Exploring the factors that influence implementation of mifepristone abortion practice in Canada: The CART-Mife Study

Approximately one-third of Canadian women will have an abortion in their lifetime. About 100,000 occur annually, of which 96 percent are provided using surgery. Mifepristone, the gold standard for medical abortion, was recently approved by Health Canada with availability anticipated in 2016. Mifepristone abortion delivered in primary care settings has been shown to be safe, effective, and not to increase abortion rates. However, international implementation of this practice varies and may be due to differences in health systems, provider training and supports, and regulations.

Best practices in knowledge translation indicate that, to maximize the impact of this health service innovation, it is necessary first to understand the barriers and facilitators that will influence mifepristone implementation in Canada. Health Canada has specified several extraordinary restrictions, including that physicians and pharmacists who provide mifepristone must be certified through an accredited training program. We propose that training and certification alone will be insufficient to support adoption and distribution of this innovation, especially in rural areas and among clinicians not currently providing abortion care.

This study seeks to explore the question “What are the barriers and facilitators that influence successful implementation and ongoing provision for medical abortion service?” Specific research objectives include:

1. Exploring health policy, system, and service barriers and facilitators to physicians and pharmacists’ adoption of mifepristone practice.
2. Developing a theoretically informed framework for supporting the implementation of mifepristone practice in Canada.

This research is embedded within a larger mixed methods program of study. I will use qualitative methods founded on Diffusion of Innovation theory. The results of the study will inform the development of a theory-based knowledge translation framework for promoting the implementation of mifepristone practice in Canada. Findings may be generalizable to implementation of other health service innovations in sexual and reproductive health in the Canadian health services context. Knowledge about the effect of the full range of health policy, system, and service determinants on access to mifepristone abortion is needed to realize the potential to increase equitable, safe, confidential abortion care closer to home.