This study identified behavioral and organizational barriers and facilitators related to the implementation of a clinic-based pediatric injury prevention program. Safe N' Sound (SNS), an evidence-based tailored injury prevention program designed for pediatric primary care, was implemented in five pediatric clinics in North Carolina. Office managers participated in structured interviews; health care providers participated in focus groups. Waiting room observations were conducted in participating clinics. Qualitative data captured perceptions of program implementation, including experience in integrating the program into clinical practice, usage by parents and providers, and recommendations for improving implementation. Reported facilitators of program use included usefulness and likeability of customized materials by parents and physicians and alignment with clinic priorities for injury prevention. Barriers included perceived staff burden despite the program's low staff requirements. Consequently, practices experienced difficulty integrating the program into the waiting room environment and within existing staff roles. Recommendations included formalizing staff roles in implementation. Waiting room observations supported greater technology maintenance and staff involvement. Findings suggest a dynamic relationship between program implementation and the adopting organization. In addition to considering characteristics of the intervention, environment, and personnel in intervention development, implementation may require customization to the organization's capacity.
Keywords: anticipatory guidance; barriers; dissemination; evidence-based; facilitators; implementation; injury prevention; pediatric counseling.