Evidence map›Paper›PMID 33766793›Full record

ArticleJournal of pediatric and adolescent gynecology2021

Facilitators and Barriers to Implementation of Long-Acting Reversible Contraceptive Services for Adolescent Girls and Young Women in Gaborone, Botswana.

Drisana Henry, Sarah Wood, Neo Moshashane, Kehumile Ramontshonyana, Christina Amutah, Pegah Maleki, Claire Howlett, Merrian J Brooks, Aamirah Mussa, Dipesalema Joel and 3 more

Open access · greenAbstract read
In one paragraph

Article in Journal of pediatric and adolescent gynecology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
1.0field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 4 citations in OpenAlex.

  1. The FemTech revolution: Unlocking the potential of new technology for optimizing pregnancy outcomes in low- and middle-income countries and remote areas.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
    Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 5 institutions in 3 countries.

Drisana HenryDivision of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: drhenry121@gmail.com.
Sarah WoodDivision of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Neo MoshashaneBotswana-Harvard AIDS Institute Partnership; Botswana-UPenn Partnership.
Kehumile RamontshonyanaBotswana-Harvard AIDS Institute Partnership; Botswana-UPenn Partnership.
Christina AmutahUniversity of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
Pegah MalekiPolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Claire HowlettPolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Merrian J BrooksDivision of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Aamirah MussaBotswana-Harvard AIDS Institute Partnership.
Dipesalema JoelUniversity of Botswana, Gabarone, Botswana.
Andrew P SteenhoffUniversity of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Botswana-UPenn Partnership; University of Botswana, Gabarone, Botswana.
Aletha Y AkersDivision of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
Chelsea MorroniBotswana-Harvard AIDS Institute Partnership; Botswana-UPenn Partnership; MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom.
Children's Hospital of Philadelphia · USBotswana Harvard AIDS Institute Partnership · BWUniversity of Pennsylvania · USUniversity of Botswana · BWUniversity of Edinburgh · GB

Funding

Virus & Reservoirs CoreP30AI045008 · NIAID · UNIVERSITY OF PENNSYLVANIA · PI Ronald G Collman · 1999 to 2026
$78.6M
Health Coaching to Improve Comprehensive HIV and Sexually Transmitted Infection Prevention in Adolescent Primary CareK23MH119976 · NIMH · CHILDREN'S HOSP OF PHILADELPHIA · PI WOOD, SARAH MARIAN · 2020 to 2024
$926k
NIAID NIH HHS P30 AI045008NIMH NIH HHS K23 MH119976
6 · The paper itself

Abstract

STUDY

objectiveBotswana has a high pregnancy rate among adolescent girls and young women (AGYW). Long-acting reversible contraceptive (LARC) use among AGYW in Botswana is low, despite its high effectiveness for preventing pregnancy. Using an implementation science framework, we assessed barriers and facilitators to LARC implementation among AGYW in Botswana.

designCross-sectional mixed methods.

settingGaborone, Botswana.

participantsTwenty sexually active AGYW ages 18-24 years; 20 health system stakeholders.

interventionsSurveys and semistructured interviews grounded in the Consolidated Framework for Implementation Research.

main outcome measuresThemes reflecting barriers and facilitators of LARC implementation.

resultsThe median age for AGYW was 22 (interquartile range, 21-23) years. Twenty percent were using an implant and none had ever used an intrauterine device. Barriers and facilitators of LARC implementation spanned factors at each Consolidated Framework for Implementation Research domain: (1) LARC characteristics like side effects; (2) the clinics' inner settings, including availability of youth-friendly services; (3) characteristics of health system stakeholders, such as LARC skills, and AGYW experiences, attitudes, and beliefs about LARCs; (4) the outer setting external to clinics and Botswana's health system including reproductive health law and policy for minor adolescents; and (5) the implementation process level such as the availability of free or low-cost LARCs.

conclusionWe identified multilevel, context-specific factors that affect LARC implementation. Our findings can inform the development of interventions to increase LARC implementation in Botswana by addressing intersecting factors across patient, clinic, health system, and sociopolitical levels, such as providing confidential services to minors and improving LARC training and supply chain pipelines.

Indexed as

AdolescentAdultBotswanaContraceptive Agents, FemaleCounselingCross-Sectional StudiesFemaleHealth Services AccessibilityHumansIntrauterine DevicesLong-Acting Reversible ContraceptionPregnancySurveys and QuestionnairesYoung AdultContraceptive Agents, FemaleAdolescentBotswanaImplantIUDLARCLong-acting reversible contraceptives

Identifiers

PMID33766793
PMCPMC8277689
OpenAlexW3138161933

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.