as it related to young couples’ decision making regarding ECPs. Are the Results Validity?

The design was based on the grounded theory method which is a qualitative research approach that allows development of theory about phenomena of interest (Beaulieu et al. 2011). This was an appropriate design for the study because it allows the authors to construct a theory where no theory exists or where existing theories fail to provide evidence to explain a specific set of circumstances (LoBiondo-Woods & Haber, 2010). Given the research presented, there is a gap in the knowledge and currently no theory exists to explain couple decision making and the negotiation process relating to ECP use. Although qualitative research does not provide as strong evidence as quantitative randomized control studies, the domain identified is qualitative, and grounded theory method would be an optimal choice. Two strengths to the studies include achieving data saturation, and conducting member checks. Data saturation is used to help ensure that no new themes will emerge among the data (LoBiondo-Woods & Haber, 2010). In the study, when new categories emerged, interview guides were revised and additional couples were recruited in order to explore these new categories only. Similarly, conducting member checks allows participants to affirm the accuracy and completeness of the research. These strategies aid in strengthening the studies trustworthiness, credibility and dependability by accounting for all possible themes or categories that could explain the phenomenon being explored.

One weakness of the study would be the participant racial make-up. Out of the 44 participants, 34 were Caucasian, and 40 had at least 1 year of college education. I feel that these demographics would make it difficult to generalize these findings to other populations. This would decrease the studies credibility. Another weakness would be that the participants in the study all came from an area where ECP was readily available and education regarding ECP was a requirement for the study. These weaknesses would weaken the studies credibility, dependability and auditability because it would not be easy to replicate a study with such specific participants and make the results less generalizable. Results

Results of this study indicated that the researchers identified 4 related conditions that contributed to how and why young couples make the decision to use or not use ECPs. These conditions included shifting the locus of responsibility, relationship power, woman’s autonomy over her own body, and conflicting views on ECPs. The overall human experience was clearly identified. The authors broke down the categories that emerged during the study and provided detailed accounts for each category. Also the author’s identified patterns that were consistent among participants and themes that were generally woven through each interview. Shifting locus of responsibility noted that in a perfect world the decision to use or not use ECP should be shared equally among each partner; however that is often not the case. This leads into the idea that there is a power differential among genders with women having greater responsibility and power. The third theme, which is closely tied to the power differential, is the woman’s control over her own body. Lastly, there were two couples who held conflicting views regarding the use of ECP, although based upon disinformation. Application of Results

The target population included young couples between the ages of 18-25 who had knowledge of ECP. The authors used a convenience sampling approach and participants contacted the authors via email or phone. The participants were appropriate because they were in the target age, had knowledge about ECP, and in a sexually active relationship. One threat to transferability would be the limited demographic make-up of the participants. Also I do not feel that the study had thick descriptions of study context and setting. Interviews could have been completed at a public place or the participant’s home. Other procedural information was not included and briefly glossed over. Application of Nursing Practice

In this particular scenario the study findings would be applicable. The client who presented in the Women’s Health Clinic was a 21 year old Caucasian female in a sexual relationship. Also the female presented to the clinic with her boyfriend asking about ECP, therefore, indicating some knowledge in the subject. She represents the majority of the participants in the current research study.

The projected significance of the work to nursing is that being able to better understand the how and potentially why young couples make the decision to use or not to use ECP would allow us to better help our patients. Although each decision is individual, if common theories can be identified, then nursing would have a more concrete platform to educate their patients on the decision of using an ECP.

References

Beaulieu, R., Kools, S.M., Kennedy, H.P., & Humphreys, J. (2011). Young adult couple’s decision making regarding emergency contraceptive pills. Journal of Nursing Scholarship 43:1, 41-48. LoBiondo-Wood, G., & Haber, J. (2010). Nursing research: Methods and critical appraisal for evidence-based practice (7th ed.). St. Louis, MO: Mosby, Inc. World Health Organization. (2005). Unsafe abortion. Global and regional estimates of the incidence of unsafe abortions and associated mortality in 2003. Retrieved December 7, 2012, from http://www.who.int/reproductive-health/publication/unsafeabortions_2003/ua_estimates03.pdf