Community-Led Operationalization of a Champion Implementation Strategy for Anal Cancer Prevention in Nigeria

Abstract

Abstract Context-specific adaptation of implementation strategies is an important component of promoting evidence-based intervention use. But guidance on systematic approaches is limited. Here we described our mixed method approach to adapting (Study 1) and monitoring (Study 2) a champion implementation strategy to improve implementation of anal cancer prevention procedures at an HIV clinic in Abuja, Nigeria. Building from existing literature, in Study 1, an implementation team of eight Nigerian stakeholders adapted a champion implementation strategy model. Team members ranked different attributes in terms of their importance for defining the strategy. The responses were aggregated and presented to the team who then discussed until consensus was reached on the operationalization of the strategy. In Study 2 we monitored the implementation of the strategy by one champion over six weeks by collecting daily checklists and weekly reflections from the champion. Study 1 team members described the champion as needing to be reliable and confident in using anal cancer prevention procedures, with responsibilities that included providing mentorship and raising awareness. In Study 2 the champion reported engaging in strategy-related activities 75% of the 36-day period (six weeks, each with six days) with coordinating activities (42%) and securing resources (17%) reported most frequently. A thematic analysis revealed four themes depicting the champion’s activities: (1) tool development and procedural changes, (2) capacity building, (3) relationship development, and (4) sustainability efforts. These studies demonstrate an exploratory proof of concept for using community-engaged approaches for adapting implementation strategies to inform both use and monitoring.