Table 3 Examples of implementation strategy modifications

 Modification

Reduced frequency of peer support meetings from 1x/month to 1x/2 months

Additional information shared between clinics within a wedge

Additional questions in the assessment organizations complete at baseline

 When did modification occur

After wedge 1

Within wedge 3

After wedge 2

 Who made decision to modify

IST

Practice coach

IST

 Goal of modification

Increase acceptability of the implementation effort

Improve outcomes

Improve fit

 Nature of modification

Shortening, reduced frequency

Adding elements

Adding elements

 Reason for modification

Organizational

Organizational, Available Resources, Staffing

Organizational, Context

 Source information for reason

Based on discussion during IST meetings

Stated by clinic during check in meeting

Based on discussion during IST meetings

 CFIR domain

Access to Knowledge and Information

Available Resources

Readiness for implementation

 ERIC category

Provide Interactive Assistance

Develop Stakeholder Interrelationships

Use Evaluative and Iterative Strategies

 ERIC implementation strategy

Facilitation

Capture and share local knowledge

Assess for readiness and identify barriers and facilitators

 Primary actor

Practice coach

Practice coach requests information from clinic with expertise

Practice coach

 Supporting actor(s)

Project champions

Project champion at study clinic, staff at peer clinic

IST, project champion

 Action

Meetings which include project champions and members of the implementation teams of all clinics within a study wedge. Practice coach facilitates meetings. Project champions attend meetings and share information between clinics

Practice coach requests information from clinic with expertise. Clinic with expertise shares knowledge, clinic seeking expertise reviews and uses the information

IST members modified the baseline assessment to include questions about determine whether aspects of the intervention have already been implemented at the clinic. Project champion completes the assessment. Practice coach uses the assessment to plan implementation support

 Format

Virtual meeting

Email to request information, word document to share information, follow-up meeting to discuss information

Learning session, coaching call, email or other informal contact

 Dose

Once a month

1 time

1 time

 Temporality

Throughout the study

Prior to step 3

Prior to step 1

 Justification

Pragmatic justification – meeting frequency should be feasible and acceptable to study participants

Pragmatic justification - peer-to-peer learning can be effective where there is no empirical evidence is limited

Pragmatic justification - understanding context can inform facilitation efforts

 Action target

Clinic champion knowledge and self-efficacy

Clinic champion has increased knowledge of the role of community health worker

Practice coach has increased knowledge about clinic context prior providing implementation support

 Outcome

Improved implementation through increased knowledge

Clinic champion is prepared to work within the clinic to develop an appropriate staffing plan

Practice coach feels more prepared to provide implementation support appropriate for clinic context

 Enacted

Yes

Yes

Yes

Notes