Barriers and Facilitators to Implementing Immediate Postpartum Contraceptive Implant Programs: A Formative Implementation Research

Figures & data

Table 1 Characteristics of Healthcare Providers (n = 29)

Characteristics	n (%)
Role
Physician administrator	3
Nurse administrator	2
Physician	12
Nurse	9
Policy maker	3
Healthcare facility (n = 26)
University Hospital	10
General Hospital	11
District Hospital	5
Experience treating postpartum women (years)
Fewer than 5	15
5–9	4
10–14	4
15 or more	6
Contraceptive implant experience
Counsels about or provides contraceptive implants	21
Some training about contraceptive implants but does Does not currently counsel or provide the service	2
No training or education about contraceptive implants; personal or anecdotal experience only	6

Table 2 Characteristics of Postpartum Women (n = 10)

Characteristics	n
Age (mean, range)	26.6 (17–36)
Education
Secondary school	3
High school	4
Bachelor’s degree or higher	3
Partner’s education
Secondary school	4
High school	4
Bachelor’s degree or higher	2
Total monthly family income (Baht)
˂10,000	4
10,000 −30,000	4
> 30,000	2
Parity
Primiparous	3
Multiparous	7
Intended index pregnancy
Yes	6
Desire to use contraceptive implant
Yes	5
Contraception prior to conception
None	1
COCs	3
DMPA	1
Condom	2
Implant	1
IUD	1

Abbreviations: COCs, combined oral contraceptive pills; DMPA, depot medroxyprogesterone acetate; IPI, inter-pregnancy interval; IUD, intrauterine device.

Table 3 Facilitators and Barriers to Immediate Postpartum Contraceptive Implantation Using the Consolidated Framework for Implementation Research

CFIR Domain	Barriers	Facilitators
Intervention
Characteristics
● Evidence Strength and Quality  ● Relative Advantage  ● Cost	● Lacking funding for a training course	● Strong evidence of safety and efficacy ● More advantages when compared to delayed insertion
Outer setting
● Patient Needs and Resources  ● Cosmopolitanism  ● External Policies and Incentives	● Policy does not support non-teenagers ● Disconnect among organizations	● Teenagers received contraceptive implants free of charge ● Other organizations were able to provide support ● Reimbursement policy and laws that promote autonomy
Inner setting
● Organizational Incentives & Rewards (Implementation Climate sub-construct) ● Available Resources (Readiness for Implementation sub-construct) ● Access to Knowledge & Information (Readiness for Implementation sub-construct)	● Time constraints of providers and limits to device availability ● Lack of a training course	● Setting key performance indicator (KPI)
Characteristics of Individuals
● Knowledge and Beliefs about the intervention  ● Self-efficacy	● Fear of pain during insertion and side effects of contraceptive implants ● Misbelief regarding timing of discontinuation ● Providers’ lack of insertion and counselling ability.	● Receiving positive information from mother, friends, or providers
Process
● Champion (Engaging sub-construct)  ● External Change Agents (Engaging sub-construct)  ● Innovation Participants	● Teachers’ negative attitudes towards sex education	● The family planning unit nurse was referred to as a champion. ● Village health volunteers (VHVs) provide information ● ANC counselling ● Multimedia intervention such as video clips

Abbreviation: ANC, antenatal care.