Using coincidence analysis to understand implementation of a play-promotion program through a national learning collaborative

Objective Prescription for Play (P4P) helps pediatric primary care providers promote early childhood play through caregiver education. The P4P Learning Collaborative (LC) was launched to support P4P implementation through expert-led education and coaching. This study used coincidence analysis (CNA) to identify the minimally necessary and sufficient conditions for achieving implementation fidelity among LC participants. Methods Twenty teams participated in the 6-month LC. Teams included a site coordinator, responsible for managing implementation, and a provider champion, who promoted care team engagement. Teams self-reported organizational characteristics and were categorized according to whether they did or did not meet fidelity criteria. Monthly learning sessions and coaching call attendance were tracked. CNA identified combinations of organizational characteristics and engagement factors linked to fidelity. Results The final CNA model for meeting fidelity criteria demonstrated 100% consistency and 90% coverage, revealing two pathways: teams that achieved fidelity either (1) had a provider champion in an administrative role and high learning session attendance or (2) operated within a medium-to-large pediatric practice and had high learning session attendance. The model for not meeting fidelity criteria had similarly high consistency (100%) and coverage (80%) and identified teams with low learning session attendance as sufficient. Conclusions Findings highlight the importance of sustained LC engagement and enabling factors in supporting implementation of a play-promotion program and demonstrate the utility of CNA for identifying implementation pathways in pediatric primary care.