Abstract
Introduction
In the United States (U.S.), perinatal quality improvement collaboratives have pursued implementing immediate postpartum long-acting reversible contraception (LARC) initiatives to increase people’s access to contraception and support their fertility desires. This process evaluation aimed to identify barriers and facilitators to implementing an immediate postpartum LARC initiative in Florida.
Methods
Data collection included in-depth qualitative assessments (i.e., interviews, small focus group discussions) with hospitals in pre- and early stages of the implementation process. Snowball sampling was used to recruit participants. Interviews were conducted in-person or via Zoom or phone and were audio-recorded and transcribed verbatim. Four of the five domains within the Consolidated Framework for Implementation Research (e.g., process, intervention characteristics, inner and outer settings) informed the study design and data collection/analysis.
Results
Fourteen staff of diverse job roles from five hospitals participated. Factors that facilitated implementation were the strength of the evidence, relative advantage, internal and external networks, and engaging staff. Barriers to implementation included billing and reimbursement and needing significant support from external networks to progress through implementation phases.
Discussion
Findings suggest that depending on the task or phase, multiple factors work in tandem to serve as implementation barriers and facilitators. Additionally, evaluating hospitals’ progress at the pre- and early implementation phases was critical for quickly finding solutions and benefited other hospitals in different stages. As this initiative requires substantial support, health systems should create and sustain a culture of excellence and efficiency to facilitate implementing initiatives that improve care quality.
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References
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Funding
We received funding from the Florida Department of Health to conduct this work.
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RL: Methodology, formal analysis, investigation, data curation, writing—original draft, writing—review and editing, visualization, project administration; CV: Methodology, formal analysis, writing—review and editing, project administration, supervision); LD: Resources, writing—review and editing, funding acquisition; WS: Resources, writing- review and editing, funding acquisition, supervision.
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This evaluation was deemed exempt by the University of South Florida Institutional Review Board.
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We obtained written or verbal consent to participate in the evaluation from each hospital and participant prior to data collection, including consent to audio-record interviews and focus group discussions.
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Logan, R.G., Vamos, C.A., Detman, L.A. et al. An Initiative “that you do for one person”: Identifying Barriers and Facilitators to Implementing an Immediate Postpartum LARC Initiative in Florida Hospitals. Matern Child Health J 26, 2283–2292 (2022). https://doi.org/10.1007/s10995-022-03491-6
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DOI: https://doi.org/10.1007/s10995-022-03491-6