Using implementation research frameworks to identify facilitators and barriers to implementation of ferric carboxymaltose intravenous iron among moderately anemic postpartum women participating in a trial in India
5 affiliations
- 1Women's and Children's Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India.
- 2RTI International, Durham, NC, United States of America.
- 3Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
- 4Asano-Gonnella Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
- 5Department of Global Affairs, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
Abstract
Postpartum anemia affects approximately 75% of women in India. We conducted this implementation research (IR) related to the use of ferric carboxymaltose (FCM) intravenous (IV) iron as part of a trial in anemic postpartum women. The aim of the IR study was to understand potential facilitators and barriers to implementation of single-dose FCM IV iron. This is a mixed-methods study in three secondary-level healthcare facilities in Belagavi, India, designed to explore selected Consolidated Framework for Implementation Research constructs and Proctor’s framework elements. Quantitative data were gathered via surveys of postpartum women who received IV FCM (n = 308) and from healthcare workers and administrators (n = 16). Qualitative data included in-depth interviews with 15 women who received IV FCM, 15 family members of women, and 15 healthcare workers and administrators. Quantitative data were analyzed descriptively, and interview transcripts underwent directed content analysis to augment survey findings. Nearly all women believed IV iron made anemia symptoms better, 76% felt the single infusion process was very easy, 58% completely agreed to receive treatment again, and 69% were very likely to recommend treatment to family or friends. Family members were supportive of women receiving FCM. Health workers felt that single dose FCM had comparative advantages over oral iron; however, 4/10 health workers said giving FCM IV iron is harder than oral iron because of the patient monitoring involved and 8/16 health workers and administrators felt there were not enough trained staff to provide the service. Fewer than half of health workers and administrators (7/16) believed their hospital had enough resources to implement IV FCM infusions, and 9/16 said getting the necessary supplies would be a moderate or major barrier. In conclusion, the intervention was well accepted by women and their families and feasible for government health staff within the context of a trial. Future scale up of FCM IV iron would require out-of-pocket costs to be covered by public funding, staff training on the intervention, and strategies, such as dedicated staff or task shifting, to allow for monitoring during and after the infusion.
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BibTeX
@article{charantimath2026using,
title = {{Using implementation research frameworks to identify facilitators and barriers to implementation of ferric carboxymaltose intravenous iron among moderately anemic postpartum women participating in a trial in India}},
author = {Umesh Charantimath and Valerie L Flax and Ashwini Dandappanavar and Anika Hannan and Mrityunjay C Metgud and Avinash Kavi and Manjunath Somannavar and Shivaprasad S Goudar and Simal Thind and Rosemary Frasso and Lauren Wiener and Sabrina LaRosa and Cecilia Rasco and Elizabeth M McClure and Richard Derman},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0359787},
url = {https://doi.org/10.1371/journal.pone.0359787},
note = {CC BY},
}
RIS
TY - JOUR
TI - Using implementation research frameworks to identify facilitators and barriers to implementation of ferric carboxymaltose intravenous iron among moderately anemic postpartum women participating in a trial in India
AU - Umesh Charantimath
AU - Valerie L Flax
AU - Ashwini Dandappanavar
AU - Anika Hannan
AU - Mrityunjay C Metgud
AU - Avinash Kavi
AU - Manjunath Somannavar
AU - Shivaprasad S Goudar
AU - Simal Thind
AU - Rosemary Frasso
AU - Lauren Wiener
AU - Sabrina LaRosa
AU - Cecilia Rasco
AU - Elizabeth M McClure
AU - Richard Derman
PY - 2026
DA - 2026/10/21
JO - PLOS One
DO - 10.1371/journal.pone.0359787
UR - https://doi.org/10.1371/journal.pone.0359787
AB - Postpartum anemia affects approximately 75% of women in India. We conducted this implementation research (IR) related to the use of ferric carboxymaltose (FCM) intravenous (IV) iron as part of a trial in anemic postpartum women. The aim of the IR study was to understand potential facilitators and barriers to implementation of single-dose FCM IV iron. This is a mixed-methods study in three secondary-level healthcare facilities in Belagavi, India, designed to explore selected Consolidated Framework for Implementation Research constructs and Proctor’s framework elements. Quantitative data were gathered via surveys of postpartum women who received IV FCM (n = 308) and from healthcare workers and administrators (n = 16). Qualitative data included in-depth interviews with 15 women who received IV FCM, 15 family members of women, and 15 healthcare workers and administrators. Quantitative data were analyzed descriptively, and interview transcripts underwent directed content analysis to augment survey findings. Nearly all women believed IV iron made anemia symptoms better, 76% felt the single infusion process was very easy, 58% completely agreed to receive treatment again, and 69% were very likely to recommend treatment to family or friends. Family members were supportive of women receiving FCM. Health workers felt that single dose FCM had comparative advantages over oral iron; however, 4/10 health workers said giving FCM IV iron is harder than oral iron because of the patient monitoring involved and 8/16 health workers and administrators felt there were not enough trained staff to provide the service. Fewer than half of health workers and administrators (7/16) believed their hospital had enough resources to implement IV FCM infusions, and 9/16 said getting the necessary supplies would be a moderate or major barrier. In conclusion, the intervention was well accepted by women and their families and feasible for government health staff within the context of a trial. Future scale up of FCM IV iron would require out-of-pocket costs to be covered by public funding, staff training on the intervention, and strategies, such as dedicated staff or task shifting, to allow for monitoring during and after the infusion.
SN - 1932-6203
ER -