Skip to main content

Table 2 Details of success and failure factors and contextual factors identified in the 52 studied publications

From: Characterizing social-ecological context and success factors of antimicrobial resistance interventions across the One Health spectrum: analysis of 42 interventions targeting E. coli

Main domain of CFIR classification Subdomain of CFIR classification Description of the factor (success, failure, or contextual factor)
Interventions characteristics Importance of evidence strength and quality Success factor: A proper strategy for data access, management, and analysis was identified as a success factor. Data should also be checked for plausibility and completeness
Failure factors: Several publications highlighted data limitations as potential failure factors of their intervention, including small number of data/samples, quality of the data (e.g., sampling, recording, entering the data in the database, consistency of data recording, bias in data collection, quality control, semantic homogeneity), low representativeness of the data, and the need for long-time data
Some authors also mentioned the lack of adequate literature and knowledge to help them conducting their research
Adaptability Success factor: Interventions were reported more successful if individually tailored regarding their features and methods while remaining flexible to adapt along with the intervention lifecycle. Activities that were adapted or changed as needed during their lifecycle were more likely to be accepted, useful, and to successfully lead to intended outcomes. For instance, some interventions changed AMU guidelines, expanded the scope of a surveillance system, and conducted or recommended that interventions be evaluated throughout their lifecycle
Complexity of intervention Success factors: Multimodal interventions were also reported to increase the success of interventions. For example, one activity such as surveillance of AMU in animals can be supported by several others like guideline implementation, awareness campaigns, group discussions, and media dissemination. Interdisciplinary teams and collaboration between disciplines was identified several times as a catalyst for success. It has been suggested as a factor of success but also an empowering factor for achieving goals. Early involvement of all actors (e.g., stakeholders, multidisciplinary actors) was another supportive action for the intervention
Decentralising actions to regional and local groups with a diversity and multiplicity of actors was considered to increase the success of the interventions. Also, embedding the intervention in pre-existing structures and using existing resources (e.g., sampling strategy already in place) and collaboration with local scientific and political partners may increase the success of the intervention
Costs Success factor: Interventions were identified as costly and require a sustainable financial support to access data and maintain activities
Outer and inner setting Networks and communication Success factors: The communication with the general public, sometimes with the collaboration with media, was a real asset for intervention to increase acceptability but also visibility, transparency, and support
Communication within the intervention team and actors was important to encourage the implication and compliance to the intervention. Feedback from actors was also necessary for adapting the intervention if its design did not fit its purpose
Collaboration and participation
External policies and incentives Contextual factors: Interventions at the national level that were implemented concurrently with the studied intervention made an independent assessment of the intervention’s impact difficult, and it might have increased its acceptability/compliance within the target population (e.g., surveillance system and vaccination programme)
Access to healthcare was found to have an influence in the access of AMs, their use, and willingness of people to be treated (e.g., lack of health insurance policy)
Culture Contextual factor: A commitment for AMR control in the country was found to make an intervention better accepted by the actors and targeted population. However, a track record of actions against AMR was also suggested to lead to smaller impact of the intervention, as the previous interventions already improved the situation regarding AMR in the country. This might reflect the diminishing return of some action with a low leverage point. Nonetheless, having functioning institutions in a state, which ensures compliance with interventions, is an essential cornerstone for limiting AMR
Process Engaging Failure factor: The lack of results was also related to the lack of incentives to participate and follow instructions of the intervention
Success factors: Direct and strong support from the hierarchy was mentioned as a factor to enhance success of the intervention by providing leadership and support. Assigning clear responsibilities for the intervention can also contributed to successful intervention implementation. The funding of a specific coordinator or assistant within the intervention was also described as important
Threshold for intervention effectiveness Failure factor: Threshold for intervention effectiveness reached was identified in one publication which mentioned that the intervention implemented in the country could have reached the limits of effectiveness
  1. Details of success and failure factors and contextual factors that had an impact on the interventions as described in the 52 studied publications, following the classification of the CFIR framework (Consolidated Framework for Implementation Research) developed by Damschroder et al. [24]