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Some state health departments in the United States are in the process of increasing access to immediate postpartum long-acting reversible contraception (LARC), an evidence based approach to preventing unintended pregnancy. Changing state Medicaid policies for immediate postpartum LARC reimbursement has proven insufficient for overcoming access barriers, so states developed implementation strategies to conduct multiple, coordinated systems changes. This research was conducted to understand the roles of social networks in implementing a complex health systems change. In 2015 and 2018, semi-structured telephone interviews were conducted with state teams engaged in increasing access to immediate postpartum LARC. Transcriptions of interviews were coded based on the Consolidated Framework for Implementation Research and implementation strategies, then themes were refined through discussion. A web-based assessment in 2018 evaluated degree of implementation accomplishment. Teams found that increased formal or informal social engagement among members aided timeliness, resource coordination, accountability, and enthusiasm, and over the course of 2 years, reduced disruptions due to staff turnover. The composition of the team influenced the social ties it could draw upon. Preexisting relationships were the most common source of social networking. Bridging social ties connected state teams to novel information and instrumental aid used to seek funding, conduct consumer awareness activities, and train healthcare providers. Cultivating and maintaining relationships among agencies and organizations as part of routine operations enables them to be available for future implementation efforts. Multi-agency teams may benefit from prioritizing time for internal and external relationship-building to enhance implementation progress.

Objectives: Implementation science provides useful tools for guiding and evaluating the integration of evidence-based interventions with standard practice. The objective of our study was to demonstrate the usefulness of applying an implementation science framework—the Consolidated Framework for Implementation Research (CFIR)—to increase understanding of implementation of complex statewide public health initiatives, using the example of Medicaid immediate postpartum long-acting reversible contraception (LARC) policies. Methods: We conducted semistructured telephone interviews with the 13 state teams participating in the Immediate Postpartum LARC Learning Community. We asked teams to describe the implementation facilitators, barriers, and strategies in 8 focus areas of the Learning Community. We audio-recorded and transcribed interviews and then coded each interview according to the domains and constructs (ie, theoretical concepts) of the CFIR. Results: Cosmopolitanism (ie, networking with external organizations) was the most frequently coded construct of the framework. A related construct was networks and communications (ie, the nature and quality of social networks and formal and informal communications in an organization). Within the construct of cost, state teams identified barriers that were often unable to be overcome. Trialability (ie, ability to test the intervention on a small scale) and engaging champions (ie, attracting and involving persons who dedicate themselves to supporting the intervention in an organization) were among the most salient constructs of the framework and were the sources of many implementation strategies. Conclusions: State leaders and program staff members may benefit from considering the CFIR domains and constructs in the planning, implementation, and evaluation of complex statewide public health initiatives.