Dong Xiaodong, Guan Hongyu, Liu Wenting, Zhao Junling, Wang Huan, Shi Yaojiang, Ma Xiaochen
School of Public Health, Peking University, Beijing, China.
China Center for Health Development Studies, Peking University, Beijing, China.
BMJ Open. 2025 Jul 24;15(7):e097809. doi: 10.1136/bmjopen-2024-097809.
To identify the barriers and facilitators to implementing the social franchising model '' for delivering eye care services to children in rural China, using the updated Consolidated Framework for Implementation Research (CFIR 2.0) as a theoretical basis to evaluate implementation performance drivers and propose strategies for effective scaling and sustainability.
This qualitative study involved semi-structured interviews with key stakeholders from both the supply side and demand side. Interview guide development, coding, analysis and reporting of findings were thoroughly informed by the CFIR 2.0.
operated in 23 poverty-designated counties across four western provinces in China, collaborating with local public hospitals, private optical shops and third-party non-governmental organisations.
Key informants included two project managers, six representatives from local education and health bureaus and ten vision centre employees and franchise operators.
Key facilitators of implementation included a robust evidence base, high trialability and adaptability of the innovation, relative advantages over competitors, standardised resources and effective training programmes. Major barriers included challenges in cross-departmental collaboration, underestimated variable costs, competition from private providers, high employee turnover due to inadequate incentives and the lack of feedback mechanisms for contextual adaptation.
This study highlights critical barriers and facilitators to implementing social franchising models for eye care in low-resource settings. While demonstrated success in scalability, achieving sustainability requires addressing financial constraints, staff retention and adaptive feedback mechanisms. The findings provide a context-specific framework for scaling health innovations in low- and middle-income countries, offering valuable lessons for bridging the gap between social and business objectives in hybrid models.
利用更新后的实施研究综合框架（CFIR 2.0）作为理论基础，识别在中国农村地区为儿童提供眼保健服务实施社会特许经营模式的障碍和促进因素，评估实施绩效驱动因素并提出有效推广和可持续发展的策略。
这项定性研究包括对供应方和需求方的关键利益相关者进行半结构化访谈。访谈指南的制定、编码、分析和结果报告均充分参考了CFIR 2.0。
在中国西部四个省份的23个贫困县开展，与当地公立医院、私营眼镜店和第三方非政府组织合作。
关键信息提供者包括两名项目经理、当地教育和卫生局的六名代表以及十名视力中心员工和特许经营者。
实施的关键促进因素包括有力的证据基础、创新的高可试验性和适应性、相对于竞争对手的相对优势、标准化资源和有效的培训计划。主要障碍包括跨部门合作的挑战、可变成本估计不足、来自私营提供者的竞争、由于激励不足导致的员工高流动率以及缺乏情境适应的反馈机制。
本研究强调了在资源匮乏地区实施眼保健社会特许经营模式的关键障碍和促进因素。虽然在可扩展性方面已证明取得成功，但要实现可持续性需要解决财务限制、人员保留和适应性反馈机制等问题。研究结果为中低收入国家扩大卫生创新提供了一个因地制宜的框架，为弥合混合模式中社会和商业目标之间的差距提供了宝贵经验。
