Table 2.

Summary of key results by theme and country

Theme	Related CFIR constructs and other codes	Common findings across three sites	Country-specific findings
			Benin	India	Malawi
Key facilitators for launching cMDA
Effective, tailored community sensitization is a key component of successfully launching cMDA	Engaging participants Engaging leaders Design quality and packaging Intervention complexity	Strong outreach activities at baseline are particularly important for overcoming myths related to cMDA rollout	Outreach activities will need to be tailored to address adults who may believe they are at low risk for STH infection	Outreach activities will need to be tailored to address adults who may believe they are at low risk for STH infection Outreach activities should be further tailored by geography, education, and socio-economic status	Outreach messages need to be tailored to community sub-groups, such as religious groups
Opportunities to leverage existing health campaign infrastructure is important for policy stakeholders to support cMDA launch	Structural characteristics Tension for change Adaptability	Existing school-based and lymphatic filariasis MDA resources can be used to support the launch of cMDA including human resources and existing infrastructure	cMDA for STH should be integrated within child health programs	cMDA for STH should be integrated within maternal and reproductive health program objectives	No additional Malawi-specific findings
Key barriers to launching cMDA
Policy stakeholders are concerned about health worker workload when implementing cMDA	Available resources Organizational incentives Implementation climate Relative advantage Intervention complexity Readiness	Stakeholders are concerned that Community Drug Distributors (CDDs) are overworked and that increasing workload will lead to poorly delivered cMDA programs	Stakeholders believe there are not enough CDDs available to support a cMDA program Insufficient incentives and a focus on performance-based targets are barriers to successfully launching cMDA Supervisors may not be able to provide adequate supervision to CDDs during cMDA programs	Stakeholders suggest that the CDD workforce would need to be increased to deliver cMDA and overcome challenges including delivery to hard-to-reach places The health workforce may not immediately accept launching cMDA if it increases their workload	Stakeholders believe there are not enough CDDs readily available to support a cMDA program Launching cMDA would require additional monetary incentives for the involved health workforce The CDD workforce would need to be expanded The cMDA program would need to account for challenges including delivery in hard-to-reach areas, inadequate time to deliver, and multiple visits
Policy stakeholders are uncertain about the sustainability of cMDA programs without additional external funding	Relative priority Available resources Financial cost Donor relationships	There are a limited number of donors and partners supporting NTD programs globally, which might compromise the ability to scale-up cMDA programs more broadly	cMDA will not be successful in the long-term without support from donors and non-governmental organizations	Financial resources were not perceived to be a major barrier due to reduced donor dependence	cMDA will not be successful in the long-term without support from donors and non-governmental organizations
Concerns about existing intragovernmental partnerships are barriers to launching cMDA	Cosmopolitanism	No common finding across all three countries	Did not highlight cross-ministry or partner coordination challenges	Did not highlight cross-ministry or partner coordination challenges	Stakeholders are concerned about the lack of formal information-sharing systems and supervisory structures necessary to collaborate between involved government ministries
Cross-cutting theme
Future updates to STH policy will require rigorous evidence to ensure buy-in from policy stakeholders	Knowledge and beliefs Evidence strength and quality	Rigorous clinical and implementation evidence are needed before updating current STH policies Policymakers had positive attitudes that cMDA could potentially eliminate STH, primarily because they believed that tools are currently available to achieve targeted endpoints	No additional Benin-specific findings	No additional India-specific findings	No additional Malawi-specific findings