Phase 1—Development and training of CoPs

We established CoPs in three states of Mexico (Hidalgo, Morelos, and Veracruz) and three departments of Nicaragua (Chontales, Jinotega, and Matagalpa) where existing national maternal health programs were being implemented. The selection of states and departments was based on two main criteria: (a) maternal mortality rates above national averages and (b) presence of health authorities willing to participate in the project. Two research teams, one in Mexico and one in Nicaragua, met with the pertinent health authorities to agree on the objectives of the project, the definition of settings, and the profile of CoPs’ members. Initial contacts with health authorities helped ensure that stakeholders engaged in the CoPs had the authority to perform programmatic changes and improve implementation processes using research findings. The research team documented the context of each CoP emphasizing the most relevant aspects, including sociopolitical, organizational, and epidemiological events. The six CoPs included strategic personnel—health unit directors, maternal health program managers—and tactic frontline staff, including physicians, nurses, and health promoters directly involved in the implementation of maternal health programs. The six CoPs were assigned the same funding to perform the implementation research projects. Development, training, and activities of the six CoPs followed a streamlined process and participation was on a voluntary basis (Fig. 2).

Communities of Practice development, training, and activities. *Health Ministries are the highest level health authorities in each Mexican state and SILAIS in Nicaraguan Departments

During the first workshop, the research team identified the CoPs’ “policy champions,” namely health personnel with high interest and agency to support the project and communicate its importance to higher level health authorities [39]. We further identified a “facilitator” in each CoP, to act as mediator between the research team, the policy champion, and the CoP members while guiding and promoting members’ participation. We selected facilitators based on their leadership skills and abilities in using information and communication technologies.

Between June 2013 and May 2015, we organized workshops every 2 months with the research team, the policy champions, and the CoP’s facilitators, to provide implementation research training and follow-up on the CoPs’ activities. Concurrently, online activities were organized to strengthen the CoPs’ teamwork through an online platform [42], using a concept mapping process. This method helps conceptualize and give objectivity to the ideas of a group of people on a particular issue. It is particularly useful to identify and prioritize ideas collated in a conceptual framework highlighting their interrelations [42, 43]. We also used social media to convene virtual asynchronic meetings and provide working spaces. Training workshops and online activities focused on conducting literature reviews on implementation problems identified through concept mapping, using research results to inform decision-making, developing implementation research protocols, and presenting implementation research findings. In 2014, four leaders from each CoP attended a 5-day training workshop in Nicaragua focused on the development and execution of implementation research protocols. One more leader per CoP received a full scholarship to attend courses during the Mexico National Institute of Public Health Summer Program on Epidemiology and Public Health.