Scaling up depot medroxyprogesterone acetate (DMPA): a systematic literature review illustrating the AIDED model

Abstract

Background: Use of depot medroxyprogesterone acetate (DMPA), often known by the brand name Depo-Provera, has increased globally, particularly in multiple low- and middle-income countries (LMICs). As a reproductive health technology that has scaled up in diverse contexts, DMPA is an exemplar product innovation with which to illustrate the utility of the AIDED model for scaling up family health innovations.

Methods: We conducted a systematic review of the enabling factors and barriers to scaling up DMPA use in LMICs. We searched 11 electronic databases for academic literature published through January 2013 (n = 284 articles), and grey literature from major health organizations. We applied exclusion criteria to identify relevant articles from peer-reviewed (n = 10) and grey literature (n = 9), extracting data on scale up of DMPA in 13 countries. We then mapped the resulting factors to the five AIDED model components: ASSESS, INNOVATE, DEVELOP, ENGAGE, and DEVOLVE.

Results: The final sample of sources included studies representing variation in geographies and methodologies. We identified 15 enabling factors and 10 barriers to dissemination, diffusion, scale up, and/or sustainability of DMPA use. The greatest number of factors were mapped to the ASSESS, DEVELOP, and ENGAGE components.

Conclusions: Findings offer early empirical support for the AIDED model, and provide insights into scale up of DMPA that may be relevant for other family planning product innovations.

Figure 1

Schematic of the AIDED model for scaling up family health innovations. Legend: The figure presents the five non-linear, interrelated actions of the AIDED model: 1) assess the landscape, 2) innovate to fit user receptivity, 3) develop support, 4) engage user groups, and 5) devolve efforts for spreading innovation. The model suggests that successful scale up occurs within a complex adaptive system, characterized by interdependent parts, multiple feedback loops, and several potential paths to achieve intended outcomes. Source: Bradley et al. [9]. Copyright is held by the authors under the Creative Commons License and permission is granted for reproduction in this manuscript.

Figure 2

Peer-reviewed literature review sample selection process. Legend: The figure summarizes the results of each stage in the search and review process for selecting the sample of peer-reviewed literature. Source: Authors.