Table 1.

Factors that may affect breast cancer guideline‐concordant treatment implementation organized by Consolidated Framework for Implementation Research domains [23]

Domain	Description
Intervention characteristics	Knowledge of respective breast cancer treatment guideline; the source of the guideline and strength of the evidence supporting the recommendations; the relative advantage of the identified guideline and how well adapted it is to the Botswana setting; complexity of the guideline, design quality and packaging as well as the cost of implementing all elements of the respective guideline.
Outer setting	Policies that support breast cancer guideline implementation or provide free cancer diagnostics, medicines, and other treatment modalities for breast cancer; staff contact with other cancer treatment facilities; patient perceptions, cultural pressures, barriers, and facilitators faced by patients and families while undergoing treatment for breast cancer.
Inner setting	Adequacy of oncology clinical staff; communication and networks between staff members across different specialties, hospital climate; tension of change and prioritization of breast cancer treatment and implementation of guideline‐concordant care; existence of goals and feedback to providers regarding therapy delivery; leadership within the hospital system for breast cancer care delivery; and availability and location of education materials.
Characteristics of individuals	Knowledge and skills of providers providing breast cancer care and communication with patients and families; self‐efficacy related to breast cancer management, counseling patients and families; attitudes and beliefs about breast cancer and care and about educating patients about breast cancer treatment.
Implementation process	Engagement of end‐users, that is cancer care providers at the hospital in the planning, designing, and introduction of breast cancer treatment guidelines; appointed internal health care system, team leaders and champions to increase implementation dissemination and adherence to guidelines; input from national policy advisors; collaboration with external partners; development of stepwise implementation plan that includes timeline, benchmarks, monitoring and evaluation and feedback to staff.