From: Adaptation and implementation of the WHO Safe Childbirth Checklist around the world
Intervention challenges | CFIR challenge construct |
Dependence on external funding for sustainability (NGOs) | ● Intervention source ● Cost |
Funding for ongoing mentorship/coaching | ● Intervention source ● Cost |
Effective coordination and structure of mentorship/coaching | ● Design quality and packaging |
SCC not designed for teams | ● Adaptability |
SCC not integrated into medical record | ● Adaptability |
SCC perceived to be tool for LMICs only | ● Relative advantage |
Cost of printing SCC and missing SCC | ● Complexity ● Cost |
Inability to adapt SCC due to government mandate | ● Adaptability |
Outer setting challenges | CFIR challenge construct |
Government does not enforce or support SCC | ● External policy and incentives |
Patient care seeking behavior and preferences | ● Patient needs and resources |
Lack of timely referral system | ● Patient needs and resources ● Cosmopolitanism |
Incentives required for motivation | ● Peer pressure ● External policy and incentives |
Tension between data collection for research and sustainable implementation | ● Cosmopolitanism ● Patient needs and resources ● External policy and incentives |
Inner setting challenges | CFIR challenge construct |
Tension and interpersonal dynamics between different cadres | ● Networks and communications ● Culture |
Lack of leadership support for SCC | ● Readiness for implementation |
Staff turnover | ● Readiness for implementation |
Lack of required infrastructure (personnel, supplies, space) | ● Structural characteristics ● Readiness for implementation |
Quality of care not perceived as a priority | ● Implementation climate ● Readiness for implementation |
Characteristics of individuals challenges | CFIR challenge construct |
Lack of motivation and perceived burden of SCC | ● Knowledge and beliefs about the intervention ● Other personal attributes |
Gaps in technical knowledge/skills in labor management | ● Self-efficacy ● Other personal attributes |
Resistance to behavior change | ● Individual stage of change |
Process challenges | CFIR challenge construct |
No clear process for evaluation or audit of individuals | ● Reflecting and evaluating |
Difficult to use SCC in emergency situations | ● Executing |
SCC not integrated into routine workflow | ● Planning ● Executing |
No clear mechanism for identifying once practices have become habit without SCC | ● Reflecting and evaluating |
Successful strategies | CFIR domain |
● Incorporate accountability into SCC documentation and implementation | Intervention |
● Government policy or mandate for SCC | Outer setting |
● Include birth companions in care delivery ● Link SCC implementation to other structural changes at facility ● Strengthen health facility infrastructure to accomplish SCC behaviors | Inner setting |
● Develop motivational strategy around SCC ● Long-term external coach/supervisor who has support from leadership and frontline clinicians ● Include ongoing technical training to address gaps in knowledge/skills | Characteristics of individuals |
● Embed oversight of SCC to ensure it is used with high quality ● Create supporting documentation to facilitate SCC use (discharge warning signs) ● Engage leaders at facility and district levels before implementation ● Learn from a model facility where SCC was implemented successfully (either locally or internationally) ● Mentoring/coaching system to support ongoing SCC use ● Incorporate feedback continuously ● Integrate SCC into workflow ● Integrate SCC into medical record | Process |