{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:43:41Z","timestamp":1792604621780,"version":"4.5.0"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-043250"],"award-info":[{"award-number":["INV-043250"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>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\u2019s framework elements. Quantitative data were gathered via surveys of postpartum women who received IV FCM (n\u2009=\u2009308) and from healthcare workers and administrators (n\u2009=\u200916). 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.<\/jats:p>","DOI":"10.1371\/journal.pone.0359787","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:32:10Z","timestamp":1792603930000},"page":"e0359787","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"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"],"prefix":"10.1371","volume":"21","author":[{"given":"Umesh","family":"Charantimath","sequence":"first","affiliation":[{"name":"Women\u2019s and Children\u2019s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research","place":["Belagavi, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0200-3355","authenticated-orcid":true,"given":"Valerie L.","family":"Flax","sequence":"additional","affiliation":[{"name":"RTI International","place":["Durham, NC, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwini","family":"Dandappanavar","sequence":"additional","affiliation":[{"name":"Women\u2019s and Children\u2019s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research","place":["Belagavi, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8830-5719","authenticated-orcid":true,"given":"Anika","family":"Hannan","sequence":"additional","affiliation":[{"name":"RTI International","place":["Durham, NC, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mrityunjay C.","family":"Metgud","sequence":"additional","affiliation":[{"name":"Women\u2019s and Children\u2019s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research","place":["Belagavi, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2176-4697","authenticated-orcid":true,"given":"Avinash","family":"Kavi","sequence":"additional","affiliation":[{"name":"Women\u2019s and Children\u2019s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research","place":["Belagavi, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjunath","family":"Somannavar","sequence":"additional","affiliation":[{"name":"Women\u2019s and Children\u2019s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research","place":["Belagavi, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8680-7053","authenticated-orcid":true,"given":"Shivaprasad S.","family":"Goudar","sequence":"additional","affiliation":[{"name":"Women\u2019s and Children\u2019s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research","place":["Belagavi, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0270-5525","authenticated-orcid":true,"given":"Simal","family":"Thind","sequence":"additional","affiliation":[{"name":"Jefferson College of Population Health, Thomas Jefferson University","place":["Philadelphia, Pennsylvania, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemary","family":"Frasso","sequence":"additional","affiliation":[{"name":"Jefferson College of Population Health, Thomas Jefferson University","place":["Philadelphia, Pennsylvania, United States of America"]},{"name":"Asano-Gonnella Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College, Thomas Jefferson University","place":["Philadelphia, Pennsylvania, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4753-240X","authenticated-orcid":true,"given":"Lauren","family":"Wiener","sequence":"additional","affiliation":[{"name":"Jefferson College of Population Health, Thomas Jefferson University","place":["Philadelphia, Pennsylvania, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"LaRosa","sequence":"additional","affiliation":[{"name":"Jefferson College of Population Health, Thomas Jefferson University","place":["Philadelphia, Pennsylvania, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Rasco","sequence":"additional","affiliation":[{"name":"RTI International","place":["Durham, NC, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8659-5444","authenticated-orcid":true,"given":"Elizabeth M.","family":"McClure","sequence":"additional","affiliation":[{"name":"RTI International","place":["Durham, NC, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Derman","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University","place":["Philadelphia, Pennsylvania, United States of America"],"department":["Department of Global Affairs"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"issue":"1","key":"pone.0359787.ref001","first-page":"7","article-title":"Maternal anemia with pregnancy and its adverse effects","volume":"31","author":"ME Helmy","year":"2018","journal-title":"Menoufia Med J"},{"issue":"6","key":"pone.0359787.ref002","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1097\/AOG.0000000000003557","article-title":"Maternal and perinatal morbidity and mortality associated with anemia in pregnancy","volume":"134","author":"C Smith","year":"2019","journal-title":"Obstet Gynecol"},{"key":"pone.0359787.ref003","doi-asserted-by":"crossref","first-page":"395","DOI":"10.2147\/IJWH.S58355","article-title":"Determinants of postpartum anemia among women from a rural population in southern India","volume":"6","author":"P Rakesh","year":"2014","journal-title":"Int J Womens 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Anaemia webpage. [cited 2025 May 1]. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/anaemia"},{"key":"pone.0359787.ref006","volume-title":"National Family Health Survey (NFHS-4), 2015-16: India","author":"International Institute for Population Sciences (IIPS) and ICF","year":"2017"},{"key":"pone.0359787.ref007","volume-title":"National Family Health Survey (NFHS-5): India: Volume 1","author":"International Institute for Population Sciences (IIPS) and ICF","year":"2021"},{"issue":"8","key":"pone.0359787.ref008","doi-asserted-by":"crossref","first-page":"2703","DOI":"10.4103\/jfmpc.jfmpc_386_19","article-title":"High prevalence of anemia among postnatal mothers in Urban Puducherry: A community-based study","volume":"8","author":"R Selvaraj","year":"2019","journal-title":"J Family Med Prim Care"},{"key":"pone.0359787.ref009","unstructured":"National Health Mission. Anemia Mukt Bharat. Ministry of Health & Family Welfare, Government of India. 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Indian Public Health Standards: Community Health Centre. 2022 [cited 2025 July 25]. https:\/\/nhm.gov.in\/images\/pdf\/guidelines\/iphs\/iphs-revised-guidlines-2022\/02-CHC_IPHS_Guidelines-2022.pdf"},{"key":"pone.0359787.ref023","doi-asserted-by":"crossref","first-page":"114523","DOI":"10.1016\/j.socscimed.2021.114523","article-title":"Sample sizes for saturation in qualitative research: A systematic review of empirical tests","volume":"292","author":"M Hennink","year":"2022","journal-title":"Soc Sci Med"},{"issue":"9","key":"pone.0359787.ref024","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis","volume":"15","author":"H-F Hsieh","year":"2005","journal-title":"Qual Health Res"},{"key":"pone.0359787.ref025","volume-title":"Qualitative data analysis: An expanded sourcebook","author":"MB Miles","year":"1994"},{"key":"pone.0359787.ref026","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1080\/0142159X.2022.2057287","article-title":"A practical guide to reflexivity in qualitative research: AMEE Guide No. 149","volume":"45","author":"FM Olmos-Vega","year":"2023","journal-title":"Med Teacher"},{"key":"pone.0359787.ref027","volume-title":"Anaemia Mukt Bharat Intensified National Iron Plus Initiative (I-Nipi) Operational Guidelines","author":"Ministry of Health and Family Welfare","year":"2018"},{"key":"pone.0359787.ref028","doi-asserted-by":"crossref","first-page":"200237","DOI":"10.1016\/j.hnm.2023.200237","article-title":"Compliance with iron-folic acid supplementation, associated factors, and barriers among postpartum women in Eastern India","volume":"35","author":"MV Smith","year":"2024","journal-title":"Hum Nutr Metab"},{"issue":"1","key":"pone.0359787.ref029","doi-asserted-by":"crossref","first-page":"286","DOI":"10.18203\/2394-6040.ijcmph20244033","article-title":"A community based cross-sectional study on compliance and barriers of iron and folic acid consumption among postnatal mothers of 0-6 weeks in an urban area from central India","volume":"12","author":"P Thungamithirai","year":"2024","journal-title":"Int J Community Med Public Health"},{"key":"pone.0359787.ref030","doi-asserted-by":"crossref","first-page":"66","DOI":"10.12688\/gatesopenres.13631.4","article-title":"Perceptions and experiences of intravenous iron treatment for anaemia in pregnancy in Malawi: A formative qualitative study","volume":"6","author":"L Manda-Taylor","year":"2024","journal-title":"Gates Open Res"},{"issue":"1","key":"pone.0359787.ref031","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12978-024-01743-y","article-title":"Acceptability of IV iron treatment for iron deficiency anaemia in pregnancy in Nigeria: a qualitative study with pregnant women, domestic decision-makers, and health care providers","volume":"21","author":"OR Akinajo","year":"2024","journal-title":"Reprod Health"},{"issue":"2","key":"pone.0359787.ref032","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1086\/JCE200920206","article-title":"Patients\u2019 perceptions on healthcare decision making in rural India: a qualitative study and ethical analysis","volume":"20","author":"S Seetharam","year":"2009","journal-title":"J Clin Ethics"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0359787","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:32:17Z","timestamp":1792603937000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0359787"}},"subtitle":[],"editor":[{"given":"Elingarami","family":"Sauli","sequence":"first","affiliation":[{"name":"Nelson Mandela African Institute of Science and Technology","place":["TANZANIA, UNITED REPUBLIC OF"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,21]]},"references-count":32,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0359787","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,21]]}}}