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Facility-based simulation as a programmatic tool for implementing a statewide contraceptive initiative.

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Summary

In-situ simulations effectively assessed family planning initiative fidelity, identifying gaps and improving staff knowledge. This method enhances contraceptive access program implementation and monitoring.

Keywords:
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Area of Science:

  • Reproductive Health
  • Healthcare Quality Improvement
  • Medical Simulation

Background:

  • Assessing implementation fidelity in healthcare initiatives is crucial but challenging.
  • Family Planning Elevated (FPE) is a statewide contraceptive initiative involving 28 health clinics.
  • In-situ high-fidelity simulation was developed to assess FPE adherence and educate teams.

Purpose of the Study:

  • To develop, pilot, and evaluate the use of in-situ simulation for measuring implementation fidelity.
  • To assess clinic adherence to the Family Planning Elevated initiative.
  • To provide education to implementing teams through simulation.

Main Methods:

  • Two simulation scenarios were created: one for seeking a new contraceptive method and one for discontinuation.
  • Simulations incorporated multiple program implementation aspects, including eligibility determination.
  • An adapted RE-AIM framework guided fidelity assessment, using pre-post surveys, checklists, and field notes.

Main Results:

  • Fifteen sites and 71 team members participated; 90% demonstrated key program components.
  • Clinics excelled in person-centered counseling but fell short in areas like same-day IUD insertion confirmation (54.2%).
  • Participants showed improved knowledge (p<0.001), client identification skills (p=0.02), and self-efficacy (p=0.03).

Conclusions:

  • Realistic in-situ simulations are acceptable and improve knowledge and confidence among family planning teams.
  • Simulation effectively identifies system gaps in clinical care and program implementation.
  • Simulation provides a valuable method for monitoring the implementation fidelity of family planning initiatives.