Table 4 Implementation strategies coded using the ERIC framework
From: Strategies to adapt and implement health system guidelines and recommendations: a scoping review
ERIC category | Occurrences | Implementation strategies (author/year) |
|---|---|---|
Conduct ongoing training | 11 | Conduct ongoing training (Ejeta et al. 2020 [107]; Lovero et al. 2019) [93] Training sessions (Xia et al. 2015) [89] Education and retraining (Callaghan-Koru et al. 2020) [86] Training (Kavle et al. 2018 [114]; Rahman et al. 2020 [105]) Clinical training (Sami et al. 2018) [102] Staff in primary care settings to receive training and supervision for basic mental health screening, diagnosis and treatment (Lovero et al. 2019) [93] Trained in key modules of WHO’s Mental Health Gap Action Programme Intervention Guide (Ryan et al. 2020) [109] Capacity-building of medical doctors (MDs) through high-intensity training and onsite supervision (Miguel-Esponda et al. 2020) [69] Develop and conduct tailored training for nurse midwives and clinical officers at dispensaries (Mkoka et al. 2014) [94] |
Build a coalition | 8 | Establishment of task teams, appointing leaders and NGO partnerships to lead and manage change (Schneider and Nxumalo 2017) [97] The programme proposal was presented and discussed with the staff. With the approval of the team, the process was gradually implemented (Bergerot et al. 2017) [79] Mutual promotion between national and local policies (Zhou et al. 2019) [67] Partnering with community associations (Lavôr et al. 2016) [111] Support for referrals to specialist services (Miguel-Esponda et al. 2020) [69] Collaboration and support from international development partners; national procurement planning and coordination (Rahman et al. 2020 [105]) Establish primary healthcare (PHC) network in one district of each province in the first year (Moshiri et al. 2016) [95] Integrated into curative health services provided by the national government (Gueye et al. 2016) [108] |
Develop educational materials | 7 | Develop educational materials (Ejeta et al. 2020 [107]; Andrade et al. 2017 [75]) Standardization of materials (Roman et al. 2014) [66] New training methods to create a more harmonized and educated workforce (Kihembo et al. 2018) [57] Written policy statement that is routinely communicated (Kavle et al. 2018) [114] Designed training materials (self-reading, teaching aids and videos) based on the principles of participatory learning (investigators of WHO Low Birth Weight [LBW] Feeding Study Group, 2016) [110] Treatment guidelines (Rahman et al. 2020) [105] |
Use of advisory boards | 6 | Stakeholder engagement (Roman et al. 2014) [66] Community groups and activist and healthcare professional acceptance and support; obtaining assistance from community health workers (Mutabazi et al. 2020) [87] Development of a chlorhexidine technical working group (Callaghan-Koru et al. 2020) [86] Promote collaboration between healthcare staff, support groups and local community; orientation of national policy- and decision-makers, management and community committees (Kavle et al. 2018) [114] Strategic planning workshops (Sami et al. 2018) [102] Elicited feedback on any site-specific concerns not addressed by the proposed system (Halpern et al. 2010) [77] |
Conduct educational meetings | 6 | Education to healthcare providers (Roman et al. 2014) [66] Health education sessions (Kavle et al. 2018) [114] A national training and feedback session (Halpern et al. 2010) [77] Participatory community meetings for information (Wingfield et al. 2015) [113] Conducting educational activities for adherence to directly observed therapy (DOT ; Lavôr et al. 2016) [111] Countries conducted orientation meetings (Bryce et al. 2005) [58] |
Distribute educational material | 5 | Distributed educational material (Ejeta et al. 2020) [107] Routinely distributed policy statement (Kavle et al. 2018) [114] Designed training materials (self-reading, teaching aids and videos) based on the principles of participatory learning (investigators of WHO LBW Feeding Study Group, 2016) [110] Printed educational materials for clinical decision-making (Miguel-Esponda et al. 2020) [69] Treatment guidelines (Rahman et al. 2020) [105] |
Promote network-weaving | 5 | Leading and managing change—establishment of task teams, appointing leaders and NGO partnerships (Schneider and Nxumalo 2017) [97] Collaboration between national reproductive health programmes and national malaria control programmes (Roman et al. 2014) [66] Coordination of Community Cadres within the health system (Shelley et al. 2016) [99] Multi-department participation and collaboration to better implement the national essential drugs policy (Li et al. 2015) [112] Targeted interactions of PHC designers with local actors shaped a wide network of friends before the implementation phase (Moshiri et al. 2016) [95] |
Conduct educational outreach visits | 4 | Education to healthcare providers (Roman et al. 2014) [66] Ongoing onsite training provides emotional support (Stein et al. 2008) [106] Monthly visits from a member of the working group to validate reports and address any implementation issues (Halpern et al. 2010) [77] Developed management and training capacity in a limited number of districts (Bryce et al. 2005) [58] |
Access new funding | 4 | Ensuring financial stability (Roman et al. 2014) [66] Financial guarantee from the central government (Zhou et al. 2019) [67] Distribution of amoxicillin by UNICEF (Rahman et al. 2020) [105] Programme financing (Miguel-Esponda et al. 2020) [69] |
Stage implementation scale-up | 4 | Implementation scale-up (Callaghan-Koru et al. 2020) [86] Pilot project was evaluated first; when it was deemed successful, the guideline was implemented at all existing care sites, one site at a time (Halpern et al. 2010) [77] End of one phase was marked with a review meeting with the objective of synthesizing early implementation experience and planning for expansion (Bryce et al. 2005) [58] Policies were implemented in a series of stages (Leethongdee, 2007) [83] |
Develop and organize monitoring systems | 4 | Surveillance system and performance and monitoring framework (Kihembo et al. 2018) [57] Programme monitoring (Kavle et al. 2018 [114]; Bryce et al. 2005) [58] Following each assessment, quality improvement plans are generated and provided to facility managers to guide their improvement actions (Muthathi et al. 2020) [96] |
Develop resource-sharing agreements | 4 | Management of resource availability; commodities/resources availability (Roman et al. 2014) [66] Distribution of medical commodities (Sami et al. 2018) [102] Ensuring medication supply (Miguel-Esponda et al. 2020) [69] Supply and distribution of amoxicillin dispersible tablets (Rahman et al. 2020) [105] |
Provide clinical supervision | 4 | Provide clinical supervision (Sami et al. 2018 [102]; Lovero et al. 2019 [93]) Staff in primary care settings to receive training and supervision (Lovero et al. 2019) [93] Capacity-building of MDs through high-intensity training and onsite supervision (Miguel-Esponda et al. 2020) [69] |
Develop a formal implementation blueprint | 3 | Five-year strategic plan with workplans (Kihembo et al. 2018) [57] Planning and early implementation, developed national strategy and plan (Bryce et al. 2005) [58] Network expansion plan; required budget was estimated and suggested to government; establish PHC network in one district of each province in the first year (Moshiri et al. 2016) [95] |
Develop and implement tools for quality monitoring | 3 | Develop and implement tools for quality monitoring (Ejeta et al. 2020) [107] Standardization of materials; performance assessments (indicators); monitoring and evaluating (Roman et al. 2014) [66] Monitoring through a health information system (Miguel-Esponda et al. 2020) [69] |
Change physical structure and equipment | 3 | Provide essential equipment and supplies; build/improve infrastructure for service delivery (Mkoka et al. 2014) [94] Availability of basic equipment (Rahman et al. 2020) [105] Providing containers to collect sputum and other inputs in the laboratory (Lavôr et al. 2016) [111] |
Use train-the-trainer strategies | 2 | Train-the-trainer strategies (Ejeta et al. 2020 [107]; Kihembo et al. 2018) [57] |
Recruit, designate and train for leadership | 2 | Recruit, designate and train for leadership (Ditlopo et al. 2011) [91] Top-down supervision from the central government (Zhou et al. 2019) [67] |
Promote adaptability | 2 | Development and adaptation of guidelines to make them specific for low-income contexts (Callaghan-Koru et al. 2020) [86] Adapted the guidelines to their national context (Bryce et al. 2005) [58] |
Alter incentive/allowance structures | 2 | Conditional cash transfers to reduce TB vulnerability; incentivize and enable care (Wingfield et al. 2015) [113] Alter incentive/allowance structures (Ditlopo et al. 2011) [91] |
Centralize technical assistance | 2 | Centralize technical assistance (Andrade et al. 2017) [75] Development of new systems (integrating human resources, financing, etc.) that provided alignment across various departments (Schneider and Nxumalo 2017) [97] |
Conduct local consensus discussions | 2 | Stakeholder engagement (Roman et al. 2014) [66] Targeted interactions of PHC designers with local actors shaped a wide network of friends before the implementation phase (Moshiri et al. 2016) [95] |
Involve executive boards | 2 | Trained key decision-makers and built government commitment (Bryce et al. 2005) [58] Integrated care into health services provided by the national government (Gueye et al. 2016) [108] |
Involve patients/consumers and family members | 2 | Initiated groups/forums such as Mother to Mother service—where trained mothers living with HIV provided psychosocial support to pregnant women and mother of babies diagnosed with HIV (Mutabazi et al. 2020) [87] Participatory community meetings (Wingfield et al. 2015) [113] |
Obtain and use patients and family feedback | 2 | Obtain community acceptance (Shelley et al. 2016) [99] Community dialogue and action days (Kavle et al. 2018) [114] |
Organize clinical implementation team meetings | 2 | Support groups; mentorship and support (Kavle et al. 2018) [114] Elicited feedback on any site-specific concerns not addressed and encouraged system buy-in among the individuals who would ultimately implement the system (Halpern et al. 2010) [77] |
Revise professional roles | 2 | Reallocation of roles and responsibilities (Schneider and Nxumalo, 2017) [97] Stream linking tasks and roles to expand treatment and care for HIV (Mutabazi et al. 2020) [87] |
Provide ongoing consultation | 1 | Supervision/support system (Shelley et al. 2016) [99] |
Capture and share local knowledge | 1 | Capture and share local knowledge (Andrade et al. 2017) [75] |
Use other payment schemes | 1 | A new public health insurance scheme which provides treatments within a defined “core” benefits package to registered members for a co-payment (Leethongdee 2007) [83] |
Provide local technical assistance | 1 | Between visits, throughout the implementation process, working group members were available for technical consultation (Halpern et al. 2010) [77] |
Make training dynamic | 1 | Training as a facilitated, interactive and more hands-on approach to learning; integrating learning and practice clinical work allow for feedback/revisions/clarifications (Stein et al. 2008) [106] |
Make billing easier | 1 | Institution flow for timely funding (Lavôr et al. 2016) [111] |
Inform local opinion leaders | 1 | Built government commitment to move forward (Bryce et al. 2005) [58] |
Assess for readiness and identify barriers and facilitators | 1 | Baseline assessment (Kihembo et al. 2018) [57] |
Change record systems | 1 | Change record systems (Ejeta et al. 2020) [107] |
Create new clinical teams | 1 | Deploy health workers (Mkoka et al. 2014) [94] |
Tailor strategies | 1 | Tailor strategies to local context (Andrade et al. 2017) [75] |