Table 4.

Implementation strategies targeting Nutrition Now implementation delivered through Maternal and Child Health (MCH) care center.

Category (55, 56)	Strategy (# denotes ERIC implementation strategy) (57)	The Actor (deliver strategy)	The Action (specific action, steps, or process)	Action target (affected by strategy)	Implementation outcome(s)	Temporality and Dose	Justification
Use evaluative and iterative strategies	#4 Assess for readiness and identify barriers and facilitators	Implementation researchers	Conduct in-depth interviews with 6 in 12 MCH nurses and one focus group discussion (FGD) with all 5 MCH midwives.	MCH nurse and midwives	Adoption Appropriateness Feasibility	Pre-implementation from project start until the end of September 2022 One in-depth interview and one FGD	Identify factors that may disrupt implementation, and strengths that can be exploited in the implementation effort
	#18 Conduct local needs assessment	Implementation researchers	Conduct in-depth interviews with 6 in 12 MCH nurses and one focus group discussion (FGD) with all 5 MCH midwives.	MCH nurse and midwives	Appropriateness Feasibility	Pre-implementation One in-depth interview and one FGD	Use the experiences and key knowledge the partners have regarding the target groups in order to tailor intervention to context
	#56 Purposefully reexamine the implementation	Implementation researcher	Conduct monthly short iterative interviews with one selected MCH nurse and midwife, respectively.	MCH nurse and midwives	Feasibility	During the implementation process (first six months) Six short interviews with staff	Optimize implementation strategies to maximize intervention effectiveness
Adapt and tailor to context	#51 Promote adaptability	Implementation researchers	Tailor the intervention to local context, e.g., by focusing on easy-to-understand texts, extensive use of visual and humorous elements as well as translating e-learning resource into English and Arabic language.	Pregnant women and parents of infants and toddlers	Acceptability Appropriateness Feasibility	Pre-implementation Dosage amounts to six months for 6 employees	Ensure that the Nutrition Now e-learning resource is suited/adapted for the target groups and context
	#63 Tailor strategies	Implementation researchers in collaboration with web designer	Develop ways to convey information about the e-learning resource considered as appropriate by MCH nurses and midwives, e.g., small information cards in three languages, posters at MCH center, instructional pamphlet targeting MCH staff.	Pregnant women and parents of infants and toddlers	Acceptability Appropriateness Feasibility	Ongoing during implementation Dosage amounts to one week of work	Tailor implementation strategies and leverage enablers identified.
Develop stakeholder interrelationships	#6 Build a coalition	Implementation researchers	Participate in internal educational meeting for MCH nurses. Arranged 3 + 3 workshops with MCH nurses and midwives, respectively.	MCH nurse and midwives	Acceptability Feasibility	Pre implementation until e-learning resource is distributed Amounts to 20 hours spent by MCH staff and 3 researchers	Ensure a good collaborative environment between stakeholders at the setting level
	#17 Conduct local consensus discussions	Implementation researchers	Conduct repeated workshops with MCH nurses and midwives separately (3 + 3) having discussions about e-learning resource suitability and content priorities.	MCH nurse and midwives	Appropriateness Feasibility	Pre-implementation Amounts to 20 hours spent by MCH staff and 3 researchers	Agree upon resource content deemed relevant for the target groups
	#38 Inform local opinion leaders	Implementation researchers	Conduct initial and repeated preparatory meetings with MCH service leaders.	MCH service leaders	Feasibility	Three meetings, in total 3 hours spent by staff and researchers	Anchor implementation strategies with service leaders to avoid misconceptions
Train and educate stakeholders	#15 Conduct educational meetings	Implementation researchers	Conduct educational meetings with MCH nurses, midwives and service leaders to teach them about the Nutrition Now innovation (the e-learning resource)	MCH nurse and midwives	Acceptability	Pre implementation and at the start of the implementation. Amounts to 1 hour spent by staff	Increase partners’ key knowledge about Nutrition Now resource content and project fundamentals
	#29 Develop educational materials	Implementation researchers in collaboration with web designer	Develop video and supporting written material to support staff: A short manual for MCH nurses and midwives briefly explaining how to convey the content and use of the e-learning resource to parents. Small information cards with QR codes leading parents directly to the e-learning resource. Educational videos explaining rationale and how to use the resource	MCH nurse and midwives Pregnant women and parents of infants and toddlers	Feasibility	Pre implementation phase 1. Post phase 1 to develop for phase 2. 3 days of work for two researchers and 2 days for web-designer	Need for instructional materials that make it easier for staff to convey the Nutrition Now resource and for pregnant women and parents to learn about how to use the resource
	#31 Distribute educational materials	Implementation researchers	Distribute educational material in person in connection with educational meetings	MCH nurse and midwives	Fidelity Feasibility	Pre-implementation. 2 days of work for 2 researchers	Provide educational materials to staff to facilitate delivering the intervention
Support clinicians	#58 Remind clinicians (including end-users of the e-learning resource)	Implementation researchers	Conduct follow-up meetings every six months Reminder e-mails with new resource content at regular intervals	MCH nurse and midwives Pregnant women and parents of infants and toddlers	Adoption Sustainability	Throughout implementation One day work for two researchers	Help MCH staff to recall information and/or prompt them to use the e-learning resource.