Implementation, interrupted: Identifying and leveraging factors that sustain after a program interruption

BackgroundMany implementation efforts experience interruptions, especially in settings with developing health systems. Approaches for evaluating interruptions are needed to inform targeted re-implementation strategies.MethodsThis study took place in two public health centers with tuberculosis (TB) units in Uganda that previously implemented diabetes mellitus (DM) screening in 2017. In 2019, we conducted interviews with clinic staff to determine current DM practices. We mapped themes identified in the interviews to a Social Ecological Model with three levels: outer setting, inner setting, and individuals.ResultsWe conducted nine interviews with clinic staff. Respondents explained that DM screening ceased due to disruptions in the supply chain for glucose test strips. This outer setting interruption had cascading effects on the inner setting and individuals. The lack of screening supplies limited the staff’s opportunities to perform DM screening within the inner setting level, which was associated with diminished self-efficacy within the individual level. However, culture, compatibility and individual beliefs about DM screening sustained throughout the interruption.ConclusionsWe identified factors that diminished and sustained within and between ecological levels during a program interruption. Using this approach, other programs facing interruptions can identify factors and cascading effects of the interruption to target them for re-implementation.