Table 3.

Barriers and Facilitators to Implementation

	Key Themes	Supporting Quotes
Barriers
Time	PennCNB takes too long to complete	“So in a clinic setting where a healthcare auxiliary does other things in the clinic [..] I think having to do four or more assessment a day would take a significant amount of time, and that […] would just weigh down on the operations of the clinic.”
	Too many patients for duration of assessment	“We know that the healthcare system is really overwhelmed […] there’s long waiting lines. People are always waiting for service […] I think the only difficulty that they might be in this being acceptable within practice is people actually having time to complete it or to use it.”
Human resources	Shortage of HCWs	“[…] within nursing and doctors here there’s serious staff shortage.”
	Limited mental health clinicians	“And like I said, psychologists are scarce, they’re rare.”
Physical resources	Limited computer and space availability in some settings	“One of the barriers that I see […] is lack of computers in the-in the clinics or even the primary hospitals […]”
Stakeholder pushback	Reluctance from HCWs due to overwork	“I think the biggest barrier is mindset, the attitude of, is this more work? Why should we be spending time doing this when we could do other things?”
	Patients complain about time	“…If patients see that somebody went into a room and they took one and a half hour, then they might start complaining…”
Facilitators
Physical resources	Computers and space available in some settings	“Well the resources are there, the computers are there, the infrastructure is there, the patients are there.”
Procedures	Follow MoHW guidelines	“[…] if there’s a directive from the Ministry as in it’s an implemented guidelines that when a child presents with a referral about cognitive impairment, then you must assess them using at least this tool, then they have that best practice to-to use. “
	SOPs for new interventions	“But again, when something new comes, the Ministry makes sure that we do workshops [and receive training on] how a particular thing is to be done.”
Acceptability	HCWs satisfaction and high acceptability	“Well, I think it would be a great thing. It would be very, very acceptable, I mean especially to the healthcare workers because it will be something new to help in assessing kids.”
	Desire for cognitive screening	“We might not know the magnitude of the problem in terms of children having those neurocognitive issues […] So I would be very excited to see this going forward and implementing this because definitely is going to help us understand the magnitude of the problem that we may have in that field.”