Implementation, interrupted: Identifying and leveraging factors that sustain after a programme interruption

Area of Science:

• Implementation Science
• Public Health
• Health Systems Research

Background:

• Healthcare programs often face interruptions, particularly in developing health systems.
• Evaluating these interruptions is crucial for successful program re-implementation.
• Diabetes Mellitus (DM) screening integrated into tuberculosis (TB) clinics in Uganda faced sustainability challenges.

Purpose of the Study:

• To devise an approach for evaluating interruptions in health programs.
• To explore the sustainability of an integrated DM screening program within TB clinics in Uganda.
• To inform re-implementation strategies for interrupted health initiatives.

Main Methods:

• Qualitative study using nine interviews with clinic staff and direct observation of clinic visits.
• Utilized the Consolidated Framework for Implementation Research (CFIR) and a social ecological model.
• Thematic analysis mapped findings to outer setting (community), inner setting (clinic), and individual (clinician) levels.

Main Results:

• DM screening ceased due to national supply chain disruptions for glucose test strips, impacting clinics and clinicians.
• Lack of screening supplies reduced clinician opportunities and self-efficacy for DM screening.
• Programmatic elements like culture, compatibility, and clinician beliefs remained resilient despite interruptions.

Conclusions:

• An approach using CFIR and a social ecological model can evaluate health program interruptions.
• This approach identifies cascading effects of disruptions on healthcare delivery.
• It provides a basis for targeted re-implementation strategies to enhance program sustainability.