Skip to main content

Table 1 Summary of characteristics of included studies

From: Implementation research approaches to promoting universal health coverage in Africa: a scoping review

Study Country IR Framework Study design IR approach Target actors/participants Reported facilitators/barriers Targeted UHC outcomes
Adamu 2019 [50] Nigeria TDF Qualitative Pre-implementation use of IR to guide the implementation of a quality improvement programme for improving routine childhood immunisation services Parents and caregivers of children attending primary health care facilities Facilitators: Perceived benefits of vaccines and adequate communication of benefits
Barriers: inadequate knowledge of the vaccines, non-screening of home-based records, health worker’s refusal to offer immunization services, and husband’s refusal due to socio-cultural beliefs
To reduce missed opportunities for vaccination and improve routine childhood immunisation coverage
Adamu 2020 [51] Nigeria CFIR Mixed methods IR used to guide data collection, data analysis and post-implementation evaluation of routine childhood immunisation services Primary health care facility staff Facilitators: Intervention flexibility, self-efficacy among health workers, health workers’ confidence in the intervention, services integration.
Barriers: Vaccine stock out, faulty cold chain infrastructure, lack of incentives, and socio-cultural beliefs
Improved access to routine childhood immunisation services
Anaba 2019 [52] Ghana NPT Quantitative IR used to guide data collection, data analysis and post-implementation evaluation of malaria rapid diagnostic test (mRDT) practices among health workers Health workers Facilitators: three or more years of experience, clarity on the benefits, availability of innovation champions or initiators and readiness for change practices
Barriers: poor monitoring
Optimised intention to use mRDT in the diagnosis of malaria
Barac 2018 [53] Multi-country, including Nigeria and South Africa CFIR Mixed methods IR used to guide data collection, data analysis and post-implementation evaluation of typhoid control interventions Organisations involved in implementation; Health policy and health system leaders at national or subnational levels Facilitators: Use of multiple implementation strategies to target behaviour change.
Barriers: Limited resources and planning, habitual behaviours and cultural practices.
Better understanding of the effectiveness of typhoid control interventions
Bardosh 2017 [54] Multi-country, including Kenya CFIR Qualitative IR-oriented mid-implementation and evaluation of a mobile health (mHealth) intervention. Health care workers, research team members, and community members Facilitators: Perceived positive impact on patients
Barriers: Illiteracy, stigma
and, patients’ lack of phone making contact difficult
Improved HIV and Maternal, Neonatal and Child Health (MNCH) service delivery.
Cole 2018 [55] Mozambique CFIR Mixed methods IR used to guide post-implementation evaluation of a maternal health programme. Health providers in facilities involved in implementation; Patients benefiting from intervention Facilitators: Programme adaptability, shared perceives and collective goals among stakeholders.
Barriers: use of volunteer-based
implementation with actors outside of the formal health
system, with limited retention..
To explore the contextual factors that may have contributed to observed increases in skilled birth attendance.
Cooke 2019 [56] Tanzania CFIR Qualitative IR-oriented implementation and evaluation of an integrated anti-retroviral therapy and opioid treatment programme. Patients benefiting from intervention; Health providers in facilities involved in implementation Facilitators: Clearly understood roles among stakeholders and programme adaptability
Barriers: lack of space for patient confidentiality and stigma
To understand the contextual factors that influence the effectiveness of integrated methadone and anti-retroviral therapy implementation
Eboreime 2018 [57] Nigeria QIF Qualitative IR used to guide post-implementation evaluation of a primary health care system improvement intervention. Primary health care programme managers Facilitators: Adequate pre-intervention planning and stakeholder engagement
Barriers: Inadequate stakeholder engagements and poor fidelity to planned implementation processes
To identify factors influencing the implementation of a primary health care quality improvement programme.
Eboreime 2019 [58] Nigeria MUSIQ Mixed methods IR used to guide post-implementation evaluation of a primary health care system improvement intervention. Primary health care programme managers Facilitators: Subnational political will
Barriers: suboptimal subnational government leadership, management, financial and technical support
To identify factors influencing a primary health care quality improvement programme’s implementation outcomes
English 2013 [59] Kenya CFIR and TDF Qualitative IR-oriented pre-implementation evaluation of a child health programme. Organisations involved in implementation Facilitators: peer pressure, clear communications, provision of feedback, development of a learning climate,
leadership engagement, enhancement of self-efficacy
Barriers: knowledge and skills of personnel
To develop a system-oriented intervention to improve services for children in district hospitals
Finocchario-Kessler 2015 [60] Kenya Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model Quantitative Using programme data to guide post-implementation evaluation and contextualising lessons learnt. Mother-infant pairs utilising EID services and government health care providers and lab personnel Facilitators: Strong and sustained collaborations with stakeholders improve the quality and reach of eHealth public health interventions.
Barriers: Local leadership and resource constraints.
Improve HIV early infant diagnosis (EID)
Gimbel 2016 [61] Multi-country, including Mozambique, Kenya, Cote d’Ivoire CFIR Qualitative IR-oriented post-implementation evaluation of a mother-to-child-transmission (PMTCT) and paediatric HIV programme Organisations involved in implementation Facilitators: communication, available resources, external change agents, executing, and reflecting and evaluating
Barriers: Resistance from the lead nurse
To define the core and adaptable components of a facility-based intervention to address implementation challenges in prevention of mother to child transmission (PMTCT), and identify contextual influences that explain implementation heterogeneity
Gimbel 2017 [62] Multi-country, including Mozambique, Rwanda, and Zambia CFIR Mixed methods IR-oriented post-implementation evaluation of data quality assessment and improvement activities within the PHIT programmes Organisations involved in implementation Facilitators: intervention components that aligned with user priorities and government systems and the use of evidence to justify intervention to stakeholders.
Barriers: Lack of support from District Health Office
To improve aaccess to comprehensive, accurate data to guide resource allocation and programmatic improvement efforts
Jones 2018 [63] Zambia CFIR Mixed methods IR-oriented mid-implementation evaluation of a voluntary male medical circumcision programme Lay counsellors and nursing staff Facilitators: Performance evaluation with remedial feedback Increased acceptability and uptake of voluntary male medical circumcision
Maruma 2018 [64] South Africa TFA Mixed methods IR-oriented post-implementation evaluation of data collection by community health workers for tuberculosis contact tracing CHWs Facilitators: Feedback through pre-and post-assessmentsg.
Barriers: Inadequate training, lack of community acceptance and resource constraints.
To determine factors influencing the collection of information by community health workers for tuberculosis contact tracing
McRobie 2017 [65] Uganda CFIR Mixed methods IR-oriented pre-implementation evaluation of HIV testing, care and treatment policy implementation Health providers in facilities involved in implementation Facilitators: donor investment and support, strong scientific evidence, low policy complexity, phased implementation and effective planning.
Barriers: Limited human resources, infrastructure and health management information systems.
To assess implementation of national HIV policies regarding testing, treatment, and retention at health facilities serving two health and demographic surveillance sites
Nabyonga-Orem 2014 [66] Uganda (MRT) Mixed methods IR-oriented post-implementation evaluation of barriers and facilitating factors to the uptake of evidence in the process of user fee abolition Donors, policymakers, researchers, civil society, journalist, private service provider Facilitators: The political window and alignment of the evidence with overall government discourse enhanced uptake of evidence Uptake of evidence in the process of user fee abolition
Naidoo 2018 [67] South Africa CFIR Qualitative IR-oriented post-implementation evaluation of community-based HIV programmes Community members, CHWs, team leaders, facility staff, community leaders, and social workers Facilitators: networking and peer-support, recognition of the CHWs by the government, standardised training.
Barriers: Limited space and infrastructure for CHWs to work in.
To explore barriers and facilitators to implementation of community-based HIV programmes in order to produce actionable findings to improve them
Newman-Owiredu 2017 [68] Multi-country, including Malawi, Nigeria, and Zimbabwe NR Mixed methods IR-oriented post-implementation review of HIV (PMTCT) implementation capacity building activities Health care workers, research team members, and community members support staff (Expert Mothers/Mother Mentors/Mother Support Groups) Facilitators: financial incentives offered as part of national training exercises.
Barriers: health workers’ perception of research as additional work rather than an opportunity to learn or develop professionally.
Scaling up Option B+ antiretroviral treatment and retention in care.
Petersen Williams 2015 [69] South Africa CFIR Qualitative Use of IR for pre-implementation design of a screening, referral and treatment programme for substance use among women receiving antenatal care Health providers in facilities involved in implementation Facilitators: training,
adequate support, guidance, and mentoring.
Barriers: intervention being considered as additional work, lack of interest from staff, time constraints, staff shortages, overburdened workloads, and language barriers.
To investigate health care providers’ perceptions of the acceptability and feasibility of providing screening, brief intervention, and referral to treatment to address maternal substance use among pregnant women attending antenatal care
Rodriguez 2017 [70] South Africa CFIR Qualitative Qualitative interviews, focus groups discussions, workshop with district directors, clinic leaders, staff, and patients. Prospective programme evaluation. Health providers in facilities involved in implementation; health policy and health system leaders at national or subnational levels; patients benefiting from intervention Facilitators: Leader support, and employee readiness and motivation
Barriers: Hierarchical relationships between staff
To identify barriers and facilitators in the implementation, uptake, and sustainability of PMTCT protocols in a rural areas
Rodriguez 2019 [71] Zambia CFIR Mixed-methods Quantitative and qualitative evaluations of organisational, burnout, and organisational readiness functioning and barriers to implementation. Health care providers Facilitators: community engagement, leadership support, employee readiness and motivation.
Barriers: Resource constraints and poor communication of programme benefits.
Uptake of voluntary medical male circumcision
Soi 2018 [72] Mozambique CFIR Qualitative IR-oriented post-implementation evaluation of the scale-up of an human papillomavirus (HPV) vaccination programmes Health providers and educators in facilities and schools involved in implementation; health and education policy and health system leaders at national or subnational levels Facilitators: Health workers’ beliefs in importance of vaccines and an organisational culture of making personal sacrifice for immunisation, advocacy and social mobilisation through the right opinion leaders and champions
Barriers: weak infrastructural characteristics and insufficient organisational incentives
To identify implementation barriers and facilitators affecting the scale-up of HPV vaccination in Mozambique
Warren 2017 [73] Kenya CFIR Qualitative Using IR an analytical lens for post-implementation evaluation of a complex, multifaceted maternal health programme Community, facility (nurses and midwives), and policy stakeholders (ministry of health), Federation of Women’s Lawyers - FIDA Facilitators: individual champions, Collaboration with civil-society organisations like FIDA To address the causes of mistreatment during childbirth and promote respectful maternity care
White 2019 [74] Benin CFIR Mixed methods IR used to guide mid- implementation evaluation of a quality improvement programme as well as the contextualisation of evaluation findings. Health providers in facilities involved in implementation Facilitators: Surgical enthusiasm, self-efficacy and motivation, in-depth stakeholder engagement at multiple levels
Barriers: Staff viewed the checklist as irrelevant or a waste of time and leadership appeared arrogant.
To measure the sustainability of surgical safety checklist use and to evaluate the acceptability, adoption, appropriateness, feasibility and fidelity of nationwide checklist implementation, including penetration of the checklist into operating room culture
Zitti 2019 [75] Mali CFIR Qualitative IR used to guide post-implementation evaluation of a pilot performance based healthcare financing programme Health facility staff and managers Facilitators: Implementing a pilot project and good leadership Gaining contextual understanding of performance-based healthcare financing.
  1. CFR Consolidated Framework for Implementation Research, CHW Community health workers, IR Implementation research, NR Not reported, MRT Middle range theory, MUSIQ Model for Understanding Success in Quality, NPT Normalization Process Theory, QIF Quality implementation framework, RE-AIM Reach Effectiveness Adoption Implementation Maintenance, TDF Theoretical Domains Framework, TFA Theoretical framework for acceptability, UHC Universal health coverage