Table 2.
Relationships among implementation strategies and outcomes
| Strategy 1. Engage local community members and organizational stakeholders | ||
|---|---|---|
| PRISM domain | Outcomes | Description |
| External context | Reach/retention | (+) Women were more likely to participate if the community and session locations were safe and protected women |
| Maintenance | (+) Strengthened sense of agency and encouraged community participation and ownership | |
| Internal context (perspectives) | Maintenance | (±) Maintenance of intervention is subject to group dynamics, priorities and continued engagement |
| Internal context (implementation) | Reach/retention | (−) Underutilized community and social networks to advertise program |
| Adoption | (+) NGO role was valuable for facilitators and supported implementation | |
| Implementation | (+) NGO provided critical resources, logistical and community outreach support | |
| Strategy 2. Iterative co-design the intervention to promote adaptability, usability and fit | ||
| 2a. Conduct a series of human-centered design workshops to iteratively develop, refine and pilot the intervention with members of the community. | ||
| 2b. Design intervention with guidelines and flexibility for adapting to each implementation context and different modalities (e.g., virtual, in person, hybrid) | ||
| PRISM domain | Outcomes | Description |
| External context | Reach/retention | (±) Session flexibility and adaptability made it more feasible to attend sessions, but issues related to limited time, childcare and other responsibilities could not be fully overcome |
| Maintenance | (+) Strengthened sense of agency and encouraged community participation and ownership | |
| Internal context (characteristics and perspectives) | Reach/retention | (±) Remote/hybrid delivery increased access for some who were not able to attend in person due to other responsibilities or transportation issues, but decreased access for people without a stable internet connection or technology that would enable them to join remotely [Also related to PRISM Domain: Overarching Issues] |
| Implementation | (+) Flexibility to work (facilitators) and participate (participants) in session from home was helpful | |
| Internal context (implementation) | Effectiveness | (−) In-person sessions offered better potential to connect with others, motivation and make referrals to additional resources. Facilitators noted the importance of reading body language to accomplishing these objectives, which was difficult when sessions were conducted remotely [Also related to PRISM Domain: Fit of intervention] |
| Implementation | (+) Adaptability of the intervention implementation enabled facilitators to tailor aspects of program to make content more accessible | |
| (+) Complying with COVID-19 regulations alleviated concerns about risks of attending sessions | ||
| Maintenance | (+) Manual encourages participants to tailor intervention to local needs for continued implementation | |
| Strategy 3. Community-based and group delivery format | ||
| PRISM domain | Outcomes | Description |
| Internal context (characteristics and perspectives) | Reach/retention | (±) Having the intervention sessions take place in the communities and close to some women’s home increased access for some. However, for others (e.g., people with disabilities) some of the locations were inaccessible |
| (+) Group format met participant expectations and encouraged them to participate and continue to attend sessions | ||
| Effectiveness | (+) Group discussions were motivating, helped them develop a better support system, and was seen as a critical factor to improving their mental health. | |
| Implementation | (−) Some participants were not comfortable sharing their problems with others in a group setting | |
| (+) Attending the sessions outside their home and within communities helped them disconnect from their other worries/responsibilities and focus on the information in the sessions | ||
| Internal context (implementation) | Reach/retention | (+) Participants promoted or were eager to promote the intervention within their communities to expand reach |
| (+) Implementing organization outreach and provision of resources was valuable for increasing reach, recruiting a broader demographic and support general implementation | ||
| Implementation | (+) Having a dedicated and reliable space with necessary materials within the community was critical for implementation | |
| (+) The community-based nature of the intervention enabled facilitators to form positive relationships with participants characterized by good communication and empathy | ||
| Strategy 4. Task-sharing (training of nonspecialists to deliver the intervention) with ongoing training and supervision | ||
| PRISM domain | Outcomes | Description |
| Internal context (characteristics and perspectives) | Adoption | (+) Receiving training, materials and ongoing support by supervisors/program staff enabled the facilitators to deliver the intervention as intended |
| Implementation | (+) Facilitator characteristics were critical to the successful implementation of the program: motivation, enthusiasm, responsible, competent, empathetic, dedicated and having enough time for their role | |
| (+) Having facilitators from their community led to greater satisfaction among participants and these facilitators served as important linkages to other services/supports through the implementing organization and other resources | ||
| Maintenance | (+) Having facilitators and participants come from the same community may encourage them to tailor implementation to improve the program | |
| Internal context (implementation) | Implementation | (−) Facilitators faced challenges to implementation, some of which they felt could have been addressed with further training: poor communication or disagreements between co-facilitators, challenges involving participants (e.g., lack of motivation, lateness), holding online sessions, difficulties with the content and not knowing how to manage complex situations with participants (e.g., emergencies) |
| Strategy 5. Provide financial compensation | ||
| 5a. Provide stipends to facilitators | ||
| 5b. Reimburse participants for transportation and connectivity/communication costs | ||
| PRISM domain | Outcomes | Description |
| Internal context (implementation) | Reach/retention | (−) Additional economic support would encourage attendance and participation |
| Effectiveness | (+) Economic support/reimbursement for participants had a positive impact on the perceived impact and accessibility of the intervention | |
| Adoption | (+) Compensating facilitators enabled them to deliver the intervention and was helpful given that many were unemployed | |
| Implementation | (±) While the reimbursements were appreciated, additional economic support and livelihood/skills training components for participants would improve the relevance of the program to help meet their basic needs | |
Abbreviations: PRE, Pre-implementation; IMP, Implementation; POST, Post-implementation; +, Promoted implementation outcome; −, Hindered implementation outcome.