Applying the Consolidated Framework for Implementation Research to Identify Implementation Determinants for the Integrated District Evidence-to-Action Program, Mozambique

Celso Inguane; Caroline Soi; Sarah Gimbel; Nélia Manaca; Isaías Ramiro; Florência Floriano; Georgina de Castro; Orvalho Augusto; Stélio Tembe; James Pfeiffer; Quinhas Fernandes; Kenneth Sherr

doi:10.9745/GHSP-D-21-00714

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TABLE 1.

Participants in Study on Integrated District Evidence-to-Action Program to Reduce Under-5 Mortality in 4 Districts, Mozambique

Participants	IDI	FGD	TotalNo. (%)	Women No. (%)
Provincial managers	4	0	4 (9.8)	2 (50.0)
District managers	8	0	8 (19.5)	5 (62.5)
MCH facility managers	0	14	14 (34.1)	14 (100)
Nurses	10	5	15 (36.6)	15 (100)
Total	22	19	41 (100)	36 (87.8)

Abbreviations: FGD, focus group discussion; IDI, in-depth individual interview; MCH, maternal and child health.

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TABLE 2.

CFIR Constructs and Subconstructs Used to Analyze Study on Integrated District Evidence-to-Action Program to Reduce Under-5 Mortality in 4 Districts, Mozambique

CFIR Domains	Constructs and Subconstructs Used in Final Analysis
Intervention characteristics	Intervention source Relative advantage Adaptability
Outer setting	Peer pressure External policy and incentives
Inner setting	Structural characteristics^a Networks and communications^a Compatibility Relative priority Access to knowledge and information (subconstruct of readiness for implementation)^a
Characteristics of individuals	Knowledge and beliefs about the intervention Self-efficacy
Process	Planning Innovation participants (subconstruct of engaging)^a Executing Linkages among intervention components^b

Abbreviation: CFIR, Consolidated Framework for Implementation Research.
↵a Construct/subconstruct that had not been prioritized before analysis but was added in the final analysis.
b Construct is not original to CFIR but is based on the investigators’ experience using CFIR.

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TABLE 3.

Facilitators and Barriers to Successfully Implementing Study on Integrated District Evidence-to-Action Program to Reduce Under-5 Mortality in 4 Districts, Mozambique

CFIR Domains	Facilitators	Barriers
Intervention characteristics	Advantage of core intervention components (audit and feedback meetings, supervision and mentoring, and financial support) compared to routine and similar MCH interventions (relative advantage)	Limited flexibility of intervention design, and decision making about data collection tools and use of intervention small grants (adaptability)
Outer setting	Positive pressure district managers and NGO staff exerted over health facility staff (external policy and incentives)	---
Inner setting	Historically established professional networks and communications among NGO and government staff and managers at provincial and subprovincial levels (networks and communication)
	Relative priority given to MCH at national and subnational levels of Mozambique’s health system (implementation climate)	Intervention did not adequately address nurse shortages and training needs, health facility infrastructure, and district transportation needs—compatibility (implementation climate)
	Access to knowledge and information about the intervention (readiness for implementation)
Process	Approach to implementing intervention components as originally planned (executing)	---