Table 2 CFIR domains and constructs associated with the challenges and lessons learned reported by health service managers and frontline health workers
CFIR domain | Theme | Challenges reported by participants | Lessons learned reported by participants | CFIR constructs |
|---|---|---|---|---|
1.Intervention characteristics  Characteristics of the RTS,S/AS01E vaccine and its delivery within MVIP | Vaccine schedule | New vaccine contact in the 2nd year of life and a long gap between the 3rd and 4th doses | Deliver the 4th dose alongside MCV-2; implement additional strategies to increase 4th dose coverage | Complexity, adaptability |
Eligibility criteria | Strict age eligibility criteria that does not fully match malaria burden | Expand the age criteria | Complexity | |
Pilot implementation | Challenges caused by not implementing the vaccine in all districts in the region | RTS,S/AS01E vaccine should be delivered in all districts in the region | Complexity | |
2.Inner setting  Features of Ghana Health Service and EPI infrastructure | Cold-chain resources | Inadequate cold-chain equipment at the health facility level | Improve cold-chain capacity at the health facility level | Available resources |
Transportation resources | Lack of functioning vehicles for transport at the district and health facility level | Ensure adequate funds are available for transport, including for fuel and repairs | Available resources | |
Communication between implementing units | Lack of communication between implementing units at the regional and health facility levels | Hold meetings or workshops between implementing regions and between implementing health facilities | Networks and communication | |
Communication and relationship between researchers and implementers | Unclear communication and understanding of the relationship between the researchers evaluating MVIP and the implementers delivering the RTS,S/AS01E vaccine | Â | Networks and communication | |
3.Implementation process | Sensitization | Inadequate initial sensitization | Need for a longer, more intensive and sustained delivery of contextually-appropriate sensitization prior to implementation | Planning, engaging |
Implementation timeline | Short initial timeline and delayed launch | Incorporate sufficient planning period in the timeline and ensure all logistic and financial resources are available prior to the launch date to prevent delays | Planning | |
Training | Inadequate training | Hold additional training sessions following vaccine introduction; train more groups of health managers and frontline workers; include more training on practical aspects of vaccine administration | Planning, engaging | |
4.Characteristics of individuals  Characteristics of the individuals who delivered and received the RTS,S vaccine | Vaccine uptake | Refusals to receive the RTS,S/AS01E vaccine due to circulating rumours | Improve the sensitization (see above); deliver the vaccine to all districts in the region; ensure that there is no delay to the advertised launch data (see above) | Knowledge and beliefs about the intervention |
Self-efficacy of CHNs | Issues with the capabilities and confidence of CHNs to apply eligibility criteria | Hold additional training sessions and include more training on eligibility criteria (see above) | Self-efficacy | |
5. Outer setting  Features of the context external to Ghana Health Service and EPI | Rumours | Circulating rumours about the RTS,S/AS01E vaccine |  | Community context* |