Cross-case Synthesis Research Articles

Logic model for opioid safety in chronic non-malignant pain management, an in-depth qualitative study

BackgroundOpioids are commonly used for the management of chronic non-malignant pain in Pakistan; but there is a lack of literature around precursors or motivators in the use of opioids.AimThe study holistically explored factors contributing towards the unsafe use of opioids and identifies strategies to overcome them.MethodExploratory qualitative methods using interviews, focus groups and non-participant observational case studies were used. Interviews and focus groups were carried out face-to-face as well as virtually and observations were conducted in community pharmacies in Islamabad and Khyber Pukhtoon Khuwa province, Pakistan. Data were collected from 4 stakeholder groups; pharmacy policy makers (n = 11), people with chronic non-malignant pain (n = 14), doctors (n = 31) and community pharmacists (n = 36) by purposive critical case sampling method. Data were analysed inductively using reflexive thematic analysis and then deductively mapped to a social ecological framework. Non-participant observations were analysed using a cross case synthesis using explanation building technique. Data from all three methods were triangulated to develop a logic model.ResultsIdentified factors at macro (regulation), meso (social perceptions of pain and opioids) and micro levels (uncontrolled pain, self-medication, health literacy) and strategies are presented holistically and were used to develop a logic model for the prevention and mitigation of factors currently causing unsafe use of opioids.ConclusionThe study provides an in-depth view of factors contributing towards diversion of pharmaceutical opioids and can help guide national and international policy makers in their future initiatives to promote safe use of opioids in the management of chronic non-malignant pain in Pakistan.

University–School Partnerships: Successes and Challenges in Designing and Implementing Strategies to Promote Racial Equity

Abstract Research–practice partnerships play an important role in critically examining racial disparities in schools, as well as supporting the immediate adoption of practice improvement. This article outlines the results of a multisite case study with students, teachers, and administrators across two racially and ethnically diverse middle schools in the Pacific Northwest. Using a multisite case study approach (N = 2), authors explored practice challenges and successes in four phases of the research–practice partnership: (1) building the partnership, (2) designing the study, (3) data analysis, and (4) translating the data into action for racial justice. Data sources include field notes, observations, teacher and administrator interviews, and student focus groups. A cross-case synthesis analytical approach was used. Linking these perspectives offers an ecological approach to identifying, understanding, and interrupting racism in schools. Article concludes by discussing the importance of research–practice partnerships for racial justice in schools and the powerful role that student and teacher voices can play in the process.

Risk, Society, and Bureaucratic Accountability

The aim of this study is to critically evaluate the sinking of the MV Sewol and the CS Bulgaria to determine key latent failures, lessons learned, and risk accountability. This inductive study combines pragmatism with a cross-case synthesis method and computer-assisted content analysis using the Atlas.ti software package. This study critically evaluated the MV Sewol sinking at Jodo-myeon, South Korea on April 16, 2014, and the sinking of the CS Bulgaria at Tartarsan, Russia, July 10, 2011 using a cross-case synthesis method. Computer-assisted content analysis resulted in 21 codes which were clustered into four categories and one core theme, namely latent failures. These findings inform five recommendations for isomorphic learning, additional disaster-specific education, training provision and oversight, enhanced vessel monitoring and inspection, and legal clarification of risk accountability.

Smart governance strategies and their relationships with SDGs in three Latin American cities

ResumoObjetivoO objetivo deste manuscrito é identificar e analisar as decisões estratégicas, especialmente aquelas focadas na governança inteligente, que foram implementadas nas cidades de Buenos Aires (Argentina), Medellín (Colômbia) e Cidade do México (México), e como elas impactaram os Objetivos de Desenvolvimento Sustentável (ODS).Projeto/metodologia/abordagemUtilizando uma abordagem qualitativa e um escopo descritivo, este manuscrito segue uma metodologia de estudo de casos múltiplos que se baseou principalmente na análise de documentos e registros arquivísticos usando correspondência de padrões e síntese de casos cruzados como técnicas analíticas.ResultadosAs cidades observadas compartilham três características principais ao implementar estratégias de governança inteligente vinculadas ao ODS16: soluções baseadas na tecnologia para resolver problemas sociais recentes e duradouros; participação cidadã ampla, diversificada e ativa; e uma abordagem sociotécnica para governança inteligente e ODS16.Limitações/implicações da pesquisaEste artigo aponta as ligações entre governança inteligente e ODS no contexto das cidades inteligentes dos mercados emergentes. Os resultados deste estudo indicam a necessidade de promover abordagens sociotécnicas – mais do que perspectivas somente técnicas – para o alcance dos ODS16. Assim, a participação cidadã, o governo aberto e as iniciativas de cocriação são fundamentais para a promoção de instituições mais inclusivas e sólidas.Originalidade/valorA contribuição mais importante deste estudo é identificar as iniciativas estratégicas desenvolvidas por três cidades inteligentes líderes na América Latina do ponto de vista da governança inteligente e sua relação com os ODS, o que é útil porque contribui para ampliar nosso entendimento de governança inteligente a partir de experiências práticas.

Middle-school mathematics teachers’ provision of non-examples and explanations in rational number instruction

This study explored four middle-school mathematics teachers’ provision of non-examples and instructional explanations in teaching rational numbers to seventh-grade students. The data sources were 8 lesson hours of observations conducted in four different classrooms. Yin's [(2018). Case study research and applications: Design and methods (6th ed.). Sage] cross-case synthesis technique was used to code the four teachers’ non-examples. Charalambous et al.'s [(2011). Prospective teachers' learning to provide instructional explanations: How does it look and what might it take? Journal of Mathematics Teacher Education, 14(6), 441–463. https://doi.org/10.1007/s10857-011-9182-z] criteria were used to code their instructional explanations. The findings showed that the four teachers seldom used non-examples of rational numbers in their classrooms and provided low-quality instructional explanations to their students. The implications for improving teachers’ provision of non-examples and instructional explanations are discussed.

Towards occupational resilience: A model to facilitate high school participation post traumatic brain injury.

This article describes the model components of a study that applied a two-phased approach towards the development of an occupational resilience model. The occupational therapy practice model that is proposed seeks to facilitate high school re-entry and school participation post traumatic brain injury (TBI). The study's first phase generated results on participants' experiences of high school re-entry and school participation post TBI. These findings contributed to the second phase of developing a practice model to improve upon school transition practice for learners post TBI. The study's first phase comprised a qualitative multi-case study of eight cases. Data collection involved semi-structured interviews, participant and contextual observation, and document analysis. Data analysis was performed via an inductive process combined with cross-case synthesis. Phase 2 employed theory generation, suggesting an occupational therapy practice model for facilitating high school participation post TBI. Participant responses revealed, following the onset of the TBI, a need for adolescents to display resilience in order to re-participate in school. This was displayed by adolescents adapting through drawing upon personal and environmental resources as well as preparing for and engaging in occupation. A deeper understanding of the experiences of key role players involved in the school transition post TBI, combined with theory generation, formed the basis of developing the proposed model of occupational resilience. Occupational resilience, through a series of resilience-promoting tasks, is offered as a mechanism to increase learners' capacity to adapt to occupational challenges and meaningfully participate in school post TBI.

Women executives and their struggle with sexual harassment: A multiple case study

Objectives This exploratory study is aimed at discovering Filipina women executives’ personal experience with sexual harassment. Methods This is a multiple case study with a qualitative approach. With non-probability convenience sampling, we selected five women executives from the capital region of the Philippines for in-depth interviews. For data analysis, we used a thematic analysis method. Results The four types of sexual harassment – physical, verbal, cyber, and non-verbal – were all evident in our study. One major theme found through the cross-case synthesis was the calling for proactive actions. Conclusion Filipina women executives have personal experience with all types of sexual harassment. Neither their inner drive for excellence nor their exceptional career achievements prevent sexual harassment from happening to them and around them. Thus, women executives call for sufficient and effective sexual harassment prevention education programs. Keywords Women executives, multiple case study, gender equality, the Philippines, sexual harassment prevention education

Designing Strategies to Improve the Competitiveness of Special Economic Zones

The development of Special Economic Zones (SEZs) is a way for many countries to increase their economic growth and competitiveness. Indonesia has been one of the countries that has developed the SEZ model since 2009, although long before the economic zone model in other forms had been implemented. SEZ's main activities currently cover the processing and tourism industries. However, the development of SEZs in Indonesia has not been entirely able to become a driving force for the economy to increase economic growth and regional and national competitiveness. This study aims to identify the determinants and design strategies that can improve the competitiveness of SEZs in Indonesia. The qualitative multiple-case study method was applied to answer the research problem. Focus Group Discussions, Group Interviews, in-depth interviews, and document studies were carried out to obtain data, then processed by compiling them into open coding, axial coding, and selective coding, and then identification, looking at the patterns formed and interpretation of the existing data using techniques cross-case synthesis analysis. There are six determinant factors in research findings: innovation, collaboration, human resources, governance, location, and incentives. Furthermore, these six factors become the basis for designing strategies to improve the competitiveness of SEZs in Indonesia.

Co-production and arts-informed inquiry as creative power for knowledge mobilisation

Background:Interest in using arts-informed approaches within research to increase stakeholder engagement is growing; however, there is little work describing how these approaches are operationalised across contexts. This article addresses that gap by exploring the use of arts-informed approaches across three projects. Aims and objectives:We explore how conceptualising research and evaluation as creative endeavours, particularly in arts-informed approaches to co-production, create opportunities to move knowledge into action (knowledge mobilisation). We propose an actionable configuration of context + mechanism = outcome (CMO) to understand the influence of arts-informed approaches to co-production. Methods:Multi-case design and cross-case synthesis was conducted of three studies that used arts-informed approaches. A common focus across our cases was evidence use in the K-12 education sector; however, each engaged with this focus by involving different types of evidence and sets of education stakeholders. Findings:Arts-informed approaches and co-production were influenced by a variety of contextual factors such as relationships between researchers and stakeholders, ethical issues of collaborative research activities, approaches to meaningful stakeholder engagement, co-production of knowledge, capacity-building support and resources, and communication between multi-stakeholder partners. Outcomes included new ways of thinking about research topics based on arts-informed approaches, more positive attitudes about co-production, more relevant and useful research and evaluation findings, and increased openness to future co-productive work. Discussion and conclusions:Four propositions arising from this article include: (1) arts-informed approaches address context specificity and sensitivity; (2) arts-informed approaches promote engagement; (3) arts-informed approaches enhance and intertwine skills; (4) arts-informed approaches broaden thinking about impact.

Qualitative study on overcoming heterosexist harassment at work: indian cases

The Purpose of this paper is to understand the heterosexist harassment faced by Lesbian and Gay employees at the workplace in an Indian context where gender stereotypes are rooted throughout society. It also aims at exploring the coping mechanisms used by these gay/lesbian employees to deal with this harassment. In-depth interviews of six lesbian/gay employees from the NCR region of India were conducted for collecting data and information through open-ended questionnaire. The samples were selected through purposive non-probability sampling technique. Each interview has been explained through a case study by identifying themes and patterns based on cross-case synthesis, pattern matching and explanation building among them. The results revealed that the Lesbian/gay employees frequently experienced bullying, unwanted jokes, discrimination based on sexual orientation, sexual assault, dismissal from the job, social ostracism and isolation. Several coping strategies were identified which help the lesbian/gay employees to deal with these heterosexist harassments at workplace. Four broad categories of coping strategies were identified as support seeking, confrontation, inaction, and quitting. It was also revealed that participants resorted to secrecy and withdrawal as a way of managing labeling and stigma and to further avoid the subsequent heterosexual abuse. The findings of the study will advance the knowledge in the heterosexist harassments and coping mechanism used by lesbian/gay employees at workplace. The results contribute to meaningful social change to build safe work environments for Lesbian and gay employees.

A Comparative Analysis of Residential Care: A Five-Country Multiple Case-Design Study

BackgroundDespite a global policy push toward the advancement of family- and community-based care, residential care for children and youth remains a relevant and highly utilized out-of-home care option in many countries, fulfilling functions of care and accommodation as well as education and treatment.ObjectiveAs part of a larger project involving five European countries (Finland, Germany, Italy, Lithuania, and Spain), the objective was “to map” the context and content of residential care in each country, thereby building a foundation for meaningful comparisons and deepened understanding of each system’s inherent logic. Within the context of global deinstitutionalization efforts, the study also aimed to understand factors that hinder or enhance the transformation of residential care.MethodUsing an embedded multiple-case design, data was gathered by each country on its residential care macro context as well as salient variables related to three units of analysis–residential care system/program features, residential care training and personnel, characteristics of youth. Cross-case synthesis was used to summarize and compare cases across relevant dimensions.ResultsThe analysis highlighted areas of overlap and singularity, particularly with regard to utilization rates, concepts and methods, workforce professionalization, and characteristics of youth.ConclusionsFindings provide a more nuanced understanding of how residential care continues to be viewed and utilized in some countries, challenging the ‘residential-care-as-a-last-resort-only’ rhetoric that is currently dominating the discourse on residential care. It further provides an understanding of historical and sociocultural factors that need to be considered when trying to transform services for children, youth, and their families.

Improving primary health care through partnerships: Key insights from a cross-case analysis of multi-stakeholder partnerships in two Canadian provinces.

Background and AimsMulti‐stakeholder partnerships offer strategic advantages in addressing multi‐faceted issues in complex, fast‐paced, and rapidly‐evolving community health contexts. Synergistic partnerships mobilize partners' complementary financial and nonfinancial resources, resulting in improved outcomes beyond that achievable through individual efforts. Our objectives were to explore the manifestations of synergy in partnerships involving stakeholders from different organizations with an interest in implementing organizational solutions that enhance access to primary health care (PHC) for vulnerable populations, and to describe structures and processes that facilitated the work of these partnerships.MethodsThis was a longitudinal case study in two Canadian provinces of two collaborative partnerships involving decision makers, academic representatives, clinicians, health system administrators, patient partners, and representatives of health and social service organizations providing services to vulnerable populations. Document review, nonparticipant observation of partnerships' meetings (n = 14) and semi‐structured in‐depth interviews (n = 16) were conducted between 2016 and 2018. Data analysis involved a cross‐case synthesis to compare the cases and framework analysis to identify prominent themes.ResultsFour major themes emerged from the data. Partnership synergy manifested itself in the following: (a) the integration of resources, (b) partnership atmosphere, (c) perceived stakeholder benefits, and (d) capacity for adaptation to context. Synergy developed before the intended PHC access outcomes could be assessed and acted both as a dynamic indicator of the health of the partnership and a source of energy fuelling partnership improvement and vitality. Synergistic action among multiple stakeholders was achieved through enabling processes at interpersonal, operational, and system levels.ConclusionsThe partnership synergy framework is useful in assessing the intermediate outcomes of ongoing partnerships when it is too early to evaluate the achievement of long‐term intended outcomes. Enabling processes require attention as part of routine partnership assessment.

Self-harming adolescents: how do they perceive and explain this behavior?

Abstract Self-harm is a prevalent adolescence behavior, indicated as a public health problem. The objective was to understand how adolescents perceive and explain this behavior, considering family and school characteristics. It’s a multiple case study, in which five self-harming adolescents participated, enrolled in a public school in Novo Hamburgo-RS, participated in the study. They answered the following instruments: Sociodemographic Data Sheet, Semi-Structured Interview, Family Support Perception Inventory, Youth Self-Reporting and Delaware School Climate Survey-Student. Each case was individually analyzed and cross-case synthesis was performed. Self-harm was indicated as a strategy to relief suffering and regulate emotions. Low familial support, lack of skills, and presence of internalizing and externalizing problems were evidenced, as well as negative evaluation of peer relations and student engagement. When faced with a complex phenomenon, it is important to contemplate individual and relational issues in interventions.

Developmental Journeys from Teaching Experiences to the Teaching Profession: Cases of New Secondary Science Teachers

ABSTRACT Although there are initiatives to attract individuals with STEM degrees and experiences into teaching, little is known about the characteristics and development of qualified professional scientists with previous uncertified teaching experiences becoming teachers. One approach to prepare second career certified teachers (SCCTs) for teaching is through teaching fellowships. This qualitative case study investigated the experiences and development of three SCCTs who were accepted into a one-year, intensive teacher fellowship preparation program. The study focused on the SCCTs development and transformations over the fellowship year. The data collected consisted of questionnaires, interviews, and teaching observations. Cross-case synthesis revealed similarities and differences in the coherences and tensions experienced by the SCCTs throughout the clinical preparation year. In addition, the SCCTs experienced shifting identities from scientists, to students, to teachers, to professionals. This study suggests that science teacher educators need to recognize the diverse prior experiences of SCCTs and assist them in balancing and negotiating tensions that might exist between previous and current teaching experiences.

Vulnerable populations: A cross-case synthesis of correctional facility disaster response during Hurricanes Katrina and Maria.

This study aims to critically evaluate the Orleans Parish Prison (OPP), New Orleans, Louisiana response to Hurricane Katrina in 2005 and the Metropolitan Detention Center (MDC), Guaynabo, Puerto Rico, response to Hurricane Maria in 2017 to determine key areas for policy development. This study uses an interpretivist paradigm to conduct an inductive, cross-case synthesis and content analysis. The OPP in Katrina and the MDC in Maria; case-studies determined by similar exposure to hurricanes in the Caribbean and inmate population. Inmates as an intrinsically vulnerable population. Cross-case synthesis of the two selected case-studies comparing response to separate hurricanes. The ProQuest, Wiley, Scopus, Science Direct, and Google Scholar databases were used to establish a corpus of qualitative data focused on the evacuation and humane treatment of inmates. Inductive content analysis resulted in three themes which informed seven policy recommendations for enhanced correctional facility preparedness for natural and human-induced hazards. The preparedness of correctional facilities remains inadequate despite significant experience during Katrina, Maria, and other disasters demonstrating a failure in isomorphic learning. The theoretical contributions of this study are encapsulated in seven recommendations. Three are recommended accountability and support measures for the Bureau of Prisons (BOP) and state institutions by involving the FEMA and the Government Accountability Office (GAO). The other four are recommended improvements in EM planning for counties and municipalities.

ASPECTS OF PUBLIC SPACE IN THE INFORMAL ECONOMIC SPACES AT LOW-COST APARTMENT BUILDING (RUSUNAWA) IN SURABAYA

The human needs for livelihood have become important part as an effort to maintain its survival. Therefore, one of the job opportunities that can be done is to work in the informal sector. The informal sector also appears in public spaces, the example is at low-cost apartment building (rusunawa), such as food stalls and grocery stores in corridors, playgrounds or parking areas of rusunawa. This study looks at the development of the function of the rusunawa as a residence into an informal economic space in the Rusunawa in the City of Surabaya. This study used a qualitative descriptive method, by connecting the correlation between the public space and the informal economy space (logic model analysis and cross-case synthesis). So that it can provide knowledge about the planning and development of rusunawa in the future, as policy guidelines regarding the planning and development of rusunawa.
 Keywords : Public Space, Informal Economic Space, Affordable Rental Apartments, Surabaya

Active Ingredients and Mechanisms of Change in Motivational Interviewing for Smoking Cessation in Patients With Coronary Artery Disease: A Mixed Methods Study.

Background: For patients with coronary artery disease (CAD), smoking is an important risk factor for the recurrence of a cardiovascular event. Motivational interviewing (MI) may increase the motivation of the smokers to stop smoking. Data on MI for smoking cessation in patients with CAD are limited, and the active ingredients and working mechanisms of MI in smoking cessation are largely unknown. Therefore, this study was designed to explore active ingredients and working mechanisms of MI for smoking cessation in smokers with CAD, shortly after a cardiovascular event.Methods: We conducted a qualitative multiple case study of 24 patients with CAD who participated in a randomized trial on lifestyle change. One hundred and nine audio-recorded MI sessions were coded with a combination of the sequential code for observing process exchanges (SCOPE) and the motivational interviewing skill code (MISC). The analysis of the cases consisted of three phases: single case analysis, cross-case analysis, and cross-case synthesis. In a quantitative sequential analysis, we calculated the transition probabilities between the use of MI techniques by the coaches and the subsequent patient statements concerning smoking cessation.Results: In 12 cases, we observed ingredients that appeared to activate the mechanisms of change. Active ingredients were compositions of behaviors of the coaches (e.g., supporting self-efficacy and supporting autonomy) and patient reactions (e.g., in-depth self-exploration and change talk), interacting over large parts of an MI session. The composition of active ingredients differed among cases, as the patient process and the MI-coaching strategy differed. Particularly, change talk and self-efficacy appeared to stimulate the mechanisms of change “arguing oneself into change” and “increasing self-efficacy/confidence.”Conclusion: Harnessing active ingredients that target the mechanisms of change “increasing self-efficacy” and “arguing oneself into change” is a good MI strategy for smoking cessation, because it addresses the ambivalence of a patient toward his/her ability to quit, while, after the actual cessation, maintaining the feeling of urgency to persist in not smoking in the patient.

Factors influencing the implementation of mental health recovery into services: a systematic mixed studies review

BackgroundCountries around the world have committed in policy to transforming their mental health services towards a recovery orientation. How has mental health recovery been implemented into services for adults, and what factors influence the implementation of recovery-oriented services?MethodsThis systematic mixed studies review followed a convergent qualitative synthesis design and used the best-fit framework synthesis method. Librarians ran searches in Ovid- MEDLINE, Ovid-EMBASE, Ovid-PsycInfo, EBSCO-CINAHL Plus with Full Text, ProQuest Dissertations and Theses, Cochrane Library, and Scopus. Two reviewers independently screened studies for inclusion or exclusion using DistillerSR. Qualitative, quantitative, and mixed methods peer-reviewed studies published since 1998 were included if they reported a new effort to transform adult mental health services towards a recovery orientation, and reported findings related to implementation experience, process, or factors. Data was extracted in NVivo12 to the 38 constructs of the Consolidated Framework for Implementation Research (CFIR). The synthesis included a within-case and a cross-case thematic analysis of data coded to each CFIR construct. Cases were types of recovery-oriented innovations.ResultsSeventy studies met our inclusion criteria. These were grouped into seven types of recovery-oriented innovations (cases) for within-case and cross-case synthesis. Themes illustrating common implementation factors across innovations are presented by CFIR domain: Intervention Characteristics (flexibility, relationship building, lived experience); Inner Setting (traditional biomedical vs. recovery-oriented approach, the importance of organizational and policy commitment to recovery-transformation, staff turnover, lack of resources to support personal recovery goals, information gaps about new roles and procedures, interpersonal relationships), Characteristics of Individuals (variability in knowledge about recovery, characteristics of recovery-oriented service providers); Process (the importance of planning, early and continuous engagement with stakeholders). Very little data from included studies was extracted to the outer setting domain, and therefore, we present only some initial observations and note that further research on outer setting implementation factors is needed.ConclusionThe CFIR required some adaptation for use as an implementation framework in this review. The common implementation factors presented are an important starting point for stakeholders to consider when implementing recovery-oriented services.

Factors inhibiting the psychological recovery process of children in conflict with the law

Psychological assistance is strongly needed in relation to the recovery of the psychological state of children who are in conflict with the law. Semarang City has developed a school-based restorative justice program as a response to such needs. This research aims to explore the factors which could potentially obstruct the psychological recovery process of these children during the implementation of the program. The study adopts a qualitative design through multiple case studies, with the participation of three children and those close to them. The case study data analysis was conducted based on Yin's (2015) techniques, consisting of pattern matching, explanation building, logic models, and cross-case synthesis. The results show that negative support from peers, drug abuse, negative role models, emotional detachment from close friends and relatives, and negative stigma were the factors obstructing the recovery process of the participants. These findings could be essential for practitioners’ design of psychological interventions which are more relevant to the children’s recovery needs.

Implementing immediate postpartum contraception: a comparative case study at 11 hospitals

BackgroundImmediate postpartum long-acting reversible contraception (LARC) is an evidence-based practice, but hospitals face significant barriers to its adoption. Our objective was to examine how organizational context (e.g., size, employee attitudes toward the clinical practice) and implementation strategies (i.e., the actions taken to routinize a clinical practice) drive successful implementation of immediate postpartum LARC services, with a goal of informing the design of future implementation interventions.MethodsWe conducted a comparative case study of the implementation of inpatient postpartum contraceptive care at 11 US maternity hospitals. In 2017–2018, we conducted site visits that included semi-structured key informant interviews informed by the Consolidated Framework for Implementation Research. Qualitative measures of implementation success included stakeholder satisfaction, routinization, and sustainability of immediate postpartum LARC services. Qualitative content analysis and cross-case synthesis explored relationships among organizational context, implementation strategies, and implementation success.ResultsWe completed semi-structured interviews with 78 clinicians, nurses, residents, pharmacy and revenue cycle staff, and hospital administrators. Successful implementation required three essential conditions: effective implementation champions, an enabling financial environment, and hospital administrator engagement. Six other contextual conditions were influential: trust and effective communication, alignment with stakeholders’ professional values, perception of meeting patients’ needs, robust learning climate, compatibility with workflow, and positive attitudes and adequate knowledge about the clinical practice. On average, sites used 18 (range 11-22) strategies. Strategies to optimize the financial environment and train clinicians and staff were commonly used. Strategies to plan and evaluate implementation and to engage patients emerged as promising to address barriers to practice change, yet were often underused.ConclusionsImplementation efforts in maternity settings may be more successful if they select strategies to optimize local conditions for success. Our findings elucidate key contextual conditions to target and provide a menu of promising implementation strategies for incorporating recommended contraceptive services into routine maternity practice. Additional prospective research should evaluate whether these strategies effectively optimize local conditions for successful implementation in a variety of settings.