Table 3.

Barriers to the dissemination, diffusion, scale up, or sustainability of DMPA by AIDED model components

Barrier	# sources citing factor	AIDED model component(s) to which factor was mapped
Lack of system capacity (e.g., delivery or administrative challenges, lack of equipment, supply chain stock-outs due to mismanagement, staff burden)	5	Innovate, Develop
Rural nature of program areas (e.g., difficulties in maintaining supply chain or human resource levels)	5	Devolve
Inadequate resources for scaled-up activities	4	Devolve
Competing alternatives (e.g., other types of family planning products such as condom, diaphragm, or pill)	3	Develop
Misaligned government policies and priorities (e.g., preference for HIV/AIDS projects, longer acting methods, or provision of family planning by medical personnel)	3	Assess, Develop, Devolve
Data collection challenges (e.g., insufficient contact between front line and supervisors, front line failure to understand tools, follow-up challenges)	3	Develop
Social or cultural norms (e.g., male dominance or power, elder family member objections, general concerns about fidelity and family size)	1	Assess, Innovate, Engage,
Lack of knowledge or awareness (e.g., inadequate counseling or patient education, lack of patient-centered care, limited information sharing)	1	Develop, Engage
Opposition by medical professionals	1	Assess, Engage
Lack of ongoing stakeholder support (e.g., key leaders left after pilot phase)	1	Devolve