Second, we aim to assess whether observer assessment and support contribute to facilitator skills improvement over time. First, we measure the association between implementation time (experience), and implementation fidelity. This study analyzes quantitative data from Master Trainer assessments and explores additional information and insights from qualitative reports completed by Master Trainers. The study recommended future implementation of group ANC/PNC in Rwanda continue collection of self-assessment data, assessment by expert observers and expert coaching and mentoring. The study analyzed and compared quantitative data from observer completed fidelity monitoring tools and provider self-assessments but found, that while there was overall high model fidelity as assessed by observers, there was poor correlation between observers and provider self-assessment tools.
The program previously conducted a process analysis of implementation fidelity. The trial assessed the impact of group antenatal care (group ANC) on gestational age at birth, finding no impact. Eighteen health centers were randomized to receive group ANC while 18 health centers continued to provide individual ANC. The Preterm Birth Initiative (PTBi)–Rwanda conducted a cluster randomized controlled trial of 36 health centers, using a standardized tool to assess number of providers, ANC volume, suitable space for group care, services, and equipment. Considering the many components involved in effectively carrying out an intervention, maintaining implementation fidelity is critical to successfully translate evidence-based interventions into practice. A further threat to implementation fidelity is the decay of skills that is commonly seen after trainings. Intervention components impacting complexity include: the number of sessions within an intervention, the number of participants and the incorporation of group level interventions. Implementation fidelity is affected by several factors, including the level of complexity of the intervention. One challenge is to ensure “implementation fidelity,” which is defined as the degree to which an intervention is implemented as intended. Successful introduction of any new outpatient care strategy that disrupts the status quo to clinic flow and systems, poses numerous challenges, particularly in low-resource settings.
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