Evaluating the implementation of the Reproductive Life Plan in disadvantaged communities: A mixed-methods study using the i-PARIHS framework

Abstract

Introduction The Reproductive Life Plan (RLP) is a clinical tool to help clients find strategies to achieve their reproductive goals. Despite much research on the RLP from high-income countries, it has never been studied in low-or middle income countries. Together with health workers called Mentor Mothers (MMs), we used a context-adapted RLP in disadvantaged areas in Eswatini. Our aim was to evaluate the implementation of the RLP in this setting. Methodology MMs participated in focus group discussions (FGDs, n = 3 MMs n = 29) in January 2018 and at follow-up in May 2018 (n = 4, MMs n = 24). FGDs covered challenges in using the RLP, how to adapt it, and later experiences from using it. We used a deductive qualitative thematic analysis with the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, creating themes guided by its four constructs: facilitation, innovation, recipients and context. The MMs also answered a questionnaire to assess the implementation process inspired by normalization process theory. Results The RLP intervention was feasible and acceptable among MMs and fit well with existing practices. The RLP questions were perceived as advantageous since they opened up discussions with clients and enabled reflection. All except one MM (n = 23) agreed or strongly agreed that they valued the effect the RLP has had on their work. Using the RLP, the MMs observed progress in pregnancy planning among their clients and thought it improved the quality of contraceptive counselling. The clients' ability to form and achieve their

Conceptual and relational advances of the PARIHS and i-PARIHS frameworks over the last decade: a critical interpretive synthesis

“… Sandstrom et al (2015) [ 17 ] a Geerligs et al (2020) [ 19 ] a Societal culture, social systems, or hegemony Note. Particularly relevant in implementation of public health interventions Niemeyer Hultstrand et al (2020) [ 18 ] b Conceptualization of leadership Leadership as a social collective process that has dynamic relationships with team culture, is characterized by diversified styles and diverse actions and operates in multiple ways and on multiple levels in the organization. Oye et al (2016) [ 23 ] a Leadership (of nurse managers) as a facilitator of evidence implementation: • Effective teamwork ○ Communication between managers and staff nurses ○ Foster collaboration • Effective organizational structures ○ Strategic governance (leadership combining management and clinical experience, awareness of the impact of improved outcomes) • Transformational leadership ○ Influence on evidence application (culture of expectations, inspiring a shared vision, sustaining evidence-based practice) ○ Readiness for change among leaders (enabling empowering, focus on teaching and learning, recognition, using resources in management) Note.…”

‘If we don’t assess the patient’s vision, we risk starting at the wrong end’: a qualitative evaluation of a stroke service knowledge translation project

“…This also influenced the participants’ experiences of how appropriate it was to use the KROSS tool in their services. Integration in the services’ existing routines and systems [ 31 ], together with a motivation for gaining additional knowledge and better routines for vision after stroke, were the facilitators for a sustainable change of practise [ 32 ].…”

Reproductive Life Planning in Adolescents

“…Other individual studies have also shown that RLP is feasible in both HIC and LMICs. 44 45 While the aforementioned studies indicate that RLP interventions are acceptable and feasible to health providers and patients, more research is required to explore potential benefits in adolescent populations, specifically.…”

“…One study of a modified RLP intervention delivered to adult women in Eswatini, South Africa, by community workers called Mentor Mothers reported increased knowledge and confidence to facilitate RLP conversations with women in the Mentor Mothers. 45 Whether more knowledgeable and confident Mentor Mothers increased women's knowledge or changed health behaviors was not explored, but there was reported increased contraception uptake.…”

“…The Mentor Mothers modified RLP intervention 45 commented on social, cultural, and financial barriers to women having autonomy in family planning. These included partners using conception as a form of control over one another, stigma, taboos around RLP discussions outside of families, and men being disengaged with RLP conversations and decisions.…”