Implementation mapping, research capacity building and reflexivity: a case study on how to select implementation strategies to increase reach of HPV vaccination in Zambia

Human papillomavirus (HPV) vaccination is effective in preventing most cervical cancer, but coverage is low in Zambia. In this methods paper, we describe how we adapted implementation mapping to select and develop implementation strategies for HPV vaccination delivery by embedding reflexivity and research team capacity building throughout the process. In this article, we describe our process and its value for incorporating different perspectives from various community members in the selection and development of strategies. Task 1 involved needs assessment using rapid ethnographic assessment with girls age-eligible for the HPV vaccination (9–14 years), healthcare providers, household members, and community leaders. Task 2 involved a collaborative process defining implementation outcomes and performance objectives. Task 3 involved selecting theory-based methods and implementation strategies, also based on community input. Tasks 4 and 5 are ongoing and will be reported elsewhere. We embedded reflexivity and capacity building in implementation mapping for the research team and collaborators during each task. A total of 225 participants provided input about the context of implementing HPV vaccination in Task 1. In Task 2, we identified performance objectives and developed an implementation logic model to help select the strategies. Three strategies were selected In Task 3, we identified performance objectives for each participant, and drafted causal pathway diagrams for each of the strategies selected. We hosted 22 journal clubs among team members and carried out reflexivity exercises across the Tasks. We developed a resource for research teams using implementation mapping to explicitly embed, if appropriate, reflexivity and research team capacity building activities throughout their process. This study outlines how to explicitly embed reflexivity and capacity building activities during implementation mapping. It also shows, through a case study, how to incorporate various voices of participants in the selection of implementation strategies. Replicating, adapting, and evaluating these steps in the future may help the field of implementation research to support the development of team infrastructure while maintaining scientific rigor.