Implementation factors of group antenatal care in low-resource settings in Tanzania: A qualitative study using the Consolidated Framework for Implementation Research

Antenatal care (ANC) is essential for improving maternal and newborn health, yet many women do not complete the recommended follow-up visits and often experience suboptimal quality of care and weak provider-client interactions. Group antenatal care (G-ANC) offers an alternative service delivery model that combines clinical assessments with group-based education, facilitated discussion, and peer support for women with similar gestational age (GA). This study examined the facilitators and barriers to G-ANC implementation in low-resource settings in Tanzania using the Consolidated Framework for Implementation Research (CFIR).A qualitative study was conducted in the Geita Region from June to November 2024. Data were collected through Focus Group Discussions (FGDs) with pregnant and recently delivered women who participated in G-ANC. Key Informant Interviews (KIIs) included the healthcare providers (HCPs), facility leaders, and health managers. Using NVivo Version 14.0 software, we managed and analysed all interviews to explore facilitators and barriers to the implementation of G-ANC. Data were grouped and reported according to their relevance to the CFIR constructs. Implementation of G-ANC was shaped by interacting factors across all CFIR domains. Key facilitators included the perceived relative advantage of G-ANC over conventional ANC, adaptability of the model to local contexts, supportive facility leadership, effective teamwork, and peer support among women. Similarly, implementation processes such as proper scheduling of group sessions supported continuity of G-ANC services. In addition, the positive experiences of community health workers (CHWs), HCPs and pregnant women reinforced sustained implementation. Major barriers included inadequate space for meetings, workforce shortages, competing clinical demands, socioeconomic constraints and privacy concerns in group settings. Successful implementation of G-ANC in low-resource settings requires alignment between intervention design, health system capacity, and community context. Addressing multilevel barriers while strengthening identified facilitators is critical for the successful adoption of G-ANC and its integration into other maternal and newborn health services.