Abstract
Objective: To identify facilitating and hindering factors for implementing a care transition
strategy for adult patients undergoing elective colorectal cancer surgery, within a primary
health care (PHC) context, addressing gaps in the literature on implementation challenges
and contextual factors influencing such strategies. Methods: This complex mixed methods
study combined a randomized clinical trial (RCT) and a qualitative component within an
Implementation Research framework. The RCT enrolled adult patients with colorectal cancer,
while the qualitative phase included a multilevel sample of participants. Iterative data
integration occurred throughout the planning, implementation, and evaluation phases. The
intervention was assessed using the RE-AIM (Reach, Efficacy, Adoption, Implementation,
Maintenance) framework. Statistical analyses were conducted using IBM SPSS Statistics
22.0, applying descriptive and inferential methods. Results: Our findings revealed that the
adoption of the intervention was satisfactory; however, Reach, Efficacy, and Implementation
were not achieved. Facilitating factors included recognition of the potential of the care
transition strategy to improve patient outcomes, and the intervention’s feasibility, replicability,
and low cost. The main hindering factors identified included poor communication
between care levels, inadequate material resources, and high workload. Integration of
qualitative insights helped explain the limited quantitative impact, highlighting contextual
challenges during the COVID-19 pandemic. Conclusions: The care transition strategy
was well accepted by participants and health care providers, demonstrating potential to
strengthen continuity of care between hospital and PHC services. Nonetheless, significant
organizational and resource-related barriers hindered its effectiveness. Future studies are
required to adapt transitional care models to overcome communication gaps, optimize
resource allocation, and enhance implementation in similar settings.