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 |