Use of implementation science to advance family planning programs in low- and middle-income countries: A systematic review

Abstract

ObjectiveAs environmental and economic pressures converge with demands to achieve sustainability development goals, low- and middle-income countries (LMIC) increasingly require strategies to strengthen and scale-up evidence-based practices (EBP) related to family planning (FP). Implementation science (IS) can help these efforts. The purpose of this article is to elucidate patterns in the use of IS in FP research and identify ways to maximize the potential of IS to advance FP in LMIC.Design and methodsWe conducted a systematic review that describes how IS concepts and principles have been operationalized in LMIC FP research published from 2007–2021. We searched six databases for implementation studies of LMIC FP interventions. Our review synthesizes the characteristics of implementation strategies and research efforts used to enhance the performance of FP-related EBP in these settings, identifying gaps, strengths and lessons learned.ResultsFour-hundred and seventy-two studies were eligible for full-text review. Ninety-two percent of studies were carried out in one region only, whereas 8 percent were multi-country studies that took place across multiple regions. 37 percent of studies were conducted in East Africa, 21 percent in West and Central Africa, 19 percent in Southern Africa and South Asia, respectively, and fewer than 5 percent in other Asian countries, Latin America and Middle East and North Africa, respectively. Fifty-four percent were on strategies that promoted individuals' uptake of FP. Far fewer were on strategies to enhance the coverage, implementation, spread or sustainability of FP programs. Most studies used quantitative methods only and evaluated user-level outcomes over implementation outcomes. Thirty percent measured processes and outcomes of strategies, 15 percent measured changes in implementation outcomes, and 31 percent report on the effect of contextual factors. Eighteen percent reported that they were situated within decision-making processes to address locally identified implementation issues. Fourteen percent of studies described measures to involve stakeholders in the research process. Only 7 percent of studies reported that implementation was led by LMIC delivery systems or implementation partners.ConclusionsIS has potential to further advance LMIC FP programs, although its impact will be limited unless its concepts and principles are incorporated more systematically. To support this, stakeholders must focus on strategies that address a wider range of implementation outcomes; adapt research designs and blend methods to evaluate outcomes and processes; and establish collaborative research efforts across implementation, policy, and research domains. Doing so will expand opportunities for learning and applying new knowledge in pragmatic research paradigms where research is embedded in usual implementation conditions and addresses critical issues such as scale up and sustainability of evidence-informed FP interventions.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020199353.

Raising the issue of quality in implementation science reporting in global health: Implications for health planning and practice

“…Several systematic reviews of implementation outcomes in global health have been conducted, examining key barriers and facilitators to global health intervention, and all raised concerns about the quality of outcomes reporting. [8][9][10][11][12][13][14] Common quality-related concerns across reviews included exclusion of implementation outcomes from study objectives, inaccurate operationalisation (e.g., operationalising feasibility with a measure that does not capture feasibility), lack of clear hypotheses about implementation outcomes, and lack of theory to guide outcome selection. Reviews have also highlighted issues around use of non-standardized or study-specific measures that are not clearly described ("How satisfied are you with this intervention?")…”

“…Unfortunately, the quality of implementation outcomes reporting in the global health literature to date is poor. Several systematic reviews of implementation outcomes in global health have been conducted, examining key barriers and facilitators to global health intervention, and all raised concerns about the quality of outcomes reporting 8–14 . Common quality‐related concerns across reviews included exclusion of implementation outcomes from study objectives, inaccurate operationalisation (e.g., operationalising feasibility with a measure that does not capture feasibility), lack of clear hypotheses about implementation outcomes, and lack of theory to guide outcome selection.…”

Turning the promise of multipurpose prevention technologies into a market reality: a commentary

“…Increasingly, implementation science has been identified as an integral approach for new product introduction because it offers frameworks, tools, and methodologies that support the systematic, holistic roll out of a new product using a socio-ecological model (33,34). Ultimately, insight gained from implementation science studies and related work leads to better informed choice counseling and adherence strategies to respond to clients' evolving needs across their lifetime (35). It further provides national stakeholders and communities with a sustainable pathway to scale up prevention interventions through a continuous, research-to-practice learning process.…”