Table 1.

Barriers to mobile Inspección Visual con Ácido Acético (mIVAA) system implementation mapped to the Consolidated Framework for Implementation Research (CFIR) domains.

CFIR domain, construct, and potential barrier to implementation				Supporting quote or data notes
Intervention characteristics
	Adaptability
		Internet connectivity			“This is a system that depends on internet connectivity, it will be as good as the internet connection we have.”
		Vibrations and dust			“Some mobile units park on loosely packed earth and photo quality is affected by vibrations from movement in the unit.”
		Lack of electricity in some units			“Sometimes there is no light [electricity] or water, which delays the activities, because without light the tablets or the laptops wouldn’t work.”
	Complexity
		Time for sterilization of USB-connected imaging device			“When you prepare in the squirt bottle [...] is a time that must be considered.”
		Conflicting priorities and timing of transmitting mIVAA images			“Most of the patients came to the mobile unit at 12 noon. This makes it difficult for the midwife to send the images to the colposcopists, complete patient’s report, and other activities as soon as possible (prior to the closing time).”
		Distinguishing results given after VIAa with mIVAA from Papanicolau results			“There in that moment [with images from the digital device] you are not going to tell her, lady look there isn’t anything, come in a year. No, she [still] has to get her Pap [result] which was already taken.”
	Cost
		Financial impact of screening fewer women			“The goal of patients seen per day is 30 patients [...] With the implementation of the [mIVAA] we would have to evaluate how much the number of patients that are attended per day would decrease.”
		Cost of colposcopists’ time			“We have to think about the budget...Right now I think it is a lie to say that a doctor will stop whatever he is doing to look at the screen and make that his priority.”
Outer setting
	Patient needs and resources
		Delivery of results from mIVAA to women who have been screened	“...most of our women who are screened in the mobile units are mothers and have many duties at home, which can make it difficult for them to wait or return for their results.”
	External policy and incentives
		Legally allowable health care provision	Peruvian law states that only colposcopists may provide final review of cervical images, not midwives.
Inner setting
	Networks and communications
		Communication with and availability of colposcopists	“When the colposcopist is not at La Liga, we would have to find a way in which he would be able to connect to Wi-Fi and be able to review the images and send them back to the mobile unit.”
	Implementation climate-relative priority
		Colposcopists’ desire for Papanicolau smear cytology results before evaluation	“In case the patient is scheduled for a colposcopy, we need to get Pap results as soon as possible, since some colposcopists only do colposcopy if patients have an alteration in their Pap results.”
	Implementation climate—compatibility
		Ability to correct a misdiagnosis on the telehealth platform			“What happens if I close it and maybe I made a mistake and I want to correct it?”
		Ability to record mIVAA result in the existing WebLiga system			“Is there going to be a way to link this platform with the WebLiga system? Because when the study is done there must be a register of something.”
	Readiness for implementation—available resources
		MUb space for disinfecting baths			“Mobile Unit 4 has a small space only to put the laptop [not reprocessing baths].”
		Scheduling follow-up appointments based on mIVAA results			“There might be an accumulation of patients to follow up, which can generate more workload.”
	Characteristics of individuals-self-efficacy
		Possibility of colposcopist missing a transmitted cervical image	“The oncologist gynecologist works in different institutions. At La Liga, they only work two to three times a week with medical appointments of two hours, so I believe that it is necessary to verify the read receipt of the images.”

^aVIA: visual inspection with acetic acid.

^bMU: mobile unit.