What motivates primary care providers to prescribe mifepristone medication abortion? Results of a qualitative investigation in Canada.

BACKGROUND: Mifepristone-misoprostol, the gold standard medication abortion drug regimen, became available in Canada in 2017. However, there is limited evidence regarding the factors that influence primary care providers to begin prescribing medication abortion. We aimed to explore perspectives of the behavioural, social, and system factors that influence implementation of medication abortion prescribing among primary care providers in Canada. METHODS: We led a qualitative investigation involving one-on-one interviews with primary care providers who were interested in becoming or already were low-volume medication abortion prescribers in Canada. We collected data at two time points: (1) in 2018 after the first year of mifepristone's availability and (2) in 2023. We recruited participants through partner health organizations' online platforms and listservs. We conducted reflexive thematic analysis to understand resolved, novel, and ongoing factors influencing the implementation of mifepristone in primary care and mapped our results to Diffusion of Innovation theory. RESULTS: We completed 18 interviews with primary care providers from across Canada. We identified 5 core Diffusion of Innovation factors that were important to primary care provider implementation of medication abortion care. These factors included adoption and assimilation (motivation), where prescriber pro-choice attitudes and commitment to provide abortion as part of generalist primary care were facilitators. The innovation (knowledge required to use it) and implementation (external collaboration) were interrelated constructs: after training in the knowledge and skills to offer medication abortion, prescribers needed ongoing collaboration and support with physician and pharmacist peers. System antecedents (a receptive context for change) included challenges with abortion-related stigma and harassment in professional and community settings. Finally, system readiness (dedicated time and resources) was necessary to ensure ease in the logistics of medication abortion care, including billing, counseling, and delays in timely care. CONCLUSIONS: Our results highlight that, after five years, barriers still exist to providing mifepristone medication abortion in Canadian primary care. We illustrate the importance of addressing ongoing perceptions of logistical barriers to care, concerns about advertising abortion services to the community, and the need for robust mentorship and consultation pathways.