Experimental implementation strategy versus control
CRF
CRF
This study evaluated SAIA, an evidenced-based five-step cycle composed of multiple implementation strategies [After FP clinics were randomized, the clinic staff from SAIA facilities were invited for a full-day SAIA training that launched the trial. This training included facility-level flow mapping, discussion of each clinics’ cascade analysis using data from the CAT, and selection of the first micro-intervention. Cascade analysis and micro-intervention development, testing, and implementation were repeated monthly for 18 months from January 2020 to July 2021. Flow mapping was repeated as needed when clinic flow and processes had substantially changed. While the study staff supported the FP clinic staff in developing micro-interventions, the FP clinic staff were the implementers of their micro-interventions. FP clinics randomized to SAIA documented their monthly SAIA cycles on structured implementation plan posters provided by the research team. The posters included the CAT step targeted, barrier identified, and micro-intervention proposed. At the end of each monthly cycle, the clinic and research staff determined whether the micro-intervention was completed fully, partially, or not at all based on the tasks proposed and whether they were completed. The research staff photographed and transcribed these implementation plans to create a record of each SAIA cycle to categorize and track micro-interventions. Members of the research team (MCE and GW) categorized micro-interventions into categories that focused on the individual and health system levels. Where data were missing or questions arose, the staff examined the implementation plan photos to supplement the record. When transcribing the implementation plans, the study staff made notes about contextual factors for consideration when interpreting the data, such as clinic closure, staff on strike, or no FP clients seen during this interval.The study staff conducted structured interviews with at least one staff member from each FP clinic in the trial to understand clinic and staff characteristics [There was minimal interaction between the study staff and clinics randomized to the control arm. The study staff informed these FP clinics about the trial and its objectives, and the staff from control clinics participated in the structured interviews about clinic and staff characteristics. Outcome data from the FP registers was collected in control clinics on a quarterly basis.Several data-cleaning steps were undertaken. Database entries were examined, and the FP register image was reviewed to determine whether data were available for missing responses. If so, these were added to the CRF and database. In addition, CRFs used to abstract FP register data were reviewed by a second study team member who independently viewed the digital FP register, verifying that the response on the CRF matched the data on the register image. Any discrepancies were resolved by discussion between data abstracters to arrive at a consensus about original register entries. Following data entry, the study staff performed a question-by-question assessment comparing hard copy CRFs to the digital database to identify and correct key-in errors.