P45 Identifying Barriers and Facilitators to Implementing Policy, Systems, and Environmental Change Work in Cooperative Extension Using the Consolidated Framework for Implementation Research

Cooperative Extension (Extension), part of the land-grant university system, has been engaged in rural communities for more than a century. While the focus of Extension’s efforts has largely centered on agriculture, there is an important thread of work that has similarities to public health. As Extension settles into its second century, we are working to be even more engaged in efforts that improve the health and well-being of rural communities in particular. Extension faculty and staff are accomplishing this through direct-to-the-population education and through partnerships with more classically oriented public health organizations able to leverage Extension’s networks and positive reputation in communities to engage them and improve their health. A component of these partnerships includes Extension faculty and staff increasingly engaging in policy, systems, and environment work and other initiatives that help ensure longer-term, systemic changes more likely to improve health outcomes. In short, Extension clearly changed the agricultural system of the United States, and because of its reach into rural communities, it has the capacity to do for health in rural communities in this second century what it did for agriculture in the first century.

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Barriers and facilitators of implementation of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda using the Consolidated Framework for Implementation Research

Implementation Science ◽

10.1186/s13012-020-01065-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Rawlance Ndejjo ◽

Rhoda K. Wanyenze ◽

Fred Nuwaha ◽

Hilde Bastiaens ◽

Geofrey Musinguzi

Keyword(s):

Cardiovascular Disease ◽

Low Income ◽

Implementation Research ◽

Health Workers ◽

Scale Up ◽

Barriers And Facilitators ◽

Prevention Programme ◽

Intervention Implementation ◽

Design Quality ◽

Middle Income

Abstract Background In low- and middle-income countries, there is an increasing attention towards community approaches to deal with the growing burden of cardiovascular disease (CVD). However, few studies have explored the implementation processes of such interventions to inform their scale up and sustainability. Using the consolidated framework for implementation research (CFIR), we examined the barriers and facilitators influencing the implementation of a community CVD programme led by community health workers (CHWs) in Mukono and Buikwe districts in Uganda. Methods This qualitative study is a process evaluation of an ongoing type II hybrid stepped wedge cluster trial guided by the CFIR. Data for this analysis were collected through regular meetings and focus group discussions (FGDs) conducted during the first cycle (6 months) of intervention implementation. A total of 20 CHWs participated in the implementation programme in 20 villages during the first cycle. Meeting reports and FGD transcripts were analysed following inductive thematic analysis with the aid of Nvivo 12.6 to generate emerging themes and sub-themes and thereafter deductive analysis was used to map themes and sub-themes onto the CFIR domains and constructs. Results The barriers to intervention implementation were the complexity of the intervention (complexity), compatibility with community culture (culture), the lack of an enabling environment for behaviour change (patient needs and resources) and mistrust of CHWs by community members (relative priority). In addition, the low community awareness of CVD (tension for change), competing demands (other personal attributes) and unfavourable policies (external policy and incentives) impeded intervention implementation. On the other hand, facilitators of intervention implementation were availability of inputs and protective equipment (design quality and packaging), training of CHWs (Available resources), working with community structures including leaders and groups (process—opinion leaders), frequent support supervision and engagements (process—formally appointed internal implementation leaders) and access to quality health services (process—champions). Conclusion Using the CFIR, we identified drivers of implementation success or failure for a community CVD prevention programme in a low-income context. These findings are key to inform the design of impactful, scalable and sustainable CHW programmes for non-communicable diseases prevention and control.

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