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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]