Limitations
Seven Master Trainers conducted observations and completed MFAs, however, fidelity of Master Trainer support was not documented, and due to financial and logistical constraints, inter-rater reliability for MFAs was not measured [A single Master Trainer was assigned to complete Activity Reports and MFAs for their designated health centers for the duration of the program. Due to Master Trainers’ workloads and scheduling challenges, continuity was not always maintained. Master Trainers occasionally completed Activity Reports and MFAs for health centers other than what they were assigned to, potentially contributing to variance in perceptions of fidelity and MFA scores. In addition, due to a small sample size of 160 MFAs, there is an increased likelihood of Type 2 error.