Although knowing the implementation environment is critical, there is a scarcity of research on how to investigate it systematically in quality improvement (QI) projects. As a result, in this study, researchers used the consolidated framework for implementation research (CFIR) to guide a systematic evaluation of an ongoing QI program’s implementation context to generate rapid site-specific feedback that can be used to improve subsequent plan-do-study-act (PDSA) cycles. The convergent mixed methods design was used for formative cross-case assessment. The research was carried out in five primary health care (PHC) institutions that were implementing the QI program. A self-administered, Likert-based rating instrument was used to gather quantitative data, while an interview guide was used to obtain qualitative data. The interviews were verbatim transcribed, and theme analysis was done. Methodological integration took place during the design, analysis, and reporting phases. This study comprised 165 health workers with an average age of 33.43 years. PHC 1 and PHC 5 health workers reported higher QI program scores across all five CFIR domains. Intervention adaptability, relative advantage, health worker self-efficacy, health worker trust in the intervention, and service integration were all implementation facilitators. While vaccine stock outs, inadequate cold chain infrastructure, a lack of incentives, and socio-cultural attitudes were among the implementation hurdles.

This study revealed that theory-driven formative assessment may be used in low-resource QI programs. It reinforced the importance of performing such assessments since they may be used to produce fast feedback on issues influencing implementation success, which can then be addressed in following cycles.