Enhancing Self-Administered Contraception through Embedded Research (EASIER): Protocol for embedding implementation research in the introduction and scale up of self-administered DMPA SC in public health systems (Preprint)

Abstract

The introduction of self-administered injectable contraception presents an opportunity to address unmet need for family planning. As ministries of health scale up self-administered injectable contraception as an additional contraceptive choice in health systems, there is a scarcity of knowledge on the implementation practices and contextual conditions that help and hinder these efforts and whether implementation addresses the perceived needs of users While embedding implementation research (IR) can help address this, in many countries there are gaps in health systems’ capacity to translate findings into programmatic decisions. The Department of Sexual and Reproductive Health and Research in the WHO launched the “Enhancing Self-Administered family planning through Embedded Research Project” (EASIER) to address these challenges.

Objectives of the project was to (1) Assess the coverage of self-injectable contraception, and readiness of health systems to integrate it into the contraceptive method mix. (2) Document strategies used to introduce and scale up self-injectable contraception and understand practices that have led to success and challenges. (3) Identify the contextual factors that affect the adoption and implementation of self-injectable contraception throughout health systems. (4) Understand whether implementation addresses users’ preferences and needs. (5) Strengthen collaboration between decision-makers, researchers and implementers, support and build capacity to use evidence.

The EASIER project developed a global protocol that IR teams in Burkina Faso, Ghana, and Kenya can adapt into country-level embedded IR projects. In all countries, the following data collection will occur: 1) At national level, IR teams evaluate the policy environment for scaling up of DMPA-SC for self-administration by conducting a desk review and in-depth interviews with national stakeholders; (2) At the local government level IR teams implement quantitative questionnaires on structural and organizational readiness to integrate self-injection into the method mix; (3) In “case study” districts (or counties, provinces) IR teams conduct in-depth interviews and focus group discussions with FP practitioners and stakeholders, community members, and users of self-administered injectable contraception, and (4) in dissemination meetings, IR teams use Participatory Action Research to elicit stakeholder participation and translate findings into programmatic decisions.

EASIER has been launched in all three countries. In Burkina Faso, data collection has been completed and analyses are underway. In Kenya, the IR team is currently collecting data, and in Ghana IR partners are in the process of adapting the protocol for local context.

The EASIER protocol presents a strategy to embed IR in contraceptive method introduction and scale up efforts, address local needs for new knowledge, devise ways to maximize the impact of new technologies when delivered through routine systems, and build capacity for using evidence in programmatic decisions. Adaptation and implementation of country-level IR studies will help advance the use of IR to strengthen FP programs.

ACTRN12622001228774 (Australia New Zealand Clinical Trials Registry)