Factors influencing the implementation of evidence-based interventions with street-connected children and youth: two case studies from Eldoret, Kenya

Abstract

Street-connected young people face tremendous social, economic, and health inequities, as well as myriad barriers to accessing health and social services and supports. However, there are few evidence-based health and social programs for street-connected young people in low- and middle-income countries such as Kenya. This is an opportunity to apply implementation research to adapt evidence-based interventions with and for street-connected young people to ensure that they are culturally and contextually relevant, and to promote the health and well-being of this underserved population. In this paper, we present a qualitative case study of two evidence-based interventions that were adapted with and for street-connected young people in Eldoret, Kenya. Interview and focus group data is derived from 38 street-connected young people and six facilitators, as well as observational notes, identified factors influencing the implementation of these two interventions. Data were analyzed deductively using the Consolidated Framework for Implementation Research (CFIR). Key factors influencing implementation coalesced around five CFIR domains: the importance of building trust and establishing meaningful and authentic relationships with street-connected young people; considering gender identities, norms, and dynamics; and ensuring adequate operational and logistical planning to respond to the unique needs of this population. Emphasizing the importance of ongoing, active, and meaningful engagement with street-connected young people, we conclude with recommendations for implementing evidence-based interventions with this population in resource-constrained settings.