Formative Work to Guide Implementation of an Evidence-Based Breast and Cervical Cancer Prevention and Early Detection Behavioral Health Program in Clinics: Qualitative Study Guided by the Consolidated Framework for Implementation Research.

BACKGROUND: Salud en Mis Manos (SEMM) is a community health worker-delivered evidence-based intervention shown to increase breast and cervical cancer screening in medically underserved Latinas. Despite SEMM's success in community-based settings, clinic-based implementation is limited. OBJECTIVE: This study aimed to identify factors influencing the implementation of SEMM in clinic settings using the Consolidated Framework for Implementation Research (CFIR) to inform and refine implementation strategy development. METHODS: We developed theory-informed (eg, CFIR, Social Cognitive Theory, and Readiness) interview guides to elicit barriers and facilitators of SEMM clinic implementation. We conducted 12 semistructured interviews with clinic leaders, outreach coordinators, and community health workers from 4 Texas health centers serving low-income Latinas. Transcribed interviews were coded and analyzed using qualitative thematic analysis and CFIR. RESULTS: Barriers and facilitators fell within 17 constructs of the 5 CFIR domains. Across all interview participants, key facilitators fell within intervention characteristics (eg, SEMM addresses community needs), inner setting (eg, clinic staff buy-in can facilitate SEMM implementation), and outer setting (eg, established partnerships may leverage SEMM uptake) domains. Barriers were inner setting (eg, limited time and clinic staff capacity may limit SEMM implementation) and intervention characteristics (eg, challenges with SEMM training duration and content). CONCLUSIONS: CFIR, a theory-based systematic approach, enabled key stakeholder-identified barriers and facilitators to SEMM clinic implementation. These factors help identify implementation support strategies distinct from prior community-based implementation efforts. Findings (part of the initial steps of the Implementation Mapping protocol for strategy development) refined the design of a multifaceted implementation strategy to support SEMM clinic uptake.