Applying implementation science to assess readiness for community-based management of acute malnutrition: a qualitative baseline study from Meghalaya, India
1
Indian Institute of Public Health Shillong, Shillong, India
Popul. Med. 2026;8(Supplement Supplement 1):A2333
ABSTRACT
BACKGROUND:
Community-Based Management of Acute Malnutrition (CMAM) is being introduced in Meghalaya to strengthen early identification and treatment of under-5 malnutrition through community engagement and primary health systems 1. While CMAM is supported by strong clinical evidence 2, successful scale-up depends on health system readiness and community acceptance. This study applies an implementation science lens to examine factors influencing readiness prior to programme rollout, using the Consolidated Framework for Implementation Research (CFIR) to systematically assess barriers and facilitators in the local context 3.
METHODS:
A qualitative baseline study was conducted across three pilot blocks using CFIR as the guiding analytical framework. In-depth interviews were undertaken with caregivers, community influencers, frontline health workers, and programme functionaries. Topic guides were explicitly mapped to CFIR domains, including intervention characteristics, outer and inner setting, characteristics of individuals, and implementation processes. Transcripts and field notes were analysed thematically and organised according to CFIR constructs to generate relevant insights for programme design and implementation.
RESULTS:
Findings demonstrated strong perceived relative advantage of the CMAM model compared to previous nutrition interventions, particularly due to its focus on early identification and treatment rather than food distribution alone. Trust in frontline workers and existing community institutions emerged as key facilitators. However, gaps were identified in caregiver understanding of malnutrition and workload pressures among frontline staff. Contextual barriers such as geographic isolation, limited food access, and opportunity costs for families were found to influence participation. The CFIR-based analysis highlighted the importance of aligning programme design with local workflows, strengthening supervision and incentives and leveraging community networks to support sustained implementation.
CONCLUSIONS:
This study demonstrates the value of applying an implementation science framework to inform intervention design and rollout. By systematically identifying contextual enablers and constraints using CFIR, the research provides actionable insights to strengthen programme feasibility, acceptability, and sustainability.
Community-Based Management of Acute Malnutrition (CMAM) is being introduced in Meghalaya to strengthen early identification and treatment of under-5 malnutrition through community engagement and primary health systems 1. While CMAM is supported by strong clinical evidence 2, successful scale-up depends on health system readiness and community acceptance. This study applies an implementation science lens to examine factors influencing readiness prior to programme rollout, using the Consolidated Framework for Implementation Research (CFIR) to systematically assess barriers and facilitators in the local context 3.
METHODS:
A qualitative baseline study was conducted across three pilot blocks using CFIR as the guiding analytical framework. In-depth interviews were undertaken with caregivers, community influencers, frontline health workers, and programme functionaries. Topic guides were explicitly mapped to CFIR domains, including intervention characteristics, outer and inner setting, characteristics of individuals, and implementation processes. Transcripts and field notes were analysed thematically and organised according to CFIR constructs to generate relevant insights for programme design and implementation.
RESULTS:
Findings demonstrated strong perceived relative advantage of the CMAM model compared to previous nutrition interventions, particularly due to its focus on early identification and treatment rather than food distribution alone. Trust in frontline workers and existing community institutions emerged as key facilitators. However, gaps were identified in caregiver understanding of malnutrition and workload pressures among frontline staff. Contextual barriers such as geographic isolation, limited food access, and opportunity costs for families were found to influence participation. The CFIR-based analysis highlighted the importance of aligning programme design with local workflows, strengthening supervision and incentives and leveraging community networks to support sustained implementation.
CONCLUSIONS:
This study demonstrates the value of applying an implementation science framework to inform intervention design and rollout. By systematically identifying contextual enablers and constraints using CFIR, the research provides actionable insights to strengthen programme feasibility, acceptability, and sustainability.
| eISSN: | 2654-1459 |
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