Accepted for/Published in: JMIR Formative Research
Date Submitted: Dec 11, 2025
Date Accepted: Jun 5, 2026
A CFIR-guided qualitative study to identify factors influencing the implementation of an evidence-based breast and cervical cancer prevention and early detection behavioral health program
ABSTRACT
Background:
Salud en Mis Manos (SEMM) is a community-health worker-delivered evidence-based intervention shown to increase breast and cervical cancer screening in medically underserved Latinas. Despite SEMM’s success in community-based settings, clinic-based implementation is limited.
Objective:
This study sought to identify factors influencing the implementation of SEMM in clinic settings using the Consolidated Framework for Implementation Research (CFIR) to inform and refine implementation strategy development.
Methods:
We developed theory-informed (e.g., CFIR, Social Cognitive Theory, Readiness) interview guides to elicit barriers and facilitators of SEMM clinic implementation. We conducted 12 semi-structured interviews with clinic leaders, outreach coordinators, and community health workers from four Texas health centers serving low-income Latinas. Transcribed interviews were coded and analyzed using qualitative thematic analysis and CFIR.
Results:
Barriers and facilitators fell within 17 constructs of the five CFIR domains. Across all interview participants, key facilitators fell within intervention characteristics (e.g., SEMM addresses community needs), inner setting (e.g., clinic staff buy-in can facilitate SEMM implementation), and outer setting (e.g., established partnerships may leverage SEMM uptake) domains. Barriers were inner setting (e.g., limited time and clinic staff capacity may limit SEMM implementation) and intervention characteristics (e.g., challenges with SEMM training duration and content).
Conclusions:
CFIR, a theory-based systematic approach, enabled key stakeholder-identified barriers and facilitators to SEMM clinic implementation. These factors help identify implementation support strategies distinct from prior community-based implementation efforts. Findings (part of the initial steps of Implementation Mapping protocol for strategy development) refined the design of a multifaceted implementation strategy to support SEMM clinic uptake. Clinical Trial: none
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