长效可逆避孕方法的可及性：一项旨在提升初级保健机构能力的系统综述

摘要(中文译文)

本研究旨在识别并综合已发表文献中关于新西兰长效可逆避孕（long-acting reversible contraception）公平可及性的障碍与促进因素，并特别关注毛利女性（wāhine Māori）。研究采用系统综述方法，依据系统综述和荟萃分析优先报告条目2020工具（Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020），对同行评议期刊文章和灰色文献进行检索，以识别长效可逆避孕公平可及性的障碍与促进因素。采用主题分析呈现并综合结果。共纳入15条记录，从中提炼出五个关键主题：（i）健康素养，（ii）照护可及性，（iii）临床经验，（iv）文化安全性，（v）数据。每个主题均涉及对人力配置能力与培训缺口、服务可及性、数据与问责机制不足以及筹资结构不一致等问题的关切。研究结果凸显了结构性不平等对毛利女性（wāhine Māori）造成不成比例的影响。毛利女性的避孕需求更难以得到满足，这表明提供文化安全的高质量照护至关重要。加强初级保健性健康服务队伍的专业发展机会对于解决这些差异至关重要。研究结果强调需要改善可及性、提升照护质量并减少性与生殖健康不平等。

Abstract

The aim of this study was to identify and synthesise published literature on barriers and facilitators to equitable access to long-acting reversible contraception in New Zealand, with a particular focus on wāhine Māori. A systematic review utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 tool was conducted on peer-reviewed journal articles and grey literature to identify barriers and facilitators to equitable access to long-acting reversible contraception. Thematic analysis was utilised to present and synthesise the results. Fifteen records were included in the study, from which five key themes emerged: (i) health literacy, (ii) access to care, (iii) clinical experience, (iv) cultural safety and (v) data. Each theme addressed concerns regarding workforce capacity and training gaps, service accessibility, inadequate data and accountability mechanisms and inconsistent funding structures. The findings highlight structural inequities that disproportionately affect wāhine Māori (Māori women). Wāhine Māori are less likely to have their contraceptive needs met, demonstrating the importance of culturally safe, high-quality care. Strengthening access to professional development for the primary care sexual health workforce is essential to addressing these disparities. The findings highlight the need to improve access, enhance the quality of care and reduce sexual and reproductive health inequities.

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