An evaluation of barrier-strategy matching for a cervical cancer prevention intervention in Kenya: A convergent mixed methods study

Implementation strategies that address context-specific barriers are critical to improving implementation success and health outcomes. However, strategies are often misaligned with the barriers they are intended to address, limiting their impact. This study evaluates the extent to which deployed implementation strategies in a cervical cancer prevention program matched the pre-identified barriers. A mixed-methods convergent parallel design was employed between January 2024 and September 2024. Barrier-strategy match was defined as selecting implementation strategies that most effectively address specific barriers to adopting the single-visit, screen, and treat approach with thermal ablation (SV-SAT+TA). Forty participants across ten health facilities completed a structured survey and participated in small group discussions conducted at each facility to gather perspectives on how and why barriers were successfully, partially, or not addressed. Descriptive statistics summarized the survey responses, and the framework method guided the analysis of the qualitative data. Findings were integrated by merging the quantitative and qualitative results and using a narrative approach during interpretation and reporting. The majority (77%, n=32) of the participants were female, and 95% (n=38) were frontline healthcare providers. A large proportion (81%, n=17) of the reported pre-identified barriers were health system related. Overall, the implementation strategies were well-matched to the barriers, with 71% (n=15) reported as successfully addressed. Several strategies were deployed, with some addressing multiple barriers simultaneously. Key themes associated with successful barrier-strategy matching included streamlining and optimizing clinic processes to improve service accessibility and efficiency, capacity building to enhance provider knowledge, skills, and quality of cervical cancer prevention service delivery, and strengthening community engagement and communication to improve awareness and service uptake. Approximately 10% (n=2) of the barriers were partially addressed, while 19% (n=4) were not addressed. Barriers partially addressed and those not addressed were primarily associated with structural problems, including staffing challenges, workforce instability, infrastructural limitations, and lack of support systems for patient follow-up. Aligning implementation strategies with context-specific barriers improves the likelihood of successful intervention delivery and strengthens the overall impact of cervical cancer prevention efforts.