Abstract
{ "background": "Health systems in sub-Saharan Africa face persistent challenges in adopting and sustaining evidence-based interventions. Existing implementation frameworks often lack empirical validation in low-resource hospital settings, creating a gap between theoretical guidance and practical application.", "purpose and objectives": "This study aimed to empirically evaluate a novel, context-adapted implementation framework designed to increase the adoption of a standardised paediatric care protocol within district-level hospitals.", "methodology": "We conducted a stratified, parallel-group randomised field trial across 24 district hospitals. Hospitals were randomised to implement the new framework or continue with standard support. The primary outcome was the adoption rate, measured as the proportion of eligible cases managed per protocol over a six-month period. Adoption was modelled using a generalised linear mixed model: $\\logit(p{ij}) = \\beta0 + \\beta1 Ti + uj + e{ij}$, where $p{ij}$ is the probability of adoption in hospital $j$ in period $i$, $Ti$ is the treatment indicator, and $u_j$ is a hospital-level random effect.", "findings": "Hospitals using the novel framework demonstrated a significantly higher adoption rate (68%, 95% CI: 62 to 74) compared to control hospitals (47%, 95% CI: 41 to 53). The adjusted odds ratio for adoption was 2.41 (95% CI: 1.67 to 3.48, p<0.001). Key mechanisms included enhanced local facilitator engagement and structured audit cycles.", "conclusion": "The novel implementation framework significantly improved the adoption of the clinical protocol compared to standard methods, demonstrating its utility as a tool for bridging the implementation gap in resource-constrained settings.", "recommendations": "Health policymakers should consider integrating core components of this framework, particularly the structured facilitator role and audit feedback mechanism, into national scale-up strategies for new clinical guidelines.", "key words": "implementation science, health systems research, randomised trial, adoption