Implementation Research Research Articles (Page 3)

Background Non-communicable diseases (NCDs), particularly hypertension and diabetes, represent a rising public health burden in India, driven by lifestyle changes and complex social determinants. In Karnataka’s Chamarajanagar district, previous research identified a high NCD prevalence alongside systemic gaps in the continuum of care and multisectoral action. The IMPACT NCD project is an implementation research study that aims to strengthen the primary healthcare system's capacity and foster multisectoral collaboration for effective NCD prevention and management. Its primary scientific objective is to conduct a rigorous implementation evaluation. This evaluation examines the causal pathways and contextual factors that influence the success of these real-world interventions to understand what works, for whom, and why. Methodology The study is guided by a theory-driven implementation research design. Interventions, developed using a participatory approach, include two main components: Capacity building and technical support for healthcare workers at Ayushman Arogya Mandirs (AAMs) on NCD screening, follow-up, and the continuum of care. Sensitisation workshops for local elected officials, police personnel, and students in grades 8 to 12. The effectiveness of these strategies will be evaluated using a sequential mixed-methods approach to understand the pathways and mechanisms of change. First, quantitative program data will be analysed using Principal Component Analysis (PCA) and cluster analysis to stratify primary units by performance. Subsequently, a purposive sample of high-performing and low-performing units will be selected for in-depth qualitative analysis through interviews and observations to test and refine the project's Theory of Change. Discussion The project’s strong focus on implementation evaluation is critical. By moving beyond simply measuring outcomes to understanding the underlying processes and contextual factors, the study aims to identify mechanisms that drive implementation success and sustainability mechanisms of change, the study will generate crucial insights into how complex, multisectoral NCD programs can be effectively embedded within existing government systems.

Evaluating the implementation and sustainment potential of a pharmacy-embedded community health worker model.

Barriers and facilitators to implementing pharmacist-driven mobile health clinics: Identification of implementation strategies using the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC) matching tool.

Implementation of Statewide Protocols for Community-based Pharmacist Services in Virginia: A Qualitative Study Using the Consolidated Framework for Implementation Research.

Background Severe asthma remains a major problem despite pharmacological advances. Pulmonary rehabilitation (PR) is established in chronic respiratory disease but its role in severe asthma is unclear. Objectives Summarise evidence on PR in severe and uncontrolled asthma, describe PR-modalities, and outline implementation and research priorities. Methods Narrative review of systematic reviews and clinical studies of multidimensional PR programmes and isolated components [aerobic training, inspiratory muscle training (IMT), breathing retraining, neuromuscular electrical stimulation (NMES), telerehabilitation]. Outcomes included asthma control, HRQoL, exercise capacity and healthcare utilisation. Results Multicomponent PR improves exercise capacity and multiple QoL domains; pooled data show substantial increases in six-minute walk distance. Combined exercise, education and self-management produced clinically meaningful improvements in asthma control and symptoms, notably patients with uncontrolled disease and functional impairment. IMT, NMES and breathing retraining improved inspiratory strength, peripheral muscle function and hyperventilation symptoms. Telerehabilitation expands access but requires attention to digital literacy and adherence. Heterogeneity, small samples and attrition limit generalisability. Conclusion PR is a promising personalised, multidisciplinary adjunct for severe asthma. Larger phenotype-stratified trials, harmonised outcome sets and implementation research are needed to define candidate selection, optimal dose and cost-effectiveness; embedding PR within severe asthma centres may optimise outcomes and reduce healthcare use.

Background: Hypertension remains a leading cause of cardiovascular morbidity and mortality, disproportionately affecting low- and middle-income countries (LMICs), where healthcare access and awareness are limited. Excessive sodium intake, often from discretionary salt used in cooking, contributes significantly to this burden. Salt substitutes, typically formulated by partially replacing sodium chloride with potassium chloride or other minerals, offer a cost-effective dietary intervention to lower blood pressure (BP) and reduce cardiovascular risk, particularly in resource-constrained settings. Objective: This review examines the efficacy of low-sodium salt substitutes (LSSS) in reducing blood pressure (BP) and its effects on cardiovascular (CV) outcomes, safety concerns, and challenges to their implementation in LMICs. Methods: We conducted a comprehensive narrative review of studies published between 1994 and 2024 using PubMed, Embase, and Scopus databases. Eligible studies included randomized controlled trials, systematic reviews, observational studies, and implementation research that evaluated the effects of LSSS on BP, CV outcomes, safety, and feasibility in LMIC contexts. Thematic synthesis was used to summarize the findings. Key Findings: Salt substitutes consistently lowered systolic and diastolic BP across diverse populations, with mean reductions ranging from 3 to 5 mmHg. Trials have also demonstrated reductions in stroke incidence, CV events, and all-cause mortality. However, the benefits were mostly derived from studies conducted in China and other upper-middle-income settings. Safety concerns (particularly hyperkalemia in individuals with chronic kidney disease or RAAS inhibitors) warrant targeted risk screening and public education. Implementation barriers in LMICs include cost, limited availability, poor awareness, and a lack of regulatory oversight. Conclusions: Salt substitutes present a promising, scalable strategy to reduce BP and CV disease burden in LMICs. However, their adoption must be context-specific, culturally sensitive, and supported by government subsidies, regulatory frameworks, and educational campaigns. Future trials should evaluate the long-term safety and cost-effectiveness in underrepresented LMIC populations to guide equitable public health interventions.

Electronic patient-reported outcomes (ePROs)-based cancer symptom management presents an opportunity to improve patient outcomes by optimizing symptom detection and prompting clinician interventions in tertiary hospitals. However, real-world evidence is limited, especially in primary health care (PHC) settings, which are accompanied by more complex and unknown influencing factors. We conducted a qualitative study to identify facilitators and barriers associated with the implementation of ePRO-based symptom management in China's PHC settings under the implementation science (IS) framework. We further developed strategies and recommendations for real-world practices and health policies. This qualitative study was conducted from October to December 2023 in 9 purposively selected PHC institutions (5 urban and 4 rural) across 5 administrative districts of Yangzhou, Jiangsu Province, China. Community-dwelling patients with cancer, PHC providers, and medical supervisors participated in semistructured interviews and focus group discussions. We used 2 subframeworks under the IS framework-the Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change-to conduct data analysis and generate strategies. A total of 72 individuals were invited to participate in this study, including 35 community-dwelling patients with cancer (median 66, IQR 60-71.5 years; n=21, 60% men) and 23 PHC personnel (median 45, IQR 27-51 years; n=12, 52.17% men) who participated in semistructured interviews, and 14 medical supervisors (median 47.5, IQR 36.5-54 years; n=10, 71.43% men) who participated in focus group discussions. This study identified 29 barriers and 21 facilitators, and then developed 13 strategies. Crucial challenges include PHC providers' low self-efficacy and unclear role identification, coupled with community-dwelling patients' mistrust of primary care, cancer stigma, and fatalistic beliefs, which further reduce motivation; poor integration of ePRO with existing workflows and the absence of performance incentive mechanisms; a lack of nationwide standardized implementation guidelines and quality evaluation criteria; and outdated medical equipment and a limited range of medications. Common challenges included weak collaborative relationships and insufficient funding. Grounded in the IS framework, our study identifies 3 critical priorities for implementing ePRO-based cancer symptom management in PHC settings, including addressing individual-level motivational deficiencies among community-dwelling patients with cancer and PHC providers by resolving misconceptions, bridging knowledge gaps, and establishing supportive incentives; developing supportive medical partnerships and advancing tiered management systems to empower PHC settings; and creating standardized operational guidelines with clear workflows and implementing real-world data-driven regulatory feedback mechanisms to ensure quality control.

Background Although meta-analyses have demonstrated the value of parenting programs to promote child development in low- and middle-income countries, scaling them horizontally and vertically through the system has remained largely undocumented. This study examines the enablers and barriers to scaling parenting programs implemented by different organizations in four countries, namely Bhutan, Rwanda, Serbia, and Zambia. Method An independent research and learning organization collected multi-method data from three sources, toward the end of a four-year period, to identify enablers and barriers of scale. The sources and method included: in-depth semi-structured interviews with two members of the technical resource teams ( n = 8); phone surveys with a random sample of providers who delivered the program to caregivers ( n = 529) along with in-depth interviews with a smaller number of providers ( n = 44); and in-depth semi-structured interviews with key government stakeholders ( n = 57). Content analysis was conducted to identify interviewees’ comments that reflected enablers and barriers to scale. Results Findings are presented to address horizontal and vertical enablers and barriers in each of the four country programs. Regarding horizontal scale, the main enabler was an existing workforce who was quickly trained to deliver the program and who perceived a need within their communities. Expanding the reach of the programs also required advocacy to raise demand among community leaders and caregivers. Design features of the programs, such as curriculum, modality, and dosage, contributed to effective outcomes as a function of their adaptation to providers’ and caregivers’ experiences. The main enabler of vertical scale was adoption by the government, integration into the system, and engagement of multisectoral stakeholders. Based on final reflections of stakeholders, qualitative data were provided for eight indicators of successful scale: demand, reach, equity, and workforce (for horizontal scale); multisectorality, adoption, policy/finance, and integration (for vertical scale). Conclusion Planning for scale needs to be done at the start by considering facilitative design features, selection of a workforce, and ownership by the government. Ongoing implementation research conducted with different stakeholders is needed to provide feedback for course-correction during the process of scale. Eight indicators can be used to evaluate the level of successful scale achieved by programs.

Traditional surgical prehabilitation emphasizes biomechanical conditioning. In a pain landscape shaped by opioid exposure, trauma histories, and psychosocial distress, this reductionist approach is insufficient. To propose a multidimensional, whole-person framework for perioperative readiness that integrates neurobiological mechanisms with practical clinical and policy levers. Five synergistic domains-biological, psychological, social, spiritual, and existential-address discrete readiness deficits linked to dopaminergic tone, central sensitization, stress reactivity, connection, and meaning. Each domain is mapped to mechanisms, evidence-based interventions (eg, physical therapy, cognitive behavioral therapy/screening, social support linkage, chaplaincy, reflective practices), and relevant billing structures (Current Procedural Terminology Healthcare Common Procedure Coding System, International Classification of Diseases, 10th Revision Z codes). The model operationalizes a deliverables-based pathway-screen → triage → targeted interventions → outcome tracking-monitoring pain, function, opioid exposure (morphine milligram equivalents), length of stay/readmissions, depression and anxiety (Paitent Health Questionnaire-4), and pain catastrophizing (Pain Catastrophizing Scale). It aligns with risk-adjusted payment models and can be embedded within enhanced recovery after surgery programs. Reframing prehabilitation as neurobiologically informed whole-person readiness provides a low-risk, nonpharmacological strategy to reduce suffering, improve engagement, enhance postoperative pain control and recovery, and decrease opioid reliance. 5 (Expert Opinion). This perspective integrates neurobiological and behavioral theory with policy and billing frameworks to enable hypothesis-generating implementation and outcomes research.

To identify barriers and facilitators to nurse prescribing implementation through a synthesis of qualitative studies. The roles of healthcare professionals are expanding in response to the growing demand for access to high-quality healthcare services. Advanced practice nurses are a global trend, and nurse prescribing is a crucial feature of advanced practice nurses that can meet the needs of growing healthcare services. The development and promotion of nurse prescribing varies significantly across countries, and it is essential to identify the factors influencing the implementation of nurse prescribing. A systematic search of PubMed, Web of Science, Embase, Cochrane Library, CINAHL, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wan Fang and Weipu database was conducted to retrieve literature on barriers and facilitators related to the implementation of nurse prescribing. We searched records from inception to 29 March 2025. Two researchers independently performed literature screening, literature evaluation, data extraction and synthesis. Literature screening and data extraction adhered to the predefined inclusion and exclusion criteria. Literature quality was evaluated using the JBI Checklist for Qualitative Research. The results were synthesised using the thematic synthesis approach. Information was extracted using the Consolidated Framework for Implementation Research (CFIR) in a deductive way, and barriers and facilitators to the implementation were categorised based on the CFIR. Report rigour assessed via ENTREQ. The synthesis of 14 included papers identified 18 thematic categories, yielding two key findings. The main barriers identified included failure to anticipate the cost of nurse prescribing, legal constraints, social pressures, poor organisational structure, insufficient prescribing education, lack of competence of nurses leading to psychological changes, opposition and lack of cooperation of team members, and insufficient planning of nurse prescribing. Facilitating factors included prescribing experience, resource and labor conservation, cost reduction, resources, nurses' prescribing training, leadership support, patients' needs, nursing professional development, nurses' competence, and team cooperation and support. Identifying barriers and facilitators to nurse prescribing is critical for informing policy-making and clinical prescribing practices. The results offers practical guidance to develop strategic plans that enhance implementation and adoption of nurse prescribing. Nurse prescribing improves patient access while mitigating healthcare strain. By streamlining medication delivery and optimising resource use in overburdened systems, this model strengthens patient-centered care while allowing physician specialisation in complex cases. This workforce innovation enhances team-based care and ensures continuity for vulnerable populations. This paper identifies barriers and facilitators, offering policymakers, healthcare administrators, and educators actionable insights to enable nurse role expansion, reduce physician workload, and enhance outcomes through holistic care. No patient or public contribution.

Background/Objectives: Depressive disorders are among the most prevalent mental illnesses worldwide. Digital health interventions offer potential to improve access, efficiency, and outcomes in depression care. However, their sustainable integration into routine clinical practice remains limited. This study explored individual, organizational, external and contextual factors influencing digital health interventions implementation from the perspective of health professionals. Methods: Semi-structured interviews with health professionals (n = 9) were analyzed using a hybrid qualitative approach. First, structuring content analysis following Kuckartz was applied to systematically code and categorize the transcripts. Second, the resulting codes were mapped onto four domains of the Consolidated Framework for Implementation Research (Outer Setting, Inner Setting, Process, and Characteristics of Individuals) to identify implementation-relevant barriers and facilitators. This combined approach ensured a transparent, theory-informed, and reproducible analysis of factors influencing digital health intervention implementation in depression care. Results: Key individual-level enablers included openness to innovation, motivation, and prior experience with digital tools. Organizational factors such as leadership support, designated facilitators, time, training, and IT infrastructure were critical. External factors included data protection, clear regulatory frameworks, reimbursement mechanisms, and scientific validation. Barriers involved limited digital skills, ambiguous responsibilities, and concerns about misuse or risks. Conclusions: The successful implementation of digital health interventions in depression care requires alignment with organizational structures, provider capabilities, and patient needs. Supportive leadership, tailored training, and clear external frameworks can enhance acceptance and sustainability. As complementary tools, digital health interventions can help optimize mental health services and improve patient outcomes.

BackgroundProlonged invasive mechanical ventilation (IMV) increases risks of complications and healthcare burdens. Protocol-directed weaning reduces IMV duration but faces implementation barriers. Nurse-led protocolized weaning (NLPW) offers promise, yet evidence on its effectiveness within specific healthcare contexts and systematic implementation processes remains limited.ObjectivesThis hybrid type 1 effectiveness-implementation study evaluated the clinical impact and feasibility of implementation of a structured NLPW program in a surgical ICU.MethodsA mixed-methods design was employed. Quantitative component: A quasi-experimental study with historical controls compared patient outcomes (weaning duration, IMV duration, ICU stay, 24-hours reintubation) before (May-Sep 2023, n = 147) and during (May-Aug 2024, n = 147) implementing an evidence-based NLPW program guided by the Knowledge-to-Action framework. Qualitative component: Semi-structured interviews informed by the Consolidated Framework for Implementation Research (CFIR) identified implementation barriers and facilitators. Nurses’ knowledge changes and protocol adherence were assessed.ResultsAmong 294 included patients (mean age 62.3 ± 17.8 years, 50.3% male), NLPW significantly reduced mean weaning duration (1.66 ± 0.92 vs. 2.8 ± 1.35 h; Δ = 1.2 h, P < 0.001) without increasing reintubation rates or shortening total IMV duration. Post-implementation, nurses’ knowledge scores increased significantly (70.3 ± 7.6 to 83.5 ± 5.1; P < 0.05), and protocol adherence exceeded 95% for core process indicators. Qualitative analysis revealed three critical success factors: (1) individual behavioral changes, (2) optimization of nursing workflows, and (3) utilization of resources to support clinical practice.ConclusionsA theory-informed, NLPW program safely accelerated liberation from IMV in surgical ICU patients and enhanced nursing expertise. Successful implementation requires addressing contextual barriers through tailored training, workflow optimization, and resource support. NLPW represents a scalable strategy to standardize ventilator weaning, particularly in settings with limited respiratory therapy support. Future studies should evaluate long-term sustainability and generalizability across diverse ICU populations.Patient or public contribution: No Patient or Public Contribution.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12890-025-03967-5.

ABSTRACT Background Malawi has a significant burden of hypertension, including for people with HIV. The World Health Organization recommends integrated HIV-hypertension care, but such integration is not widely implemented in resource-constrained settings. Objective This study explored barriers to hypertension care in Malawi from the perspectives of healthcare providers and health system leaders. Methods We conducted a qualitative study of providers and health system leaders across 14 health facilities in Malawi. Interviews explored hypertension services in integrated (HIV and hypertension) and non-integrated clinics to identify barriers to hypertension care and compare barriers by integration status. Interview guides and analysis used the Consolidated Framework for Implementation Research. All transcripts were double coded and thematic analysis was performed. Results From April–May 2023, we interviewed 33 individuals (25 providers and 8 health system leaders). Barriers to hypertension care were largely the same in integrated and non-integrated clinics and included stockouts of antihypertensive medications, lack of equipment, lack of provider training, and weak medical record systems. Providers working in integrated care emphasized the benefits of reduced burden for clients and improved quality of care but also reported unique challenges, including capacity constraints (due to the large number of clients) and inability to provide aligned dispensing of antihypertensive medications and ART (due to antihypertensive medication stockouts). Conclusions Barriers to integrated HIV and hypertension care in our study largely reflected challenges for hypertension care more broadly. Future efforts should focus on provider training, supply chain strengthening, equipment procurement, and medical record system strengthening to improve outcomes for people with hypertension and hypertension-HIV multimorbidity.

ABSTRACTRecently, it has been argued that youth‐initiated mentoring (YIM) holds promise for justice‐involved youth. In YIM, youths select an adult mentor from their social network. Successful implementation is key to the effectiveness of an innovation, but little is known about the factors contributing to the successful implementation of YIM. We explored boosters and barriers to implementation perceived by professionals implementing YIM into a juvenile diversion programme. We performed thematic analysis on one unstructured (N = 22) and three semi‐structured focus groups (N = 7–8) guided by the Consolidated Framework for Implementation Research. Findings suggest that professionals perceived the benefits of YIM in this context. Nevertheless, the current organisational culture, grounded in Risk‐Need‐Responsivity principles, hindered the actual implementation in certain cases, possibly endangering the continuation of YIM in a juvenile diversion context. Boosters and barriers can be considered and adopted by organisations aiming to implement YIM in a selective prevention context.Trial registration number: (ClinicalTrial.gov ID #NCT05555472).

Adaptation, implementation, and evaluation of a protective mental health intervention (Resilient minds) for Canadian volunteer firefighters.

BackgroundOlder people with severe frailty (OPWSF) have palliative needs but typically do not receive specialist palliative care (SPC). Patient-Reported Outcome Measures (PROMs) may offer valuable means to capture these needs. There is a limited understanding of what to include and how to implement PROMs in settings where this group receive most care. The study aimed to: (1) Critically examine how existing PROMs are currently implemented with OPWSF within a SPC setting. (2) Understand how the items with the PROMs are used (3) Develop a programme theory to determine how PROMs can be optimally designed and implemented to effectively capture the needs and priorities of OPWSF in the care setting where they receive most care.MethodologyMixed methods study in SPC community service in an urban area in the UK including: • Healthcare professionals (HCPs) providing care to OPWSF with a minimum of 6 months experience in a patient-facing role were purposively sampled: semi-structured interviews (n11); non-participatory observations (n10) - thematically analysed. • One-year retrospective case-note review of 357 episodes of care involving service-users identified with frailty at referral. Exploratory descriptive statistics were used to analyse the use of the Integrated Palliative Outcome Scale (IPOS) alongside additional clinical-led outcome measures. • Date integration using the Consolidation Framework for Implementation Research (CFIR) to develop a programme theory.ResultsPROMs can be effectively used with OPWSF, yet existing PROMs require adapting to ensure they capture the needs that matter most. • Completion of PROMs for this group largely depends on the assistance of others. • HCPs’ use of PROMs may be driven by immediate care and priorities of the care system rather than determining changes over time, with the psycho-social aspect of the PROMs being more challenging to complete.ConclusionBy utilising the CFIR, the study highlights the complexities and variabilities of using PROMs with OPWSF. Future research should focus on adapting and validating existing PROMs to ensure they are fit for purpose with this population, with the involvement of older people with frailty and unpaid carers. Providers should extend support and training for professionals in the use and value of PROMs and psychosocial-spiritual care.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41687-025-00951-9.

Pharmacogenomics (PGx) tailors drug treatments to an individual's genetic profile and contributes to improved efficacy and reduced adverse drug reactions. Community pharmacists have shown interest in PGx, and Dutch pharmacists have been early adopters in applying PGx guidelines, particularly through integration of the Dutch Pharmacogenetics Working Group recommendations. Despite growing evidence of its benefits, large-scale implementation in community pharmacies remains limited. This raises an important question for global stakeholders: if PGx adoption is constrained even in a system with robust infrastructure and guidelines, what lessons can be drawn for broader implementation? To examine current PGx practices in leading Dutch community pharmacies and to identify key barriers, facilitators, and implementation strategies for integrating PGx into routine pharmacy care. A cross-sectional survey was conducted among Dutch pharmacy professionals with experience in PGx implementation. Participants were categorized as key opinion leaders (KOLs), involved in national PGx policymaking, research, or representing academia or professional organizations, or local champions (LCs), defined as practicing pharmacists directly involved in local PGx implementation in hospital or community pharmacies. The questionnaire was retrospectively mapped to Consolidated Framework for Implementation Research domains. Quantitative data were analyzed descriptively and qualitative responses were inductively thematically grouped to contextualize findings. Of the 67 invited professionals, 46 completed the questionnaire (response rate: 69%). Among respondents, 70% were LCs and 30% KOLs. Among KOLs (n = 14), the most frequently cited barriers included costs (79%, n = 11/14), inadequate Information and Communication Technology (ICT) support (29%, n = 4/14), and legal or regulatory uncertainty (29%, n = 4/14). A positive view on the clinical value of PGx was reported by 81% of LCs (n = 26/32) and 93% of KOLs (n = 13/14). Suggested facilitators by LCs included improved ICT infrastructure (56%, n = 18/32), enhanced education and training (44%, n = 14/32), and stronger interdisciplinary collaboration (25%, n = 8/32). PGx implementation in Dutch pharmacies is hindered by structural barriers such as fragmented ICT and lack of reimbursement, despite strong professional support. Embedding PGx into pharmacy workflows and aligning policy, infrastructure, and education are essential. These findings may inform broader efforts to integrate PGx into pharmacies across diverse systems.

Implementation outcomes included in NIDA Clinical Trials Network (CTN) studies: A systematic review of studies conducted over 20years.

BackgroundIntegrative nursing (IN) involves the application of external naturopathic nursing interventions, such as compresses, embrocations, and therapeutic baths and washes. As part of a university hospital project, patients receiving oncology care in participating wards receive IN interventions as supportive care during their hospital stay as part of a consultation service.ObjectiveThis study aims to investigate the acceptance, feasibility, and contextual conditions of implementing IN in inpatient care and to evaluate perceptions, experiences, and perceived impact of IN interventions from multiple stakeholder perspectives.MethodsWe used a convergent parallel mixed methods approach guided by the Consolidated Framework for Implementation Research. The evaluation consists of 5 substudies reflecting multiple perspectives on the project. Patients, relatives, and hospital staff will participate. Substudies include a single-arm pre-post questionnaire (substudy 1) and semistructured interviews (substudy 2) with patients, a cross-sectional survey of relatives (substudy 3), semistructured interviews with health care professionals (substudy 4), and analysis of project-related documentation (substudy 5). Qualitative data will be analyzed using qualitative content analysis, and quantitative data will be analyzed using descriptive and inferential statistical methods.ResultsFollowing separate analyses of each substudy, the findings will be integrated and triangulated to generate overarching meta-inferences. The recruitment phase lasted from October 2023 to January 2025. Data collection was completed in March 2025. As of October 2025, after data verification and plausibility checks, data analysis is ongoing. The first results are expected to be published in 2026.ConclusionsThis study presents a mixed methods research protocol aimed at exploring the implementation of IN within a university hospital setting. It is expected to provide a theory-based contribution to IN implementation in inpatient care while also offering insights into its potential effects at the patient level. The study is anticipated to advance understanding of how IN can be sustainably embedded in hospital practice and to provide actionable insights for improving patient-centered supportive care.Trial RegistrationGerman Clinical Trials Register DRKS00032318; https://drks.de/search/de/trial/DRKS00032318International Registered Report Identifier (IRRID)DERR1-10.2196/74405

Background: Innovative interventions, such as social media platforms and telemedicine, were implemented during the COVID-19 lockdown period for HIV prevention and treatment services. However, limited studies have reported on the facilitators and barriers of these innovations for HIV pre-exposure prophylaxis (PrEP) service continuity. Therefore, this study aimed to identify the barriers and facilitators of the implemented PrEP innovative interventions during COVID-19 among adolescent girls and young women (AGYW). Methods: A qualitative exploratory design was used to conduct semi-structured interviews with twelve stakeholders in the Dr Kenneth Kaunda District, North West Province of South Africa. Participants included various TB HIV Care programme stakeholders, comprising professional nurses, case managers, peer educators, and counsellors. The Consolidated Framework for Implementation Research (CFIR) 2.0 domains and constructs guided the interview questions and the analysis process. Additionally, all interviews were audio-taped, transcribed verbatim, and analyzed through thematic analysis. The facilitators and barriers of the PrEP innovative interventions were categorized according to the five CFIR domains. Results: The findings showed that despite the COVID-19 disruptions in healthcare services, the implemented innovative PrEP interventions enhanced the HIV prevention services. Facilitators included sufficient mobile data, teamwork, clear communication from managers, resilience, and existing media pages that supported social media-based PrEP service continuity. The implementation barriers included service users’ lack of cell phone devices, incorrect personal information, fear of contracting COVID-19, and limited individual movements. Conclusion: Social media and digital technologies played a crucial role in the continuation of HIV PrEP services among AGYW. These evaluations also illustrated the potential of social media platforms to be leveraged for HIV service delivery during periods of disruption, such as the COVID-19 lockdown period, for HIV service delivery. Furthermore, lessons learned from this study are significant and offer practical considerations for sustaining PrEP during service disruptions.