Table 3 Barriers to the dissemination, diffusion, scale up, or sustainability of DMPA by AIDED model components
Barrier | # sources citing factor | AIDED model component(s) to which factor was mapped |
|---|---|---|
Lack of system capacity (e.g., delivery or administrative challenges, lack of equipment, supply chain stock-outs due to mismanagement, staff burden) | 5 | Innovate, Develop |
Rural nature of program areas (e.g., difficulties in maintaining supply chain or human resource levels) | 5 | Devolve |
Inadequate resources for scaled-up activities | 4 | Devolve |
Competing alternatives (e.g., other types of family planning products such as condom, diaphragm, or pill) | 3 | Develop |
Misaligned government policies and priorities (e.g., preference for HIV/AIDS projects, longer acting methods, or provision of family planning by medical personnel) | 3 | Assess, Develop, Devolve |
Data collection challenges (e.g., insufficient contact between front line and supervisors, front line failure to understand tools, follow-up challenges) | 3 | Develop |
Social or cultural norms (e.g., male dominance or power, elder family member objections, general concerns about fidelity and family size) | 1 | Assess, Innovate, Engage, |
Lack of knowledge or awareness (e.g., inadequate counseling or patient education, lack of patient-centered care, limited information sharing) | 1 | Develop, Engage |
Opposition by medical professionals | 1 | Assess, Engage |
Lack of ongoing stakeholder support (e.g., key leaders left after pilot phase) | 1 | Devolve |