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Table 3 Barriers classified based on the socio-ecological model (SEM) and barrier category themes

From: Barriers, frameworks, and mitigating strategies influencing the dissemination and implementation of health promotion interventions in indigenous communities: a scoping review

Study (year)

Barriers (n = 100)

Socio-ecological model (SEM) level*

 

Barrier category**

Ind

Inter

Org

Comm

Soc/Pol

Social determinants of health in communities

Personnel challenges and high turnover

Funding

Lack of integration with cultural values

Limited retention and high attrition

Technology barriers

Distrust

Insufficient evaluation skills

Climate conditions

Barlow (2018) [16]

Socioeconomic, geographic, and structural challenges

X

  

X

X

X

 

X

     

X

Poverty, economic, and human resource challenges that strain home-visiting implementation

X

 

X

X

X

X

X

X

      

Lack of reliable vehicles to drive to homes and implement intervention

  

X

  

X

        

Complex issues of historical oppression and trauma that burden families

 

X

 

X

X

X

        

Homelessness as a serious challenge for clients and their “home visitors”

  

X

X

 

X

X

       

Black (2018) [17]

Insufficient broadband

  

X

       

X

   

Poorly maintained computers

  

X

       

X

   

Financial Instability

  

X

    

X

      

Loss of interest in the program and attrition

X

        

X

    

Jernigan (2020) [8]

None

              

Jernigan (2016) [20]

Inability to compare readiness scores across different stakeholder groups

  

X

  

X

  

X

     

Community members identifying themselves as members of multiple stakeholder groups

   

X

 

X

        

Changes in program leadership

  

X

   

X

       

Changes in funding support

  

X

    

X

      

Limited resources influencing readiness levels

  

X

X

  

X

       

Counil (2012) [13]

Isolation from food production and distribution centers

X

  

X

 

X

        

Communities isolated from each other

   

X

 

X

        

Extreme climate weather conditions

    

X

        

X

Cost of transportation

X

 

X

 

X

X

 

X

      

High price of imported goods

X

   

X

X

 

X

      

High costs of healthcare professionals and health promotion campaigns

  

X

   

X

X

      

High turnover of healthcare professionals, store managers, and volunteers

  

X

   

X

       

Risk of food insecurity in community

   

X

X

X

        

Clash of dietary cultures

    

X

   

X

     

Lack of language-sensitive and culturally sensitive dietary recommendations

    

X

   

X

     

Sedentary settlement due to school, trading posts, and other governmental incentives

X

  

X

X

X

        

Structural violence

    

X

X

        

Craig Rushing (2018) [12]

Infrastructure shortcomings (internet connection; mobile broadband use)

  

X

 

X

     

X

   

Low funding for the network of technical assistance

  

X

    

X

      

Lack of funding to host kick-off events to build community awareness

  

X

X

   

X

      

Lack of funding to secure approval from local tribal communities

  

X

X

   

X

      

Douglas (2013) [18]

Contextual barriers to knowledge use including individual health (comorbidities)

X

    

X

        

Lack of proper diagnosis within the healthcare system

  

X

  

X

        

Low funding levels at the level of the health system

  

X

X

X

X

 

X

      

Competing healthcare staff demands

  

X

   

X

       

Strain of acute care on health system

  

X

X

X

X

        

Access to care in remote areas

X

  

X

 

X

        

Childcare when in need of healthcare services

X

 

X

  

X

        

Negative healthcare experiences

X

    

X

X

       

Capacity of family to respond to healthcare stressors

 

X

   

X

X

    

X

  

Capacity of schools to respond to stress, variety of caregivers, and socioeconomic factors

  

X

  

X

X

X

   

X

  

Capacity of community to respond to stress, variety of caregivers, and socioeconomic factors

   

X

 

X

X

X

   

X

  

Lack of asthma awareness and low reading levels

X

  

X

 

X

        

Gates (2013) [19]

Challenges to improved dietary intakes and sustainability in the first year

  

X

X

 

X

        

Jiang (2013) [21]

Skepticism of grantee staff about the importance and success of evaluation

  

X

   

X

     

X

 

Staff had no experience in evaluating other rigorous programs

  

X

   

X

     

X

 

Challenge of participant retention

X

        

X

    

Scheduling difficulties

X

     

X

  

X

    

Participants moving away

X

        

X

    

Compromised attendance of participants due to stressful lifestyles

X

  

X

     

X

    

Challenge to sustain intervention effects for long periods of time

X

  

X

X

 

X

 

X

X

    

Kaufman (2018) [22]

Integration of new routines into settings often imbued with particular cultural expectations of care and service

  

X

X

 

X

  

X

     

Limited financial and material resources

  

X

X

  

X

X

      

Markham (2016) [10]

Frozen screens (4/6 programs)

X

 

X

       

X

   

Long loading time of activities

  

X

       

X

   

Trouble navigating programs

X

         

X

   

Technical and connectivity issues at sites

  

X

       

X

   

Martindale-Adams (2017) [23]

Staff concern about identification of caregivers in cases of loss of memory

 

X

X

  

X

X

       

Lack of awareness of public health nurses about patient memory concerns

  

X

   

X

       

Family members not identifying themselves as caregivers

 

X

   

X

        

Mokuau (2008) [24]

None

              

Moleta (2017) [25]

Short duration of staff training for the amount of material covered

  

X

   

X

       

Limited information on alternative and traditional medicine practices

  

X

   

X

       

Limited strategies to help uninsured clients

  

X

 

X

 

X

       

Nadin (2018) [26]

Limited funding for palliative care and community care services

  

X

 

X

  

X

      

Lack of service delivery funds

  

X

    

X

      

Lack of housing infrastructure and overcrowding

   

X

 

X

        

Difficulty in assessing system-level outcomes

    

X

X

        

Orians (2004) [15]

Limited experiences of tribes in providing and participating in federally funded health promotion and disease prevention programs

  

X

X

  

X

X

X

     

Limited resources for chronic disease care

  

X

X

X

X

X

X

      

Inadequate mammography services

  

X

X

X

X

        

Pei (2019) [28]

Lack of community awareness about fetal alcohol spectrum disorder

   

X

 

X

        

Stigma around the disease

   

X

X

   

X

     

Reluctance of women to admit using substances

X

          

X

  

Complex needs of clients served by Parent-Child Assistance Program

 

X

X

  

X

        

Rasmus (2019) [29]

None

              

Short (2014) [30]

Lack of integration of specific cultural and contextual variables of a given community

   

X

    

X

     

Timing of the intervention

X

 

X

X

     

X

    

Lack of integration of local customs and cultural values into program activities

  

X

X

    

X

     

Having no tribal police department and a secondary enforcement law

   

X

X

X

X

       

Shortage of police officers

   

X

X

 

X

       

High turnover in police chief positions

  

X

X

X

 

X

       

Large geographic distance between the community and the evaluation team

   

X

 

X

X

       

Limitations in evaluating community outcomes

   

X

        

X

 

Conflicts in scheduling community meetings

   

X

     

X

    

Walters (2020) [31]

None

              

Young (2017) [32]

Communication differences

X

 

X

X

    

X

     

Capacity/turn-over

  

X

   

X

       

Building trust over distance

   

X

       

X

  

Negative historical experiences with research

   

X

X

   

X

  

X

  

Local complexities

   

X

X

X

        

Multiple service providers

 

X

X

   

X

       

Timeline uncertainties

  

X

      

X

    
 

Total

22

6

49

41

26

38

29

18

11

9

7

6

3

2

  1. *Ind, individual; Inter, interpersonal; Org, organizational; Comm, community; Soc/Pol, society/policy
  2. **Level of SEM per Barrier Category: Social determinants of health in communities = Community/Society-Policy; Personnel Challenges & High Turnover = Organizational; Funding = Organizational; Lack of Integration with Cultural Values = Organizational/Community; Limited Retention and High Attrition = Intrapersonal/Organizational; Distrust = Intrapersonal/Interpersonal/Organizational; Technology Barriers = Organizational; Insufficient Evaluation Skills = Intrapersonal/Organizational; Climate Conditions = Intrapersonal/Organizational/Community/Society-Policy