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INTRODUCTION: We used a Programme Science platform, to generate evidence to support the implementation of programmes for sex workers in Africa. Female sex workers are estimated to make up 1.6% (1.3%-1.8%) of the population of women aged 15-49 years in Zimbabwe. We highlight how programme science can be used to help distinguish between when, where and with whom programmes need to be implemented and discuss two case studies that exemplify implementing better (Case study 1 (1 June 2019-30 June 2021) Optimizing implementation of a risk differentiated microplanning intervention) and implementing differently (Case study 2 (1 October 2016-30 September 2022) Reorientating implementation of DREAMS for young women selling sex). METHODS: Zimbabwe's nationally scaled programme for sex workers was established in 2009 in partnership with sex workers to provide comprehensive services for sex workers and generate evidence for programme design, implementation and scale up. Since inception, comprehensive data have been collected from all sex workers seeking services. As the scope of service provision has expanded so has the scope of data collection and analysis. At enrolment, sex workers are assigned an alphanumeric unique identifier which links consultations within and across programme sites. We conduct descriptive analyses of the Key Population (KP) programme data to guide programme implementation and redesign, embedding programmatic qualitative enquiry as required. RESULTS: Two case studies describing different approaches to programme optimization are presented. In the first, an optimization exercise was used to strengthen programme implementation ensuring that the KP programme got back on track after SARS-COV-2. In the second, an in-depth review of research and programme data led to a re-orientation of the DREAMS programme to ensure that young women at the highest risk of HIV acquisition were enrolled and had access to DREAMS social support interventions in turn strengthening their uptake of HIV prevention. CONCLUSIONS: Optimizing and sustaining HIV care and treatment programmes requires effective delivery with sufficient scale and intensity for population impact. Our programme science approach guided the scale up of the KP programme in Zimbabwe, providing evidence to support strategy, implementation and ongoing management, and importantly helping us distinguish between when we needed to just implement, implement better or implement differently.

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Safewards is a multi-intervention mental health nursing model of practice improvement aimed at preventing and reducing conflict and containment. The use of Safewards has now extended beyond mental health settings. Implementation of Safewards has been reported to be challenging and therefore requires an evidence-informed and structured approach. This review's objectives were to: (i) Comprehensively map approaches used to implement Safewards interventions; (ii) Characterise the outcomes measured in Safewards implementation studies; and (iii) Identify the facilitators and barriers to Safewards training and its implementation in practice. All quantitative, qualitative and mixed-methods publications of Safewards, the interventions, evaluations, barriers and facilitators from all healthcare services internationally were included. The Joanna Briggs Institute scoping review and Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews were used to guide methodology. Data were reported according to the 12 items of the TIDieR. Twenty-seven publications reported the implementation of Safewards. Descriptions were limited for reporting items such as intervention descriptions, materials, resources, specific procedures and processes, modifications made to interventions and delivery of interventions and training. No consistent theoretical implementation framework was reported. Collaboration, leadership, feedback and co-design were strong drivers for staff buy-in, engagement and success for implementation in mental health and acute settings. Transparency, replicability and generalisation require a detailed description of all elements of an intervention being implemented. Without adequate information, only assumptions can be drawn about the clinical governance and process of the implementation and training, and it is difficult to conclude when attempting to replicate the interventions.

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BACKGROUND: Cervical cancer is a public health concern in the sub-Saharan Africa region. Cervical cancer screening is one of the strategies for detecting early precancerous lesions. However, many women have poor access to and utilization of screening services in the region. This review aimed to synthesize evidence on the challenges and opportunities of screening, early detection and  management of cervical cancer in sub-Saharan Africa. METHODS: We conducted a structured narrative review of studies published in English. We included studies published from 1 January 2013 to mid-2022. Studies were selected following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Key search terms (detractors and enablers, cervical cancer screening, sub-Saharan Africa) were employed to identify studies from three electronic databases (HINARI, Science Direct, and PubMed). We also conducted searches on Google Scholar to identify relevant grey literatures. A thematic analysis was conducted and themes were identified, then explained using a socio-ecological framework (intrapersonal, interpersonal, organizational, community, policy levels). RESULTS: We identified 60 studies in the final review. Cervical cancer screening and early detection and management programmes are influenced by drivers at multiple levels. Individual-level drivers included a lack of knowledge about cervical cancer and screening literacy, and a low risk in perception, attitude, susceptibility and perceived fear of test results, as well as sociodemographic characteristics of women. Interpersonal drivers were community embarrassment, women's relationships with health workers, support and encouragement, the presence of peers or relatives to model preventive behaviour, and the mothers' networks with others. At the organizational level, influencing factors were related to providers (cervical cancer screening practice, training, providers' profession type, skill of counselling and sex, expert recommendation and work commitments). At the community level, drivers of cervical cancer screening included stigma, social-cultural norms, social networks and beliefs. System- and policy-level drivers were lack of nearby facilities and geographic remoteness, resource allocation and logistics management, cost of screening, promotion policy, ownership and management, lack of decentralized cancer policy and lack of friendly infrastructure. CONCLUSIONS: There were several drivers in the implementation of cervical cancer screening programmes at multiple levels. Prevention and management of cervical cancer programmes requires multilevel strategies to be implemented  across the individual level (users), community and organizational levels (providers and community users), and system and policy levels. The design and implementation of policies and programmes need to address the multilevel challenges.

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PURPOSE: Drawing on the experiences of healthcare professionals in one paediatric hospital, this paper explores the influence of context and organisational behaviour on the implementation of a person-centred transition programme for adolescents and young adults (AYA) with long-term conditions. DESIGN/METHODOLOGY/APPROACH: A single embedded qualitative case study design informed by a realist evaluation framework, was used. Participants who had experience of implementing the transition programme were recruited from across seven individual services within the healthcare organisation. The data were gathered through semi-structured interviews (n = 20) and analysed using thematic analysis. FINDINGS: Implementation of the transition programme was influenced by the complex interaction of macro, meso and micro processes and contexts. Features of organisational behaviour including routines and habits, culture, organisational readiness for change and professional relationships shaped professional decision-making around programme implementation. ORIGINALITY/VALUE: There exists a significant body of research relating to the role of context and its influence on the successful implementation of complex healthcare interventions. However, within the area of healthcare transition there is little published evidence on the role that organisational behaviour and contextual factors play in influencing transition programme implementation. This paper provides an in-depth understanding of how organisational behaviour and contextual factors affect transition programme implementation.

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The need to develop holistic public health approaches that go beyond treating the biological causes of ill health, to addressing the social determinants of health, have been highlighted in the global health agenda. Social prescribing, where care professionals link individuals to community resources that tackle social needs have gained increasing traction worldwide. In Singapore, SingHealth Community Hospitals introduced social prescribing in July 2019 to manage the complex health and social needs of the aging populace. Faced with the paucity of evidence on the effectiveness of social prescribing and its implementation, implementers had to contextualise the theory of social prescribing to patients' needs and setting of practice. Using an iterative approach, the implementation team constantly reviewed and adapted practices, work processes and outcome measurement tools based on data and stakeholder feedback to address implementation challenges. As social prescribing continues to scale in Singapore and take root in the Western Pacific region, agile implementation and continued evaluation of programmes to build an evidence pool will help to guide best practices. The aim of this paper is to review the implementation of a social prescribing programme from the exploratory phase to full implementation, and draw lessons learned in the process.

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INTRODUCTION: Uganda has high maternal, neonatal, and under-five mortality rates. This study documents stakeholder perspectives on best practices in a maternal and newborn health (MNH) quality-improvement programme implemented in the West Nile region of Uganda to improve delivery and utilisation of MNH services. METHODS: This exploratory cross-sectional qualitative study, conducted at the end of 2021, captured the perspectives of stakeholders representing the different levels of the healthcare system. Data were collected in four districts through: interviews with key informants working at all levels of the health system; focus group discussions with parents and caretakers and with community health workers; and interviews with individual community members whose lives had been impacted by the MNH programme. The initial content analysis was followed by a deductive synthesis pitched according to the different levels of the health system and the health-systems building blocks. RESULTS: The findings are summarised according to the health-systems building blocks and an account is given of three of the interventions most valued by participants: (1) data use for evidence-based decision making (with regard to human resources, essential reproductive health commodities, and financing); (2) establishment of special newborn care units and high-dependency maternity units at district hospitals and training of the health workforce (also with reference to other infrastructural improvements such as the provision of water, sanitation and hygiene facilities at health facilities); and (3) community referral of pregnant women through a commercial motorcycle voucher referral system. CONCLUSION: The MNH programme in the West Nile region adopted a holistic and system-wide approach to addressing the key bottlenecks in the planning, delivery, and monitoring of quality MNH services. There was general stakeholder appreciation across the board that the interventions had the potential to improve quality of care and newborn and maternal health outcomes. However, as the funding was largely donor-driven, questions about government ownership and sustainability in the context of limited resources remain.

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BACKGROUND: The Health Planning Process under National Health Mission (NHM) is participatory in nature and the State Programme Implementation Plan (PIP) is an aggregation of District PIPs which is examined and approved by the National Programme Coordination Committee (NPCC), Ministry of Health and Family Welfare, Government of India. Many times there are delays in releasing of Record of Proceedings (ROPs)/approvals. This affects utilisation of NHM funds at district level and below and desired outcomes are not achieved. The present study aims to analyse the process of fund flow, disbursement and utilisation of funds on various components under Reproductive Maternal New born Child and Adolescent Health (RMNCH+A) in the district Gurugram. METHODOLOGY: The study was conducted in the District Gurugram of Haryana State, India. One Community Health Centres (CHCs), two Primary Health Centres (PHCs) and four Sub Health Centres were randomly selected. Primary and secondary data were collected in the study. Medical Officer (I/C), Accounts Staff and Health Workers were interviewed using separate schedules regarding process of disbursement, delays in release and utilisation of funds. Separate checklists were prepared to collect data on availability and utilisation of funds at District, CHC and PHC levels under different components of programme. FINDINGS: Study found that PIP is prepared with inputs from Block level but community participation at (PHC) and below was not present. There was a delay in reaching funds to district due to delayed release of ROPs. Almost 30%-40% of the budget could not be utilised due to delay in receiving of budget. Utilisation of funds was less in some programme activities due to vacant positions project staff. Only 38% and 31% of the funds were utilised under the child health and family planning budget head for the district of Gurugram in the year 2016-17. Accounts staffs were overburdened which affected monitoring of funds utilisation. Budget release from State to District and below was through e-Banking. Auxiliary Nurse Midwives (ANMs) at Sub centre used to get Untied Funds at the end of third quarter. The Government introduced new 18 broad budget heads in NHM Budget for improving utilisation of budget. CONCLUSION: Delayed release of ROPs and erroneous estimation of budget under the programme, very rigid and large number of budget heads poses challenges of understanding and analysing expenditure and affects utilisation of funds under the NHM. Moreover, vacant positions in the programme, unrealistic planning, weak community participation in planning of expenditure and unexplained budget cut in ROPs were main challenges faced by the District.

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This short communication describes the development and implementation of a programme monitoring and feedback process during a cluster-randomised community mobilisation intervention conducted in rural Bushbuckridge, Mpumalanga, South Africa. Intervention activities took place from August 2015 to July 2018 with the aim of addressing social barriers to HIV counselling and testing and engagement in HIV care, with a specific focus on reaching men. Multiple monitoring systems were put in place to allow for early and continuous corrective actions to be taken if activity goals, including target participation numbers in events or workshops, were not reached. Clinic data, intervention monitoring data, team meetings and community feedback mechanisms allowed for triangulation of data and creative responses to issues arising in implementation. Monitoring data must be collected and analysed carefully as they allow researchers to better understand how the intervention is being delivered and to respond to challenges and make changes in the programme and target approaches. An iterative process of sharing these data to generate community feedback on intervention approaches was critical to the success of our programme, along with engaging men in the intervention. Community mobilisation interventions to target the structural and social barriers impeding men's uptake of services are feasible in this setting, but must incorporate a continuous review of monitoring data and community collaboration to ensure that the target population is reached, and may need to also be supplemented by changes in the structure of care provision.

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Objective: Work-ready graduates need to be equipped with expertise and therefore, critical changes are required in the curricula for health professions. Here, we aimed to review the design of an interprofessional education programme (IPE) with regards to appropriateness and implementation for the Faculty of Health Sciences at North-West University, South Africa. Methods: This study employed a sequential multi-method design to develop an IPE programme for a health science faculty in South Africa. A scoping review was conducted to synthesise the structure, development and implementation processes of IPE programmes globally. This was followed by an analysis of IPE programmes from institutions on five continents. Subsequently, the perspectives of international experts on the development and implementation of IPE programmes were explored in a qualitative study. This was followed by a university context analysis and the development of a draft IPE programme was designed based on the data synthesised from all preliminary studies. The programme was presented to faculty to evaluate and provide input by applying a nominal group technique. Results: For the scoping review, ten steps to the IPE programme development process were developed. For the qualitative document analysis, a step-by-step guide and to-do list were provided to guide educators in conceptualising, developing, implementing and reviewing their IPE programmes. For the qualitative exploratory descriptive design, four themes were identified after the analysis of transcripts. An optional 3-year IPE programme was developed to serve as a precursor for full credit integration of the IPE into the faculty of health science curricula during future development of the health science curricula. Conclusion: The optional 3-year IPE programme developed will serve as a precursor for the integration of a credit-bearing IPE programme into the Faculty of Health Sciences curricula during future development.

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Background: Health services interventions are typically more effective in randomised controlled trials than in routine healthcare. One explanation for this 'voltage drop', i.e. reduction in effectiveness, is a reduction in intervention fidelity, i.e. the extent to which a programme is implemented as intended. This article discusses how to optimise intervention fidelity in nationally implemented behaviour change programmes, using as an exemplar the National Health Service Diabetes Prevention Programme (NHS-DPP); a behaviour change intervention for adults in England at increased risk of developing Type 2 diabetes, delivered by four independent provider organisations. We summarise key findings from a thorough fidelity evaluation of the NHS-DPP assessing design (whether programme plans were in accordance with the evidence base), training (of staff to deliver key intervention components), delivery (of key intervention components), receipt (participant understanding of intervention content), and highlight lessons learned for the implementation of other large-scale programmes. Results: NHS-DPP providers delivered the majority of behaviour change content specified in their programme designs. However, a drift in fidelity was apparent at multiple points: from the evidence base, during programme commissioning, and on to providers' programme designs. A lack of clear theoretical rationale for the intervention contents was apparent in design, training, and delivery. Our evaluation suggests that many fidelity issues may have been less prevalent if there was a clear underpinning theory from the outset. Conclusion: We provide recommendations to enhance fidelity of nationally implemented behaviour change programmes. The involvement of a behaviour change specialist in clarifying the theory of change would minimise drift of key intervention content. Further, as loss of fidelity appears notable at the design stage, this should be given particular attention. Based on these recommendations, we describe examples of how we have worked with commissioners of the NHS-DPP to enhance fidelity of the next roll-out of the programme.

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Motor competence (MC) in youth is associated with positive health outcomes, yet few achieve their developmental capability. Although numerous MC studies address initial intervention effectiveness, fewer consider intervention sustainability. This study aimed to investigate whether teachers continued to implement an effective MC programme targeting girls (mean age 12.4 ± 0.3 years), three years post-intervention. Ongoing implementation was examined using three domains of the UK Medical Research Council's framework: (i) implementation, (ii) mechanisms of impact, and (iii) context. Teachers (n = 18) completed self-report questionnaires and participated in focus group discussions (FGs). Descriptive statistics analysed questionnaires. FGs were audio recorded, transcribed verbatim and analysed in NVivo 11 using a framework approach. All teachers had continued to implement the programme, or elements thereof, three years post-intervention. The intervention structure, in particular alignment to the physical education context and curriculum, most notably influenced ongoing programme implementation. Improvement, both teacher practice and student performance, emerged as a driver of sustained impact. The programme demand appeared to be the most important facilitator of programme sustainability. Adaptations made to enhance contextual fit of the programme, post-intervention, extended the programme reach. Framed by implementation science, these findings provide valuable insight into programme sustainability and potential scalability.

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A survey was conducted in UK regional children's hospitals with paediatric intensive care and paediatric infectious disease (PID) departments to describe the characteristics of paediatric antimicrobial stewardship (PAS) programmes. A structured questionnaire was sent to PAS coordinators. 'Audit and feedback' was implemented in 13 out of 17 centres. Microbiology-led services were more likely to implement antimicrobial restriction (75% vs 33% in PID-led services), to focus on broad-spectrum antibiotics, and to review patients with positive blood cultures. PID-led services were more likely to identify patients from e-prescribing or drug charts and review all antimicrobials. A PAS network has been established.

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Cultural consensus analysis (CCA) is a quantitative method for determining cohesion in a specified cultural domain and cultural modelling (CM) is a method for designing and testing connections within a cultural domain based on qualitative data collection. After a description of the methods, and examples of their application, we provide a description of three main points in the programme planning, implementation and evaluation cycle at which the method can best be utilized to plan, contextualize or evaluate programmes and policies. In addition, the use of CCA and CM is not constrained to one point in time though, in order to maximize its ability to help with programme design or evaluation, it ought to be done as early as possible in the process. Through examples from research, and a broader description of the methods of CM and analysis, we provide another tool for global public health practitioners, planners and policymakers. We argue these tools can be used to great effect in a short period of time to maximize the local suitability, acceptability and quality of proposed and implemented interventions, building on existing local strengths, not just in maternal health but, more broadly.

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BACKGROUND: To address deficits in the delivery of acute services in Ireland, the National Acute Medicine Programme (NAMP) was established in 2010 to optimise the management of acutely ill medical patients in the hospital setting, and to ensure their supported discharge to primary and community-based care. NAMP aims to reduce inappropriate hospital admissions, reduce length of hospital stay and ensure patients receive timely treatment in the most appropriate setting. It does so primarily via the development of Acute Medical Assessment Units (AMAUs) for the rapid assessment and management of medical patients presenting to hospitals, as well as streamlining the care of those admitted for further care. This study will examine the impact of this programme on patient care and identify the factors influencing its implementation and operation. METHODS: We will use a multistage mixed methods evaluation with an explanatory sequential design. Firstly, we will develop a logic model to describe the programme's outcomes, its components and the mechanisms of change by which it expects to achieve these outcomes. Then we will assess implementation by measuring utilisation of the Units and comparing the organisational functions implemented to that recommended by the NAMP model of care. Using comparative case study research, we will identify the factors which have influenced the programme's implementation and its operation using the Consolidated Framework for Implementation Research to guide data collection and analysis. This will be followed by an estimation of the impact of the programme on reducing overnight emergency admissions for potentially avoidable medical conditions, and reducing length of hospital stay of acute medical patients. Lastly, data from each stage will be integrated to examine how the programme's outcomes can be explained by the level of implementation. DISCUSSION: This formative evaluation will enable us to examine whether the NAMP is improving patient care and importantly draw conclusions on how it is doing so. It will identify the factors that contribute to how well the programme is being implemented in the real-world. Lessons learnt will be instrumental in sustaining this programme as well as planning, implementing, and assessing other transformative programmes, especially in the acute care setting.

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The Baby-Friendly Community Initiative (BFCI) is an extension of the 10th step of the Ten Steps of Successful Breastfeeding and the Baby-Friendly Hospital Initiative (BFHI) and provides continued breastfeeding support to communities upon facility discharge after birth. BFCI creates a comprehensive support system at the community level through the establishment of mother-to-mother and community support groups to improve breastfeeding. The Government of Kenya has prioritized community-based programming in the country, including the development of the first national BFCI guidelines, which inform national and subnational level implementation. This paper describes the process of BFCI implementation within the Kenyan health system, as well as successes, challenges, and opportunities for integration of BFCI into health and other sectors. In Maternal and Child Survival Program (MCSP) and UNICEF areas, 685 community leaders were oriented to BFCI, 475 health providers trained, 249 support groups established, and 3,065 children 0-12 months of age reached (MCSP only). Though difficult to attribute to our programme, improvements in infant and young child feeding practices were observed from routine health data following the programme, with dramatic declines in prelacteal feeding (19% to 11%) in Kisumu County and (37.6% to 5.1%) in Migori County from 2016 to 2017. Improvements in initiation and exclusive breastfeeding in Migori were also noted-from 85.9% to 89.3% and 75.2% to 92.3%, respectively. Large gains in consumption of iron-rich complementary foods were also seen (69.6% to 90.0% in Migori, 78% to 90.9% in Kisumu) as well as introduction of complementary foods (42.0-83.3% in Migori). Coverage for BFCI activities varied across counties, from 20% to 60% throughout programme implementation and were largely sustained 3 months postimplementation in Migori, whereas coverage declined in Kisumu. BFCI is a promising platform to integrate into other sectors, such as early child development, agriculture, and water, sanitation, and hygiene.

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Optimal complementary feeding practices, a critical component of infant and young child feeding, has been demonstrated to prevent micronutrient deficiencies, stunting, overweight, and obesity. In Kenya, while impressive gains have been made in exclusive breastfeeding, progress in complementary feeding has been slow, and the country has failed to meet targets. Recent 2014 Kenya Demographic and Health Survey reveal that only 22% of Kenyan children, 6-23 months, met criteria for a minimum acceptable diet. This case study describes key actions for complementary feeding put in place by the Kenya Ministry of Health as well as approaches for improving and monitoring complementary feeding within existing health platforms. Experience from USAID's Maternal and Child Survival Program and Ministry of Health on development of 23 complementary feeding recipes through application of a national guide for recipe development and Trials of Improved Practices is described. Challenges in how to prepare, modify, and cook foods, including meat, for young children 6-23 months of age was relayed by mothers. Addressing cultural beliefs around complementary feeding meant providing reassurance to mothers that young children are developmentally able to digest fruit and vegetables and ready to consume animal-source protein. Through the Baby Friendly Community Initiative platform, cooking demonstrations and key hygiene actions were integrated with complementary feeding messages. Future programming for complementary feeding should consider development of context specific counselling messages on consumption of animal source foods, strengthen production and use of local foods through agriculture-nutrition linkages, and include complementary indicators through routine health monitoring systems to track progress.

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BACKGROUND AND AIM: Understanding the barriers to programme use is important to facilitate implementation of injury prevention programmes in real-word settings. This study investigated the barriers to coaches of adolescent female soccer teams, in Victoria, Australia, implementing the evidence-based FIFA 11+ injury prevention programme. METHODS: Concept mapping with data collected from 19 soccer coaches and administrators. RESULTS: Brainstorming generated 65 statements as barriers to 11+ implementation. After the statements were synthesised and edited, participants sorted 59 statements into groups (mean, 6.2 groups; range, 3-10 groups). Multidimensional scaling and hierarchical cluster analysis identified a six-cluster solution: Lack of 11+ knowledge among coaches (15 statements), Lack of player enjoyment and engagement (14), Lack of link to football-related goals (11), Lack of facilities and resources (8), Lack of leadership (6) and Lack of time at training (5). Statements in the 'Lack of 11+ knowledge among coaches' cluster received the highest mean importance (3.67 out of 5) and feasibility for the Football Federation to address (3.20) rating. Statements in the 'Lack of facilities and resources' cluster received the lowest mean importance rating (2.23), while statements in the 'Lack of time at training' cluster received the lowest mean feasibility rating (2.19). CONCLUSIONS: A multistrategy, ecological approach to implementing the 11+-with specific attention paid to improving coach knowledge about the 11+ and how to implement it, linking the 11+ to the primary goal of soccer training, and organisational leadership-is required to improve the uptake of the 11+ among the targeted coaches.

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While there are a growing number of interventions and evaluations of programmes aimed at changing gender norms and violence against women and girls, there remains a dearth of documentation outlining the challenges faced in conducting these interventions and evaluations, particularly in traditional and low literacy settings. The Do Kadam Barabari Ki Ore (Two Steps Towards Equality) programme sought to understand what works to prevent violence against women and girls in Bihar, India. This paper draws insights from process evaluation data. It describes promising features and challenges of implementation, and characteristics which weaken the potential effects of complex, community based, social sector programmes that aim to change deeply entrenched gender power hierarchies. We drew on the Medical Research Council framework for process evaluation in analysing our process evaluation data, and focus on mechanisms of impact, and factors inhibiting programme success, including contextual and implementation challenges. The paper also outlines measures that may help overcome observed challenges and areas that require modifications and/or further investigation. The programme experienced several challenges. These included contextual issues, such as the lack of leadership skills of those delivering the intervention and the gap between expected responsibilities and activities of government platforms and reality. Implementation challenges were encountered in reaching men and boys, younger women and the community at large and ensuring their regular attendance; and in maintaining the fidelity of the intervention activities. Our insights call for an evidence-supported dialogue on these challenges and how best to anticipate and address them.

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BACKGROUND: Humanitarian emergencies can impact people's psychosocial well-being and mental health. Providing mental health and psychosocial support (MHPSS) is an essential component of humanitarian aid responses. However, factors influencing the delivery MHPSS programmes have yet to be synthesised. We undertook a systematic review on the barriers to, and facilitators of, implementing and receiving MHPSS programmes delivered to populations affected by humanitarian emergencies in low- and middle-income countries. METHODS: A comprehensive search of 12 bibliographic databases, 25 websites and citation checking was undertaken. Studies published in English from 1980 onwards were included if they contained evidence on the perspectives of adults or children who had engaged in or programmes providers involved in delivering, MHPSS programmes in humanitarian settings. Thirteen studies were critically appraised and analysed thematically. RESULTS: Community engagement was a key mechanism to support the successful implementation and uptake of MHPSS programmes. Establishing good relationships with parents may also be important when there is a need to communicate the value of children and young people's participation in programmes. Sufficient numbers of trained providers were essential in ensuring a range of MHPSS programmes were delivered as planned but could be challenging in resource-limited settings. Programmes need to be socially and culturally meaningful to ensure they remain appealing. Recipients also valued engagement with peers in group-based programmes and trusting and supportive relationships with providers. CONCLUSION: The synthesis identified important factors that could improve MHPSS programme reach and appeal. Taking these factors into consideration could support future MHPSS programmes achieve their intended aims.

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This study considered the monitoring and evaluation of a large-scale and domestic and global strategic change programme implementation. It considers the necessary prerequisites to overcome challenges and barriers that prevent systematic and effective monitoring and evaluation to take place alongside its operationalisation. The work involves a case study based on a major industrial company from the energy sector. The change programme makes particular reference to changes in business models, business processes, organisation structures as well as Enterprise Resource Planning infrastructure. The case study focussed on the summative evaluation of the programme post-implementation. This assessment involved 25 semi-structured interviews with employees across a range of managerial strata capturing more than 65 roles within the change programme at both local and global levels. Data relating to their perception of evaluation effectiveness and shortcomings were analysed by means of template analysis. The study identifies responsibilities for executing an evaluation alongside various methods and tools that are appropriate, thereby focussing on the "Who" (roles, responsibility for particular activities) and "How" (methods and tools) rather than "What" to monitor and evaluate. The findings are presented generically so they offer new insights and transferability for practitioners involved in managing strategic change and its associated evaluation.

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