Applying the Consolidated Framework for Implementation Research to Identify Implementation Determinants for the...

Area of Science:

• Implementation science
• Public health interventions
• Child mortality reduction strategies

Background:

• The Integrated District Evidence-to-Action program, an audit and feedback intervention, was implemented in Mozambique in 2017 to decrease under-five mortality.
• Understanding early-stage implementation barriers and facilitators is crucial for intervention success.

Purpose of the Study:

• To describe the barriers and facilitators influencing the early-stage effectiveness of the Integrated District Evidence-to-Action program.
• To utilize the Consolidated Framework for Implementation Research (CFIR) to analyze intervention implementation.

Main Methods:

• An extended case study design embedded with the CFIR was employed.
• Data collection involved document review, 22 in-depth interviews, and 2 focus group discussions with 19 healthcare professionals.
• A consensus-based iterative analysis was conducted on audio-recorded data.

Main Results:

• Facilitators included core intervention components (audit/feedback, supervision, grants), positive pressure for excellence, and accessible information.
• Barriers comprised the intervention's lack of compatibility with resource scarcity (human, financial, infrastructure) and limited adaptability in fund/tool usage.
• Participants were predominantly nurses and facility managers (70.2%), with a high proportion of women (87.8%).

Conclusions:

• The systematic application of CFIR provided detailed insights into implementation determinants.
• Findings offer a baseline for assessing future implementation phases and identifying cross-district variations.
• Stakeholder engagement in sharing preliminary results facilitated timely decision-making for intervention optimization.