Document Type

Working Paper

Date of this Version



Lawton Burns


Rapid-cycle evaluation and implementation improvement of community health interventions in low- and middle-income countries (LMICs) are systemically constrained by methodological and resource limitations. In this paper, we present and pilot an adapted approach using a modified version of the Consolidated Framework for Implementation Research (CFIR) to identify barriers, facilitators, and actionable areas of implementation improvement of mobile rural reproductive and child health (RCH) clinics conducted by a major public hospital in The Gambia. We conducted site observations of RCH clinics (n=7), surveys of community health workers (n=5), and semi-structured interviews with relevant hospital staff (n=5) to obtain thick qualitative data for our analysis. In turn, we identified 28 facilitators and 47 barriers across 29 CFIR constructs, each informing an actionable finding for rural RCH delivery implementation improvement. We believe that with further testing and refinement, this approach can have widespread application for timely assessment and improvement of community health intervention implementation in LMICs.


community health, implementation science, qualitative evaluation, reproductive health, child health, rural health, The Gambia, Sub-Saharan Africa, facilitators, barriers



Date Posted: 17 November 2022


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