. 2022 Dec 9;3:129. doi: 10.1186/s43058-022-00377-0

Table 2.

Recommended strategies for implementing use of LNG IUD as EC

CFIR-ERIC Barrier Buster Tool Implementation Strategies Recommended^a	Parallel strategies proposed by study participants	Mapping summary
CFIR Construct: Culture ERIC recommendation: Identify and prepare champions- Identify and prepare individuals who dedicate themselves to supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization	“If ACOG or someone came out saying that it was appropriate and safe that people would feel a lot more easy… they would feel a lot more comfortable doing it simply from a CYA [cover your ass] perspective. I think people are always paranoid that they’re going to do something wrong and if it’s supported in guidelines I certainly imagine that more people would feel comfortable with it.” - Provider I think in our clinic just because sometimes I feel like we’re a little bit more under the microscope. We would probably just really consult with general OB with… I mean we’d probably talk to [Department Chair] and be like, “Listen, are you guys on board with this or not?” And if there's general consensus that everybody’s on board we would do it but if we didn’t get that sort of nod, we’d probably be like, “Yeah, not doing it.” - Provider	Implementation champions should include both local individuals and those within governing/formal bodies
CFIR Construct(s): Access to Knowledge & Information/Knowledge & Beliefs about the Intervention ERIC Recommendation: Conduct educational meetings - Hold meetings targeted toward different stakeholder groups (e.g., providers, administrators, other organizational stakeholders, and community, patient/consumer, and family stakeholders) to teach them about the clinical innovation	“You also have, other providers have to do CME. If this is something that is introduced in some of the main conferences that people use for their continuing ed, that’d probably help.” - Provider “Giving informational lectures in churches works well like with mammograms. The church is where women find out where they can go, how, when, and at what cost.” - Client	Identifying and using existing venues of knowledge distribution for both clinicians and clients could facilitate educational meetings.
CFIR Construct: Access to Knowledge & Information ERIC Recommendation: Develop educational materials- Develop and format manuals, toolkits, and other supporting materials in ways that make it easier for stakeholders to learn about the innovation and for clinicians to learn how to deliver the clinical innovation	“I love the little laminated sheet that I don't know where it comes from. You guys could probably tell me but you guys have all seen. I have the [education materials] that shows your options and makes it so clear to the patient. Then the one that says — Oops, and then like tells you what the emergency contraception options are. [. . .] if you could replicate those somehow and then make one that includes the LNG IUD, that would be helpful and a good reminder to both patients and providers.” -Provider Just something along the lines of like the bathroom stall flyers to get hung. . .. Just — here are your emergency contraceptive options. By the way, there's a long-term contraceptive option that can be also used as emergency contraception so you could get both things at once. . . Because I think word of mouth, once the first few women successfully navigate the process, they quickly tell their friends. - Provider	Educational materials/toolkits can serve as both a reminder/refresher for clinicians as well as a decisional tool for clients.
CFIR Construct: Access to Knowledge & Information ERIC Recommendation: Involve patients/consumers and family members - Engage or include patients/consumers and families in the implementation effort	“Yes, but it’s good that men get involved so they can talk with their partners or girlfriends…But they can motivate them and say, “You know what? We have to be responsible.” Men can’t use an IUD, but women can. So, it’s good that they can talk with girlfriends, partners, or whoever else, right?” - Client “Honestly, I feel like it could make a good TikTok. Like if it's like — oh, fun fact. Like did you could use this as a emergency... It's just so like easy and fast and it doesn't feel like I’m being lectured, at least on like social media.” - Client Working with [Instagram] accounts that do empower women, and that make educated resources available to you, and just easy to digest, I think that would be a really helpful way to get this to someone who doesn't really have access to or know to go to WebMD or Planned Parenthood or to Google ‘How will the IUD affect me?’" -Client “You would want to hear it from your family and friends because those are the people that you kind of trust the most and you can go further into an in-depth conversation and ask them and they would be truthful with you about their experiences more than anyone.” - Client	Education about emergency contraception, including IUD as EC, should include efforts to educate male partners. Education about LNG IUD as emergency contraception should use peer-educators/peer influencers both in-person and through social media to improve visibility.
CFIR Construct: Patient Needs & Resources ERIC Recommendation: Conduct local needs assessment – Collect and analyze data related to the need for innovation	“Would they bleed at all? Like you put that [LNG IUD] in, I think a lot of people with emergency contraception like to see that it worked. Would you necessarily bleed after you had it or did you just have to take another pregnancy test or how do you know it worked?” -Provider So I’ve never counseled for one for using like an LNG IUD but has it ever kind of come up for anybody like how it works for preventing pregnancy? There’s probably a lot of lack of education and probably concern that it's like having an abortion or something...” -Provider Especially in a domestic violence situation, like say you're trying to get emergency contraception, but if you could also know that if you could get into Planned Parenthood within that five days, you could also get an IUD at the same time, I think that would be really useful. -Client	Information around both the mechanism of action and the expected outcomes of LNG IUD placement for EC in different scenarios are important data needs for future implementation projects.
CFIR Construct: Access to Knowledge & Information ERIC Recommendation: Distribute educational materials - Distribute educational materials (including guidelines, manuals, and toolkits) in person, by mail, and/or electronically	[Not identified by participants]	Distribution considerations are a possibly overlooked component of implementation success.
CFIR Construct: Patient Needs & Resources ERIC Recommendation: Obtain and use patients/consumers and family feedback – Develop strategies to increase patient/consumer and family feedback on the implementation effort	[Not identified by participants]	Channels for receiving and incorporating patient/consumer feedback are possibly an overlooked component of implementation success.

CFIR-ERIC Barrier Buster Tool Implementation Strategies Recommended^a

Parallel strategies proposed by study participants

Mapping summary

CFIR Construct: Culture

ERIC recommendation: Identify and prepare champions- Identify and prepare individuals who dedicate themselves to supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization

“If ACOG or someone came out saying that it was appropriate and safe that people would feel a lot more easy… they would feel a lot more comfortable doing it simply from a CYA [cover your ass] perspective. I think people are always paranoid that they’re going to do something wrong and if it’s supported in guidelines I certainly imagine that more people would feel comfortable with it.”

- Provider

I think in our clinic just because sometimes I feel like we’re a little bit more under the microscope. We would probably just really consult with general OB with… I mean we’d probably talk to [Department Chair] and be like, “Listen, are you guys on board with this or not?” And if there's general consensus that everybody’s on board we would do it but if we didn’t get that sort of nod, we’d probably be like, “Yeah, not doing it.”

- Provider

Implementation champions should include both local individuals and those within governing/formal bodies

CFIR Construct(s): Access to Knowledge & Information/Knowledge & Beliefs about the Intervention

ERIC Recommendation: Conduct educational meetings - Hold meetings targeted toward different stakeholder groups (e.g., providers, administrators, other organizational stakeholders, and community, patient/consumer, and family stakeholders) to teach them about the clinical innovation

“You also have, other providers have to do CME. If this is something that is introduced in some of the main conferences that people use for their continuing ed, that’d probably help.”

- Provider

“Giving informational lectures in churches works well like with mammograms. The church is where women find out where they can go, how, when, and at what cost.”

- Client

Identifying and using existing venues of knowledge distribution for both clinicians and clients could facilitate educational meetings.

CFIR Construct: Access to Knowledge & Information

ERIC Recommendation: Develop educational materials- Develop and format manuals, toolkits, and other supporting materials in ways that make it easier for stakeholders to learn about the innovation and for clinicians to learn how to deliver the clinical innovation

“I love the little laminated sheet that I don't know where it comes from. You guys could probably tell me but you guys have all seen. I have the [education materials] that shows your options and makes it so clear to the patient. Then the one that says — Oops, and then like tells you what the emergency contraception options are. [. . .] if you could replicate those somehow and then make one that includes the LNG IUD, that would be helpful and a good reminder to both patients and providers.”

-Provider

Just something along the lines of like the bathroom stall flyers to get hung. . .. Just — here are your emergency contraceptive options. By the way, there's a long-term contraceptive option that can be also used as emergency contraception so you could get both things at once. . . Because I think word of mouth, once the first few women successfully navigate the process, they quickly tell their friends.

- Provider

Educational materials/toolkits can serve as both a reminder/refresher for clinicians as well as a decisional tool for clients.

CFIR Construct: Access to Knowledge & Information

ERIC Recommendation: Involve patients/consumers and family members - Engage or include patients/consumers and families in the implementation effort

“Yes, but it’s good that men get involved so they can talk with their partners or girlfriends…But they can motivate them and say, “You know what? We have to be responsible.” Men can’t use an IUD, but women can. So, it’s good that they can talk with girlfriends, partners, or whoever else, right?”

- Client

“Honestly, I feel like it could make a good TikTok. Like if it's like — oh, fun fact. Like did you could use this as a emergency... It's just so like easy and fast and it doesn't feel like I’m being lectured, at least on like social media.”

- Client

Working with [Instagram] accounts that do empower women, and that make educated resources available to you, and just easy to digest, I think that would be a really helpful way to get this to someone who doesn't really have access to or know to go to WebMD or Planned Parenthood or to Google ‘How will the IUD affect me?’"

-Client

“You would want to hear it from your family and friends because those are the people that you kind of trust the most and you can go further into an in-depth conversation and ask them and they would be truthful with you about their experiences more than anyone.”

- Client

Education about emergency contraception, including IUD as EC, should include efforts to educate male partners.

Education about LNG IUD as emergency contraception should use peer-educators/peer influencers both in-person and through social media to improve visibility.

CFIR Construct: Patient Needs & Resources

ERIC Recommendation: Conduct local needs assessment – Collect and analyze data related to the need for innovation

“Would they bleed at all? Like you put that [LNG IUD] in, I think a lot of people with emergency contraception like to see that it worked. Would you necessarily bleed after you had it or did you just have to take another pregnancy test or how do you know it worked?”

-Provider

So I’ve never counseled for one for using like an LNG IUD but has it ever kind of come up for anybody like how it works for preventing pregnancy? There’s probably a lot of lack of education and probably concern that it's like having an abortion or something...”

-Provider

Especially in a domestic violence situation, like say you're trying to get emergency contraception, but if you could also know that if you could get into Planned Parenthood within that five days, you could also get an IUD at the same time, I think that would be really useful.

-Client

Information around both the mechanism of action and the expected outcomes of LNG IUD placement for EC in different scenarios are important data needs for future implementation projects.

CFIR Construct: Access to Knowledge & Information

ERIC Recommendation: Distribute educational materials - Distribute educational materials (including guidelines, manuals, and toolkits) in person, by mail, and/or electronically

[Not identified by participants]

Distribution considerations are a possibly overlooked component of implementation success.

CFIR Construct: Patient Needs & Resources

ERIC Recommendation: Obtain and use patients/consumers and family feedback – Develop strategies to increase patient/consumer and family feedback on the implementation effort

[Not identified by participants]

Channels for receiving and incorporating patient/consumer feedback are possibly an overlooked component of implementation success.

^aStrategies selected from list created by Powell, B.J., Waltz, T.J., Chinman, M.J. et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Sci 10, 21 (2015). 10.1186/s13012-015-0209-1