COLLECTIVE IMPACT APPROACH: LESSONS FROM SOUTH CAROLINA’S CONTRACEPTIVE ACCESS INITIATIVE

Abstract

Objectives

Choose Well, a statewide contraceptive access initiative in South Carolina, adopted a collective impact framework to enhance contraceptive access through collaboration, funding, and infrastructure support. This study evaluates facilitators, challenges, and lessons learned reported by leadership and staff implementing Choose Well and program grantees in federally qualified health center (FQHC) systems. This study is novel in examining implementation of a statewide contraceptive access initiative through collective impact principles: common agenda, shared measurement, mutually reinforcing activities, continuous communication, and backbone support.

Methods

Semi-structured interviews were conducted in 2022-2023, at the end of the initial six years of program implementation, with Choose Well staff (n=8) and FQHC administrators/clinicians (n=19) to explore implementation experiences, facilitators, and challenges. Using qualitative content analysis guided by the collective impact framework, data were triangulated to integrate perspectives from both groups.

Results

Facilitators of successful implementation included a shared vision for contraceptive access; shift to contraceptive equity and an expanded funding model; tailored clinic-level implementation with direct support; multi-channel communication through partner convenings and a web-based platform for training, resources, and collaborative communication; and clinic workflow and electronic medical record enhancements to improve efficiency. Challenges included delays in shared measurement development, variability in data reporting, and limited capacity for tracking contraceptive service metrics. Competing priorities within FQHCs and staff turnover further impacted shared measurement and learning/improvement opportunities.

Conclusions

Collective impact principles can advance statewide contraceptive access initiatives. Shared measurement challenges require investments in data infrastructure and training. Future initiatives should emphasize bidirectional communication, flexible implementation strategies, and sustainable infrastructure to enhance service delivery.