TABLE 5.

Application of the Implementation Outcomes Framework to Assess Facilitators and Barriers to PPIUD Initiative Implementation in Tanzania

Outcome and Definition	Facilitator	Barrier
Implementation Outcomes
Acceptability: Perception among stakeholders that intervention is acceptable (e.g., satisfaction with PPIUD training content, complexity, comfort)	High satisfaction with PPIUD training	Lack of providers trained on PPIUD insertion Lack of support from local health authorities
Adoption: Initial implementation of PPFP counseling and PPIUD insertion; Intention to try	Increased confidence following PPIUD training	Time constraints and inadequate staffing Gaps in referral system between satellite clinics and hospitals
Fidelity: Delivered counseling as intended (e.g., reach, content, and target population)		Individual counseling replaced by group counseling Diminished provider motivation Counseling rushed or skipped Skewed or incomplete counseling
Penetration: Diffusion of PPIUD Initiative within intervention facilities and to other non-intervention sites	Emphasis on PPIUD’s mechanism of pregnancy prevention during training	Objections from faith-based facilities Expectation for remuneration among staff who did not receive initial training
Sustainability: Long-term maintenance and institutionalization of the PPIUD Initiative	Support for population policies and family planning programs to achieve fertility reduction goals	Breakdown of supply chain and stock-outs
Service Outcomes
Equity: Extent to which the PPIUD implementation is equally available/accessible to all intended beneficiaries		Differential treatment by health care providers Financial barriers to accessing hospitals Lack of community-based PPFP counseling and services
Client Outcomes
Client receptiveness/demand for services: Client receptiveness to being counseled on PPFP and/or demand for receiving the PPIUD	Level of support from husband/partner Shared intention among couples to space pregnancy for financial reasons Community and gender norms related to birth spacing Community diffusion of preference for PPIUD and peer recommendation Women's trust in provider advice Cost-free counseling and insertion services	Fear of insertion, concerns related to sexual experiences postinsertion, unexpected expulsion and experience of unanticipated side effects (results published elsewhere²⁶).
Satisfaction with PPIUD services: Client receptiveness to being counseled on PPFP and/or receiving PPIUD; Satisfaction with counseling and services	Delivery of counseling and services by female provider Interpersonal aspects of care	Perceived provider incompetence

Abbreviations: PPIUD, postpartum intrauterine device; PPFP, postpartum family planning.