Barriers and Facilitators for the Implementation and Evaluation of Community-Based Interventions to Promote Physical Activity and Healthy Diet: A Mixed Methods Study in Argentina

Abstract

Background: Obesogenic environments promote sedentary behavior and high dietary energy intake. The objective of the study was to identify barriers and facilitators to the implementation and impact evaluation of projects oriented to promote physical activity and healthy diet at community level. We analyzed experiences of the projects implemented within the Healthy Municipalities and Communities Program (HMCP) in Argentina. Methods: A mixed methods approach included (1) in-depth semi-structured interviews, with 44 stakeholders; and (2) electronic survey completed by 206 individuals from 96 municipalities across the country. Results: The most important barriers included the lack of: adequate funding (43%); skilled personnel (42%); equipment and material resources (31%); technical support for data management and analysis (20%); training on project designs (12%); political support from local authorities (17%) and acceptance of the proposed intervention by the local community (9%). Facilitators included motivated local leaders, inter-sectorial participation and seizing local resources. Project evaluation was mostly based on process rather than outcome indicators. Conclusions: This study contributes to a better understanding of the difficulties in the implementation of community-based intervention projects. Findings may guide stakeholders on how to facilitate local initiatives. There is a need to improve project evaluation strategies by incorporating process, outcome and context specific indicators.

Evaluation of the Training and Pilot Implementation of Katatagan Kontra Droga sa Komunidad

“…The lack of integration with the overall health system was also cited in a study on community-based interventions in China (Long et al, 2018). At the same time, enablers such as motivated local leaders and intersectoral participation are similarly cited in other studies (Belizen et al, 2019). However, what appears to be unique in the case of CBDR in the Philippines is the emergence of safety and security issues which may be a function of the generally punitive approach to drug use in the country.…”

“…In terms of barriers and drivers to the implementation, results reveal a number of factors that are similar to those found in other developing countries. Challenges such as the lack of funding, lack of skilled personnel, heavy workload, inadequate equipment and resources, lack of technical support, and lack of support from local authorities have also been cited in studies in other countries (Belizen et al, 2019;Long et al, 2018). The lack of integration with the overall health system was also cited in a study on community-based interventions in China (Long et al, 2018).…”

“…Beyond the nature of treatment and facilitation, a study reports a number of barriers and drivers in the implementation of communitybased interventions. Inadequate funds, resources and equipment, a lack of skilled personnel, technical support, support from local authorities, and non-acceptance by the community are common barriers to implementation (Belizen et al, 2019). However, these barriers are also mitigated by enablers such as motivated local leaders, intersectoral participation, and the use of local resources (Belizen et al, 2019).…”

Federal and State Cooperation Necessary but Not Sufficient for Effective Regional Mental Health Systems: Insights From Systems Modelling and Simulation

“…Studies have highlighted the importance of political support from local authorities and acceptance of proposed interventions by the local community for successful implementation of public health programs. 25,26 Securing the required leadership and support for effective, coordinated implementation of best performing interventions identi ed by systems modelling requires representatives from across the regional mental health and social systems and broader community to come together to debate, weigh up the trade-offs, and prioritise the key mental health outcomes to be addressed. Regardless of whether proposed reforms are implemented in the region, the participatory systems modelling approach will be essential for coordinating regional investments in mental health system strengthening and suicide prevention, for reducing fragmentation, and creating the integrated decision analytic, monitoring and evaluation ecosystem essential to the transparency and accountability required for more effective mental health outcomes both regionally and nationally.…”

Process Evaluation of Maternal, Child Health and Nutrition Improvement Project (MCHNP) in the Eastern Region of Ghana: A Case Study of Selected Districts

“…The rest of the barriers identified were poor community participation and apathy on the part of the District Health Directorate to support CHPS-based activities when MCHNP funds were depleted. Similarly, Belizan and colleagues in their study to identify the barriers and facilitators for the “Implementation and Evaluation of Community-Based Interventions” found that adequate funding, skilled personnel, equipment, and material resources; technical support for data management and analysis; training on project designs; political support from local; and acceptance of the proposed intervention by the local community were the main barriers to the project [ 14 ]. Haver et al [ 15 ] also noted that staff inadequacy and mix, poor community engagements, and lack of motivation mitigate against smooth maternal and newborn service delivery.…”