Table 1 Systematized information of the barriers and facilitating factors for the use of the implementation of the kits

Morrison, 2015 [21]

Nepal

To explore the reasons for low CDKs utilization, and to describe community perceptions of CDKs in Nepal

Acceptability:

- Cultural: CDKs users did not always hold the decision-making power to purchase or use the CDK. The decision to use the CDK was often made by the mother-in-law or husband of the pregnant woman, who might have limited knowledge of the CDK, or do not perceive its usefulness.

- Popular Beliefs: Preparation might also be constrained by traditional belief that it would bring bad luck.

Accessibility:

- Financial: Although most people found the CDK price reasonable, some perceived it to be too expensive for poor people.

- Health literacy: The use and recognition of CDKs was low among the families.

Contact:

- Lack of awareness: CDK potential benefits were not perceived (i.e. infection).

Availability:

- For some, CDKs was not easily available. Inadequate promotion.

Acceptability:

CDK was generally well regarded by its users. The convenience and the hygienic components were the main reasons people said they used the CDK.

Reputation - TBAs in particular felt that the CDK helped them maintain their professional reputation by preventing illness during births. Readiness to change - TBAs’ attitude toward the CDK as opinion leader was decisive in their promotional efforts.

Contact:

CDKs were perceived as “clean and safe”

Availability:

CDKs with all the necessary materials in one place might reduce delays in receiving care.

Dietsch, 2011 [22]

Kenya

To learn lessons from a traditional midwifery workforce in Western Kenya

Not mentioned

Acceptability;

CDK were highly valued by TBA and might be an attraction to get linked with NGOs who distributed them and deliver seminars.

Waiswa, 2008 [23]

Uganda

To explore the acceptability and barriers to the recommended evidence-based practices. CDKs were one of the practices assessed as an evidence based intervention.

Acceptability:

- Cultural: Decision making was a male prerogative

- Popular Beliefs: Fear of preparing for the unborn whose viability is considered uncertain.

Accessibility:

- Out of stock in health units.

- Financial: CDK were perceived as expensive.

Contact:

Sanitary reasons: Using a new razorblade was considered important.

Winani, 2005 [24]

Tanzania

To gather information from CDK users and non-users in the community on the acceptability, correct use, and appropriateness of single-use, CDK.

Accessibility:

- Health literacy: Misunderstanding of the pictorial instructions.

Accessibility:

- Comprehension reasons: Even though the pictorial instructions were not well understood, women managed to use the CDK with no major complications.

Contact:

CDK were perceived as contributing to a clean delivery. Users showed willingness to pay for it, and they recommended it should` be used by other women.

PATH, 2002 [25]

Nepal

To understand the context of CDK use and non-use by women for their own childbirth and by women assisting them during delivery.

Acceptability:

- Popular beliefs: Birth preparedness (BP) was a bad presage.- The highly ritual value of washing hands could inhibit real understanding of the need for washing hands (performed as ritual more than to reduce infection)

- Cultural: Mothers themselves were not supposed to be involved in any birth preparation. Mothers had low decision-making autonomy.

Accessibility:

- Financial: Households often were not willing or able to spend the money to buy the CDK .

- Health literacy: There was low understanding of the pictorial instructions.

- The women expected to receive the CDK for free. In terms of how to spend the money, other materials and activities (name given ceremony) were seen as more important and get priority over the CDK. -

- Also, most women did not know where to buy the CDK

Contact:

- Lack of Awareness: Weak perception of the usefulness of the CDK

Acceptability:

The CDK was generally well regarded by its users.

TBAs feel that the CDK helped them maintain their professional reputation by preventing illness during births.

Contact:

People were aware that dust and dirt might cause disease and that the CDK are clean and hygienic

Availability:

- Pragmatic: All supplies were available and ready to use in one place.

Nessa, 1992 [26]

Bangladesh

To produce a CDK that would appeal to potential buyers

Accessibility:

- Health literacy: Misunderstanding of the pictorial message.

Acceptability:

Users generally approved the CDK (The one that was produced with their inputs)

Steen, 2007 [20]

United Kingdom

To explore women’s experiences of using a self-administered kit of homeopathic remedies during the latter part of pregnancy, birth experience and the early postnatal period

Not mentioned

Acceptability:

Women felt the kit could help them rather than feeling helpless or powerless. Many women and their partners expressed feelings of empowerment; the kit gave a focus.

McDougal, 2012 [28]

Lesotho

To examine the availability, feasibility, acceptability and possible negative consequences of a Minimum PMTCT Package, and to identify key learning from Lesotho’s experience with the Minimum PMTCT Package to inform future programming and evaluation of co-packaged medicines.

Accessibility:

- Comprehension: Lack of patients’ ability to follow the complex instructions. Impatience of staff explaining patients.

Contact:

Providers expressed concern about adherence issues in women who had not disclosed their HIV status to their partners. Women might interrupt ANC and not deliver in facilities when they already obtain the medication in the Kit.

Availability:

Drug availability was a major bottleneck to scale up the implementation of the kit.

Acceptability:

Providers seemed to have a positive attitude toward the Minimum PMTCT Package. They felt it saved lives and that it was reducing the number of babies born HIV positive.

It could be rapidly scaled up; it was feasible to deliver within the context of routine ANC; it was acceptable to most of providers and clients; it did not appear to adversely affect the quality of ANC; and it did not affect the care among exposed infants in the first months of life.

Availability:

Most women were very happy to have medication to prevent their child from getting sick. Providers perceived it as a potentially life-saving intervention