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Mavodza CV, Bernays S, Mackworth-Young CRS, Nyamwanza R, Nzombe P, Dauya E, Chikwari CD, Tembo M, Apollo T, Mugurungi O, Madzima B, Nguwo D, Ferrand RA, Busza J. Fidelity, Feasibility and Adaptation of a Family Planning Intervention for Young Women in Zimbabwe: Provider Perspectives and Experiences. Glob Implement Res Appl 2023. [PMCID: PMC10037356 DOI: 10.1007/s43477-023-00075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
The CHIEDZA (Community-based Interventions to improve HIV outcomes in youth: a cluster randomised trial in Zimbabwe) trial evaluated an integrated package of HIV and sexual and reproductive health services for young people aged 16–24 years in Zimbabwe. The family planning component aimed to improve access to information, services, and contraceptives delivered by trained youth-friendly providers within a community-based setting for young women. Responsively adapting the intervention was a part of the intervention design’s rationale. We investigated the factors influencing implementation fidelity, quality, and feasibility using provider experiences and perspectives. We conducted provider interviews (N = 42), non-participant (N = 18), and participant observation (N = 30) of intervention activities. The data was analyzed thematically. CHIEDZA providers were receptive to providing the family planning intervention, but contexts outside of the intervention created challenges to the intervention’s fidelity. Strategic adaptations were required to ensure service quality within a youth-friendly context. These adaptations strengthened service delivery but also resulted in longer wait times, more frequent visits, and variability of Long-Acting Reversible contraceptives (LARCS) provision which depended on target-driven programming by partner organization. This study was a practical example of how tracking adaptations is vital within process evaluation methods in implementation science. Anticipating that changes will occur is a necessary pre-condition of strong evaluations and tracking adaptations ensures that lessons on feasibility of design, contextual factors, and health system factors are responded to during implementation and can improve quality. Some contextual factors are unpredictable, and implementation should be viewed as a dynamic process where responsive adaptations are necessary, and fidelity is not static. Trial registration ClinicalTrials.gov Identifier: NCT03719521.
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Affiliation(s)
- Constancia V. Mavodza
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
- grid.8991.90000 0004 0425 469XDepartment of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Bernays
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- grid.1013.30000 0004 1936 834XSchool of Public Health, University of Sydney, Sydney, Australia
| | - Constance R. S. Mackworth-Young
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rangarirayi Nyamwanza
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
| | - Portia Nzombe
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
| | - Ethel Dauya
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
- grid.8991.90000 0004 0425 469XDepartment of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mandikudza Tembo
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tsitsi Apollo
- grid.415818.1HIV and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- grid.415818.1HIV and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | - Rashida Abbas Ferrand
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
- grid.8991.90000 0004 0425 469XDepartment of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Busza
- grid.8991.90000 0004 0425 469XDepartment of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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