20.1: Facilitators and Barriers to Program Implementation
By the end of this section, you should be able to:
- Summarize common facilitators and barriers to program implementation.
- 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 |
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| Resource utilization |
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| Program implementers |
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| Community members and stakeholders role players |
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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