Table 3 Example strategies to address multi-level contextual barriers to implementation (Step 4)
Level of identified barrier | Example strategies to address and/or assess contextual implementation barriers | |
|---|---|---|
Formative evaluation strategies | Process evaluation measures | |
Intervention population (Individual level) | • Focus groups with target population to explore barriers and facilitators to intervention design at scale and fostering sustained participation. • Needs assessments to address current gaps between what is available versus what is required by target population. | • Measure characteristics of responders and non-responders, and compare with general population to assess representativeness and generalizability. • Compare participant characteristics with retention and outcome variables. • Measure participant perceptions of intervention characteristics, and explore association with uptake, delivery and outcomes. |
Implementers (Provider level) | • Focus groups with target implementers to explore existing implementation infrastructure and feasibility of intended intervention delivery. • Participatory approaches allow target user input on intervention design, training and implementation strategy, and can assist in identifying potential ‘champion’ implementers. | • Measure level of intervention delivery (i.e. dose delivered, dose received, and fidelity/adaptation) and assess associations with implementer characteristics. • Explore associations between level of delivery and intervention, and implementer characteristics. • Measure perceived barriers and facilitators to intervention delivery and sustainability, compare changes in delivery with outcomes over time. |
Delivery setting/org. (Organizational level) | • Consultation/participatory research approaches with stakeholders (delivery settings who will support/provide the training/host implementers) on existing dissemination strategies and implementation infrastructure, to identify barriers to sustained implementation. | • Measure characteristics of delivery setting (i.e. size) and explore association with adoption decision, intervention delivery (i.e. dose) and intervention outcomes. • Compare characteristics of the delivery setting with perceived barriers and facilitators to adoption, intervention delivery and institutionalisation. |
Community factors (Community/systems level) | • Consultation with organizations who will host/fund the intervention. Explore funding infrastructures, conflicting/supporting policies and local delivery context. • Partner with relevant stakeholders and users during intervention development, ensuring intervention addresses community priorities and applicable to context. | • Measure perceived contextual barriers to intervention adoption, delivery and sustainability. • Compare characteristics of participating communities with the real-world delivery context. |