Adolescent Access to Oral Emergency Contraception in German On-Duty Community Pharmacies: A Protocol for a Nationwide Mystery Caller Investigation v2

<p>Background: Oral emergency contraceptives should be taken as soon as possible after unprotected sexual intercourse. Rapid and low-threshold access is therefore important. Evidence indicates counseling deficits and barriers to access in community pharmacies, especially for adolescents and third-party requests. On-duty community pharmacy services are highly relevant in this context, but have not yet been systematically investigated. Objectives: This protocol describes a planned nationwide study examining whether and under what conditions female adolescents and male partners requesting oral emergency contraception on behalf of an affected adolescent can obtain access to the “morning-after pill” in German on-duty community pharmacies (“appropriate outcome”). It will further assess whether pharmacy staff ask relevant counseling questions based on the checklist of the German Federal Chamber of Pharmacists and provide recommendations consistent with the information obtained. Methods: The study will use the Simulated Patient Method through standardized mystery calls, which are expected to be conducted from August 08 to September 08, 2026. The sample comprises 382 postal codes drawn as a stratified random sample proportional to the number of community pharmacies in each German federal state. Postal codes will identify on-duty community pharmacies through the official postal-code-based online search. Data will be collected using two standardized scenarios and a predefined assessment form. To ensure data quality, each call will be monitored by a second observer. Ethical Considerations: The study has been approved by the Ethics Committee of the Neubrandenburg University of Applied Sciences, Germany (protocol code HSNB/234/26). Because of the covert design, the study includes measures to minimize risks, ensure pseudonymized data processing, avoid pharmacy specific reporting, provide post-study debriefing, and general, non-pharmacy-specific performance feedback. Expected Contribution: To our knowledge, this study will provide the first nationwide evidence on access to oral emergency contraception for female adolescents and male partners requesting it on behalf of an affected adolescent. Furthermore, irrespective of indication, it will represent the first worldwide application of the Simulated Patient Method in on-duty community pharmacy services.</p>