TY - JOUR T1 - Applying the Consolidated Framework for Implementation Research to Identify Implementation Determinants for the Integrated District Evidence-to-Action Program, Mozambique JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-21-00714 VL - 10 IS - Supplement 1 SP - e2100714 AU - Celso Inguane AU - Caroline Soi AU - Sarah Gimbel AU - Nélia Manaca AU - Isaías Ramiro AU - Florência Floriano AU - Georgina de Castro AU - Orvalho Augusto AU - Stélio Tembe AU - James Pfeiffer AU - Quinhas Fernandes AU - Kenneth Sherr Y1 - 2022/09/15 UR - http://www.ghspjournal.org/content/10/Supplement_1/e2100714.abstract N2 - Key FindingsOur comprehensive and systematic use of the Consolidated Framework for Implementation Research (CFIR), embedded in an extended case study approach, demonstrates how to use the framework to inform data collection and analysis and how to use the case study approach to guide the interpretation of findings to help advance implementation of evidence-informed health programs.The Integrated District Evidence-to-Action core intervention components—audit and feedback meetings, supportive supervision and mentorship, and intervention small grants—offered a relative advantage over other similar maternal and child health interventions and routine interventions implemented to reduce mortality in children younger than 5 years.These findings illustrate factors that implementers can address to inform mid-program course modifications to implementation of an audit and feedback intervention in the study setting.Key ImplicationsSharing with stakeholders preliminary, granular, and context-specific findings that reflect the experiences and perspectives of intervention implementers, immediately after data collection and analysis, improves the likelihood of timely decision making about implementation.This approach compensates for the gap between data availability and usage, given the longer timeline for publication of study findings.Introduction:The Integrated District Evidence-to-Action program is an audit and feedback intervention introduced in 2017 in Manica and Sofala provinces, Mozambique, to reduce mortality in children younger than 5 years. We describe barriers and facilitators to early-stage effectiveness of that intervention.Method:We embedded the Consolidated Framework for Implementation Research (CFIR) into an extended case study design to inform sampling, data collection, analysis, and interpretation. We collected data in 4 districts in Manica and Sofala Provinces in November 2018. Data collection included document review, 22 in-depth individual interviews, and 2 focus group discussions (FGDs) with 19 provincial, district, and facility managers and nurses. Most participants (70.2%) were nurses and facility managers and the majority were women (87.8%). We audio-recorded all but 2 interviews and FGDs and conducted a consensus-based iterative analysis.Results:Facilitators of effective intervention implementation included: implementation of the core intervention components of audit and feedback meetings, supportive supervision and mentorship, and small grants as originally planned; positive pressure from district managers and study nurses on health facility staff to strive for excellence; and easy access to knowledge and information about the intervention. Implementation barriers were the intervention’s lack of compatibility in not addressing the scarcity of human and financial resources and inadequate infrastructures for maternal and child health services at district and facility levels and; the intervention’s lack of adaptability in having little flexibility in the design and decision making about the use of intervention funds and data collection tools.Discussion:Our comprehensive and systematic use of the CFIR within an extended case study design generated granular evidence on CFIR’s contribution to implementation science efforts to describe determinants of early-stage intervention implementation. It also provided baseline findings to assess subsequent implementation phases, considering similarities and differences in barriers and facilitators across study districts and facilities. Sharing preliminary findings with stakeholders promoted timely decision making about intervention implementation. ER -