Drisana Henry1, Sarah Wood2, Neo Moshashane3, Kehumile Ramontshonyana3, Christina Amutah4, Pegah Maleki5, Claire Howlett5, Merrian J Brooks6, Aamirah Mussa7, Dipesalema Joel8, Andrew P Steenhoff9, Aletha Y Akers10, Chelsea Morroni11. 1. Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: drhenry121@gmail.com. 2. Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 3. Botswana-Harvard AIDS Institute Partnership; Botswana-UPenn Partnership. 4. University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania. 5. PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 6. Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 7. Botswana-Harvard AIDS Institute Partnership. 8. University of Botswana, Gabarone, Botswana. 9. University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Botswana-UPenn Partnership; University of Botswana, Gabarone, Botswana. 10. Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania. 11. Botswana-Harvard AIDS Institute Partnership; Botswana-UPenn Partnership; MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom.
Abstract
STUDY OBJECTIVE: Botswana has a high pregnancy rate among adolescent girls and young women (AGYW). Long-acting reversible contraceptive (LARC) use among AGYW in Botswana is low, despite its high effectiveness for preventing pregnancy. Using an implementation science framework, we assessed barriers and facilitators to LARC implementation among AGYW in Botswana. DESIGN: Cross-sectional mixed methods. SETTING: Gaborone, Botswana. PARTICIPANTS: Twenty sexually active AGYW ages 18-24 years; 20 health system stakeholders. INTERVENTIONS: Surveys and semistructured interviews grounded in the Consolidated Framework for Implementation Research. MAIN OUTCOME MEASURES: Themes reflecting barriers and facilitators of LARC implementation. RESULTS: The median age for AGYW was 22 (interquartile range, 21-23) years. Twenty percent were using an implant and none had ever used an intrauterine device. Barriers and facilitators of LARC implementation spanned factors at each Consolidated Framework for Implementation Research domain: (1) LARC characteristics like side effects; (2) the clinics' inner settings, including availability of youth-friendly services; (3) characteristics of health system stakeholders, such as LARC skills, and AGYW experiences, attitudes, and beliefs about LARCs; (4) the outer setting external to clinics and Botswana's health system including reproductive health law and policy for minor adolescents; and (5) the implementation process level such as the availability of free or low-cost LARCs. CONCLUSION: We identified multilevel, context-specific factors that affect LARC implementation. Our findings can inform the development of interventions to increase LARC implementation in Botswana by addressing intersecting factors across patient, clinic, health system, and sociopolitical levels, such as providing confidential services to minors and improving LARC training and supply chain pipelines.
STUDY OBJECTIVE: Botswana has a high pregnancy rate among adolescent girls and young women (AGYW). Long-acting reversible contraceptive (LARC) use among AGYW in Botswana is low, despite its high effectiveness for preventing pregnancy. Using an implementation science framework, we assessed barriers and facilitators to LARC implementation among AGYW in Botswana. DESIGN: Cross-sectional mixed methods. SETTING: Gaborone, Botswana. PARTICIPANTS: Twenty sexually active AGYW ages 18-24 years; 20 health system stakeholders. INTERVENTIONS: Surveys and semistructured interviews grounded in the Consolidated Framework for Implementation Research. MAIN OUTCOME MEASURES: Themes reflecting barriers and facilitators of LARC implementation. RESULTS: The median age for AGYW was 22 (interquartile range, 21-23) years. Twenty percent were using an implant and none had ever used an intrauterine device. Barriers and facilitators of LARC implementation spanned factors at each Consolidated Framework for Implementation Research domain: (1) LARC characteristics like side effects; (2) the clinics' inner settings, including availability of youth-friendly services; (3) characteristics of health system stakeholders, such as LARC skills, and AGYW experiences, attitudes, and beliefs about LARCs; (4) the outer setting external to clinics and Botswana's health system including reproductive health law and policy for minor adolescents; and (5) the implementation process level such as the availability of free or low-cost LARCs. CONCLUSION: We identified multilevel, context-specific factors that affect LARC implementation. Our findings can inform the development of interventions to increase LARC implementation in Botswana by addressing intersecting factors across patient, clinic, health system, and sociopolitical levels, such as providing confidential services to minors and improving LARC training and supply chain pipelines.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Laura J Damschroder; David C Aron; Rosalind E Keith; Susan R Kirsh; Jeffery A Alexander; Julie C Lowery Journal: Implement Sci Date: 2009-08-07 Impact factor: 7.327
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