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Population Health for Nurses

20.1 Facilitators and Barriers to Program Implementation

Population Health for Nurses20.1 Facilitators and Barriers to Program Implementation

Learning Outcomes

By the end of this section, you should be able to:

  • 20.1.1 Summarize common facilitators and barriers to program implementation.
  • 20.1.2 Discuss strategies for identifying facilitators and barriers for a specific intervention.

Even the most well-developed, evidence-based community health programs encounter barriers to implementation that the program team should consider throughout the program planning and implementation processes. The nurse, as part of the program team, strategizes to decrease or eliminate potential barriers, when possible, and enhance facilitators of program implementation. A facilitator is a person or thing that makes the implementation of program interventions and activities easier. The program team identifies barriers and facilitators based on community needs assessment, previous literature and research, and previous experience with the target population, community, and similar programs (Fernandez et al., 2022). The program team should choose strategies to decrease barriers based on their impact on the program’s effectiveness and the strategy’s potential to decrease the barrier (Fernandez et al., 2022). For example, offering bus fare reimbursement to reduce transportation barriers should result in increased recruitment and retention of participants. The program team continues to assess for barriers during implementation and revises intervention strategies to reduce them.

Table 20.1 provides an overview of facilitators and barriers related to intervention planning and implementation, resource utilization, program implementers, and community partners found in two literature reviews (Cooper et al., 2021; Mathieson et al., 2019). The program team considers each to design strategies to enhance the likelihood of the program’s success.

Facilitators and Barriers of Program Implementation
Facilitators Barriers
Intervention planning and implementation
  • Flexible, adaptable interventions
  • Alignment of intervention with regular organization functions
  • Timely and relevant
  • Geographical accessibility
  • Previous evidence that program intervention improves participant outcomes
  • Interventions standardized, not tailored to context or population
  • Lack of evidence to support interventions
  • Use of complex interventions
  • Underestimation of coordination effort and needs
  • Lack of planning for participant recruitment and retention
Resource utilization
  • Use of existing resources
  • Return on investment
  • Cost and time effective
  • Poor availability of resources, including finances, facilities, equipment and materials, and volunteers
Program implementers
  • Clear understanding and allocation of roles
  • Strong commitment to the program
  • Skilled and trained in program topic and program implementation
  • Established relationships with the target population
  • Sense of reward
  • Competing priorities
  • Conflict of interest
  • Ineffective delivery of intervention
  • High workload
  • Inefficient knowledge, training, and skill related to program topic or implementation
  • Complexity of intervention and evaluation
Community members and stakeholders role players
  • Support and commitment from leaders
  • Role player engagement
  • Target population involved in planning
  • Use of champions from the target population
  • Effective communication among the program team, partners, and role players
  • Sense of reward with participation
  • Competing priorities
  • Conflict of interest
  • Lack of buy-in or interest
  • Low value placed on program goals
  • Ineffective communication
  • Little to no involvement in program planning, participation, or implementation
Table 20.1 Facilitators and Barriers of Program Implementation (See Cooper et al., 2021; Mathieson et al., 2019.)

The program team should be aware that facilitators and barriers to program implementation can vary and may depend on the collaborating partners, available resources, current political and social issues, geographical location, time, and participants’ values. For example, a program to increase physical activity may be more successful if delivered in the summer instead of during snowy winter months. Cooper et al. (2021) provide the following general recommendations to enhance facilitators and reduce barriers to implementation:

  • Ensure community-level coordination and communication to improve the use of existing resources and avoid duplication of services
  • Enlist local support of the program to improve community engagement
  • Focus on the reliability of program strategies
  • Develop standardized but flexible, simple, and regularly evaluated and revised program strategies
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