Why the Voucher Was Not Enough: What HASA Learned About Implementation

When a trial produces a null result, the next question is not simply whether the intervention “failed.” The delivery system may reveal barriers the added component never addressed. Ninety-three percent of responding nurses reported connectivity challenges, 73% reported heavy workload increase and only 37% considered training and field support adequate; participant barriers included lost codes, retailer-system problems, stockouts, competing obligations, delayed messages and inadequate explanation. The findings show that digital access is a workflow involving staff, phones, networks, retailers, inventory, time and understanding.