Barriers and facilitators on the implementation of physical activity in Primary Health Care: A systematic review

Manta, Sofia Wolker; Sandreschi, Paula Fabrício; Santos, Marina; Konrad, Lisandra Maria; Tassitano, Rafael Miranda; Benedetti, Tânia Rosane Bertoldo

doi:10.1016/j.pmedr.2022.101875

Cited by 3 publications

(2 citation statements)

References 56 publications

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“…This resulted in a detailed overview, displaying that the majority of the identified determinants can act both as barriers and facilitators: a factor was a facilitator if it was present; its absence was considered a barrier. This has been acknowledged in other studies as well ( 58 , 62 ), and could be due to the varying contexts where the implementation took place. Furthermore, we noticed that some constructs were only identified in the included studies and not in the CMs, while some constructs were identified more often in the CMs than in the included studies.…”

Section: Discussionmentioning

confidence: 68%

“…This construct is categorized under the CFIR construct “readiness for implementation”, suggesting that when these aspects are taken care of, the readiness of an organization to implement a given intervention will increase ( 18 ). Other research has highlighted the importance of handling “available resources” during the implementation of evidence-based interventions, within the scope of fall prevention or other contexts, as well ( 19 , 58 – 60 ). Finally, taking into account the wishes and needs of the patients appears to be of significant importance, such as practical issues (costs, transportation, location) and the usage of fall prevention-related language when reaching and interacting with older adults.…”

Section: Discussionmentioning

confidence: 99%

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Contextual determinants influencing the implementation of fall prevention in the community: a scoping review

Scherpenseel

Velde

Veenhof

et al. 2023

Front. Health Serv.

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BackgroundSuccessful implementation of multifactorial fall prevention interventions (FPIs) is essential to reduce increasing fall rates in community-dwelling older adults. However, implementation often fails due to the complex context of the community involving multiple stakeholders within and across settings, sectors, and organizations. As there is a need for a better understanding of the occurring context-related challenges, the current scoping review purposes to identify what contextual determinants (i.e., barriers and facilitators) influence the implementation of FPIs in the community.MethodsA scoping review was performed using the Arksey and O'Malley framework. First, electronic databases (Pubmed, CINAHL, SPORTDiscus, PsycINFO) were searched. Studies that identified contextual determinants that influence the implementation of FPIs in the community were included. Second, to both validate the findings from the literature and identify complementary determinants, health and social care professionals were consulted during consensus meetings (CMs) in four districts in the region of Utrecht, the Netherlands. Data were analyzed following a directed qualitative content analysis approach, according to the 39 constructs of the Consolidated Framework for Implementation Research.ResultsFourteen relevant studies were included and 35 health and social care professionals (such as general practitioners, practice nurses, and physical therapists) were consulted during four CMs. Directed qualitative content analysis of the included studies yielded determinants within 35 unique constructs operating as barriers and/or facilitators. The majority of the constructs (n = 21) were identified in both the studies and CMs, such as “networks and communications”, “formally appointed internal implementation leaders”, “available resources” and “patient needs and resources”. The other constructs (n = 14) were identified only in the .DiscussionFindings in this review show that a wide array of contextual determinants are essential in achieving successful implementation of FPIs in the community. However, some determinants are considered important to address, regardless of the context where the implementation occurs. Such as accounting for time constraints and financial limitations, and considering the needs of older adults. Also, broad cross-sector collaboration and coordination are required in multifactorial FPIs. Additional context analysis is always an essential part of implementation efforts, as contexts may differ greatly, requiring a locally tailored approach.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Contextual determinants influencing the implementation of fall prevention in the community: a scoping review

Scherpenseel

Velde

Veenhof

et al. 2023

Front. Health Serv.

View full text Add to dashboard Cite

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Common barriers and enablers to the use of non-drug interventions for managing common chronic conditions in primary care: an overview of reviews

Greenwood,

Davidson,

Thomas

et al. 2024

BMC Prim. Care

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Background Non-drug interventions are recommended for chronic condition prevention and management yet are underused in clinical practice. Understanding barriers and enablers to using non-drug interventions may help implement non-drug interventions in primary care. We aimed to conduct an overview of reviews to identify and summarise common barriers and enablers for using non-drug interventions for common chronic conditions in primary care. Methods We included qualitative and quantitative reviews that used systematic process or methods to examine barriers and enablers to using non-drug interventions for chronic condition prevention and management in primary care settings. We searched 5 electronic databases (PubMed, Cochrane Database of Systematic Reviews, EMBASE, PsycInfo and CINAHL) from inception to September 2022. Two authors independently screened reviews. One author extracted and deductively coded data to Consolidated Framework of Implementation Research (CFIR) (and where relevant, Theoretical Domains Framework [TDF]). A second author validated 10% of extracted data and coding. Data was synthesised thematically using CFIR and TDF. One author assessed the methodological quality of included reviews using a modified AMSTAR 2 tool, with 10% validated by a second author. We assessed overlap between primary studies in included reviews. Results From 5324 records, we included 25 reviews, with data predominately from patients. Overall, 130 subthemes (71 barrier and 59 enabler) were identified across 4 CFIR domains (Innovation, Outer Setting, Inner Setting, and Individuals), and all TDF domains. Common barrier and enabler subthemes were identified for CFIR constructs of Innovation Adaptability, Innovation Cost, Innovation Relative Advantage, Local Attitudes, External Pressure, Local Conditions, Relational Connections, Available Resources, and Access to Knowledge and Information. For TDF domains, important barrier and enabler subthemes were identified for Knowledge, Skills, Environmental Context and Resources, Beliefs about Consequences, Reinforcement, and Emotion. Conclusions We synthesised reviews to provide new insight into common barriers and enablers for using non-drug interventions to prevent and manage chronic conditions in primary care. The factors identified can inform the development of generalisable implementation interventions to enhance uptake of multiple non-drug interventions simultaneously. Trial Registration This study was registered in PROSPERO (CRD42022357583).

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Implementation determinants of physical activity interventions in primary health care settings using the TICD framework: a systematic review

Silva,

Godinho,

Encantado

et al. 2023

BMC Health Serv Res

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Background Translation into practice of effective physical activity interventions in primary care is difficult, due to a complex interaction of implementation determinants. We aimed to identify implementation barriers and facilitators of four primary care interventions: physical activity assessment, counselling, prescription, and referral. Methods A systematic review of qualitative, quantitative and mixed-methods studies published since 2016 was conducted. The “Tailored Implementation for Chronic Diseases” (TICD) framework was adapted to extract and synthesize barriers and facilitators. Results Sixty-two studies met the inclusion criteria. Barriers (n = 56) and facilitators (n = 55) were identified across seven domains, related to characteristics of the intervention, individual factors of the implementers and receivers, organizational factors, and political and social determinants. The five most frequently reported determinants were: professionals’ knowledge and skills; intervention feasibility/compatibility with primary health care routine; interventions’ cost and financial incentives; tools and materials; and professionals’ cognitions and attitudes. “Social, political and legal factors” domain was the least reported. Physical activity counselling, prescription, and referral were influenced by determinants belonging to all the seven domains. Conclusion The implementation of physical activity interventions in primary care is influenced by a broader range of determinants. Barriers and facilitators related with health professionals, intervention characteristics, and available resources were the most frequently reported. A deep understanding of the local context, with particularly emphasis on these determinants, should be considered when preparing an intervention implementation, in order to contribute for designing tailored implementation strategies and optimize the interventions’ effectiveness.

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Barriers and facilitators on the implementation of physical activity in Primary Health Care: A systematic review

Cited by 3 publications

References 56 publications

Contextual determinants influencing the implementation of fall prevention in the community: a scoping review

Contextual determinants influencing the implementation of fall prevention in the community: a scoping review

Common barriers and enablers to the use of non-drug interventions for managing common chronic conditions in primary care: an overview of reviews

Implementation determinants of physical activity interventions in primary health care settings using the TICD framework: a systematic review

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