(SPSS) (version 20, IBM, Armonk, NY,USA). Midwives who used the RLP and midwives who had not used the RLP were compared regarding background variables (age, years of experience of contraceptive counselling, workplace, type of clinic, number of visits for contraceptive counselling/week) with Mann–WhitneyU-test for continuous and ordinal variables and Pearson’s x2 test for categorical variables. Ethical considerations The study was approved by the Regional Ethical Review Board in Uppsala, Sweden (2012/101). Written consent was obtained when participants provided some demographic characteristics before the interview started. Results Adoption of the RLP in contraceptive counselling Initially, 78% (n ¼ 53) of all midwives in the county agreed to use the RLP in their contraceptive counselling, and 68% (n ¼ 36) of allmidwives responding to the questionnaire had used RLP in their contraceptive counselling. The characteristics of the midwives are presented in Table II. Midwives who had not used the RLP had fewer visits for contraceptive counselling per week than midwives who had used it. A higher proportion of nonresponders were employed by a private health care provider than responders. Themost common reason for not using the RLP was the midwife had not received any information about the RLP (n ¼ 8). No midwife stated they did not like the idea of RLP in contraceptive counselling. The results regarding the general experience of the RLP among the midwives who had used it are presented in. Table I Example of the analytical process in a study of how the reproductive life plan (RLP) is adopted in contraceptive counselling by midwives. Interview transcript Initial coding Sub-category Category – yes, just this is exciting... when you go a little deeper and see what knowledge or ignorance there is [FGI2] Exciting to explore women’s knowledge 1.1. A rewarding way of working and easier than expected 1. The experience of the RLP was predominantly positive – but sometimes I feel that it is rather too late when they come to us... – ... it is like you need to start already in day care, for there... children already begin to talk, ... and it then follows all the way [FGI3] Need to begin earlier 4.3. Expanding the usage to other target groups, arenas, and professions 4. Long-term implementation comprises opportunities, risks and needs FGI, focus group interview. Figure 2 Overview of the content of the reproductive life plan (RLP) booklet developed to distribute to the women. Midwives’ adoption of the reproductive life plan 1149 Downloaded from by guest on 02 February 2022 Experiences and opinions of theRLP according to the FGIs The characteristics of the midwives in the FGI did not differ from the other midwives who had used RLP, except that a higher proportion in the FGI worked for private health care providers. Midwives who participated in the FGI were also more positive regarding their general experience of the RLP than midwives who did not participate in the FGI. During the FGI, the questions most often led to a lively discussion, where the midwives often interrupted each other and expressed both agreement and disagreement. In some groups, a few participants dominated the discussion, but all midwives made their voices heard. To introduce the RLP into the counselling, some midwives used the direct question ‘do you want children in your life?’, whereas others wove it into the conversation. Some told the women about the study as a reason for raising the topic, some asked for the women’s permission to discuss the topic and some used questions about fertility to approach the topic. The RLP-guide was considered a good and relevant support for the discussion and was often placed nearby to serve as a reminder. Although the RLP-guide was seldom used literally, some midwives used it together with the patient and some had not used it at all. Some midwives used the booklet during counselling, for example as a starting point for discussion, by going through the information together with the woman or by using the fertility quiz. Some midwives gave reading instructions and others just handed it out. The booklet was generally considered an asset for the midwife, particularly when time was restricted and as an accessible information resource for the woman. Four categories emerged from the FGIs about the midwives experiences and opinions of working with the RLP (Fig. 3), and selected quotations from the midwives appear below. 1. A predominantly positive experience The midwives had various degrees of experience with the RLP. There was general lack of experience of using the RLP with women from different cultural backgrounds, with non-Swedish speaking women, when a partner was present, and with men alone. However, when used, the experience was predominantly positive. Table III General experience of the RLP among midwives who used the RLP (n 5 36). N The very idea of the RLP is... Very or rather good 35 Neither good nor bad 1 Very or rather bad 0 Missing 0 My general experiences of RLP have been... Very or rather positive 33 Neither positive nor negative 3 Very or rather negative 0 Missing 0 The booklet to the patients was... Very or rather useful 33 Neither useful nor useless 2 Very or rather useless 0 Missing 1 The RLP-guide to the midwives was... Very or rather useful 32 Neither useful nor useless 4 Very or rather