Rapid implementation mapping to identify implementation determinants and strategies for cervical cancer control in Nigeria

Abstract

BackgroundCervical cancer constitutes a huge burden among women in Nigeria, particularly HIV-infected women. However, the provision and uptake of cervical cancer screening and treatment is limited in Nigeria. Understanding implementation determinants is essential for the effective translation of such evidence-based interventions into practice, particularly in low-resource settings. COVID-19 pandemic necessitated online collaboration making implementation mapping challenging in some ways, while providing streamlining opportunities. In this study, we describe the use of a virtual online approach for implementation mapping (steps 1–3) to identify implementation determinants, mechanisms, and strategies to implement evidence-based cervical cancer screening and treatment in existing HIV infrastructure in Nigeria.MethodsThis study used a mixed methods study design with a virtual modified nominal group technique (NGT) process aligning with Implementation Mapping steps 1–3. Eleven stakeholders (six program staff and five healthcare providers and administrators) participated in a virtual NGT process which occurred in two phases. The first phase utilized online surveys, and the second phase utilized an NGT and implementation mapping process. The Exploration, Preparation, Implementation and Sustainment (EPIS) framework was used to elicit discussion around determinants and strategies from the outer context (i.e., country and regions), inner organizational context of existing HIV infrastructure, bridging factors that relate to bi-directional influences, and the health innovation to be implemented (in this case cervical cancer screening and treatment). During the NGT, the group ranked implementation barriers and voted on implementation strategies using Mentimeter.ResultsEighteen determinants to integrating cervical cancer screening and treatment into existing comprehensive HIV programs were related to human resources capacity, access to cervical cancer services, logistics management, clinic, and client-related factors. The top 3 determinants included gaps in human resources capacity, poor access to cervical cancer services, and lack of demand for services resulting from lack of awareness about the disease and servicesA set of six core implementation strategies and two enhanced implementation strategies were identified.ConclusionsRapid Implementation Mapping is a feasible and acceptable approach for identifying and articulating implementation determinants, mechanisms, and strategies for complex healthcare interventions in LMICs.

Using Implementation Mapping to develop an intervention program to support veterinarians’ adherence to the guideline on Streptococcus suis clinical practice in weaned pigs

“…If there is no (financial and/or practical) possibility of following the Implementation Mapping approach, a shorter process (e.g., rapid Implementation Mapping [ 54 ]) could be effective enough to improve or maintain adherence to the guideline. To our knowledge, this is the first time that a theory-based intervention program for a veterinary guideline has been developed, and our results and experiences could serve as a protocol for designing interventions to support adherence to diverse guidelines in animal health promotion.…”

Concept mapping sociocultural aspects of cervical cancer prevention among African American women

“…and television/radio within predominantly African American female media environments (e.g., Facebook, specific television time slots, billboards in African American communities). Concept mapping has also found to be useful for rapid implementation efforts in cervical cancer prevention (36). Along with accurate knowledge, encouraging discussions among AAW about women's health will help facilitate a culture of health within families and the community.…”