Table 3 Themes of factors operating as barriers
Themes | Times cited | Reliability of findings |
|---|---|---|
Resources | 51 | Â |
 Lack of financial resources | 13 | High reliability |
 Lack of staff resources/high staff turnover | 11 | High reliability |
 Lack of time | 8 | High reliability |
 Insufficient space for all services | 5 | High reliability |
 Resources (unspecified) | 5 | High reliability |
 Lack of resources for training | 3 | High reliability |
 Lack of scientific resources | 3 | Medium reliability |
 Lack of technical resources | 3 | Medium reliability |
Client and community factors | 37 | Â |
 Recruitment/retention issues | 14 | High reliability |
 Client resistance and non-participation | 5 | High reliability |
 Difficult population | 5 | High reliability |
 Lack of community support/community resistance | 4 | High reliability |
 Client receptiveness and commitment | 3 | High reliability |
 Client (individuals and family) attendance is poor | 2 | High reliability |
 Community resources (including substance abuse treatment) are lacking | 2 | High reliability |
 Stigma | 1 | Low reliability |
 Anonymity issues | 1 | Low reliability |
Delivery capability | 33 | Â |
 Implementation difficulty/fidelity issues. | 9 | High reliability |
 Lack of expertise/experience | 7 | High reliability |
 Lack of administrative infrastructure | 3 | High reliability |
 Cultural/language barriers | 3 | High reliability |
 Competing responsibilities | 2 | Medium reliability |
 Supervision issues | 2 | Medium reliability |
 Programme needs | 2 | Medium reliability |
 Delivering the EBI in a rural area | 1 | Medium reliability |
 Scheduling challenges | 2 | Low reliability |
 Strategic planning | 1 | Low reliability |
 Balancing needs between of the CBO and research | 1 | Low reliability |
Organisational culture | 32 | Â |
 Conflict with EBI and organisational identify/mission/culture | 6 | High reliability |
 Staff resistance | 5 | High reliability |
 Lack of prioritisation of the EBI/org support | 3 | High reliability |
 Lack of preparation of staff to become evidence based providers | 3 | High reliability |
 Lack of leadership | 3 | Medium reliability |
 Incomplete buy-in from organisation | 2 | Medium reliability |
 Resistance to change (keeping status quo) | 2 | Medium reliability |
 Change in staff and leadership | 2 | Medium reliability |
 Lack of EBI champions | 1 | Medium reliability |
 Lack of belief in the efficacy of the intervention | 1 | Medium reliability |
 Unclear mission of the organisation | 1 | Medium reliability |
 Higher level of stress | 1 | Medium reliability |
 Low cohesion in the organisation | 1 | Medium reliability |
 EBP devaluing existing practices by the TSO | 1 | Low reliability |
Adaptation issues | 22 | Â |
 Problems in adapting the EBI | 13 | High reliability |
 Lack of fit between EBI and target population of TSO | 7 | High reliability |
 Conflict between the EBI and expert knowledge of the provider | 1 | Low reliability |
 Not knowing how to communicate adaptation issues | 1 | Low reliability |
Training capacity issues | 19 | Â |
 Staff not trained well enough/ Training provided for the EBI not adequate | 8 | High reliability |
 Lack of EBI training | 4 | High reliability |
 Variance in staff training and perspectives | 2 | Medium reliability |
 Lack of training available | 1 | Low reliability |
 Training new staff | 1 | Low reliability |
 Programmes were not packaged for training | 1 | Low reliability |
 Conducting community needs assessments | 1 | Low reliability |
 Proposal development | 1 | Low reliability |
Monitoring issues | 10 | Â |
 Not having monitoring practices in place to evidence effectiveness. | 4 | High reliability |
 Data management issues | 2 | Medium reliability |
 Interoperability challenges between systems | 1 | Medium reliability |
 Issues around evaluation and monitoring of implementation | 3 | Low reliability |
Intervention-specific barriers | 10 | Â |
 Transportation | 3 | High reliability |
 State education law in conflict with EBI | 1 | Low reliability |
 State law prohibits collection of certain data | 1 | Low reliability |
 State law requires approval by school board and parental review committee | 1 | Low reliability |
 Assessing light versus moderate activity | 1 | Low reliability |
 Incorporating physical activity into the participants’ lifestyle | 1 | Low reliability |
 Geographically dispersed offices made consistent implementation difficult | 1 | Low reliability |
 Logistical issues | 1 | Low reliability |
Commissioning requirements | 8 | Â |
 Certification process was burdensome/time consuming | 3 | High reliability |
 Lack of support by funder | 2 | Medium reliability |
 Prohibition on adaptation by funders. | 1 | Medium reliability |
 Funder demand for major modifications to EBI | 1 | Low reliability |
 Funder rejection of modifications to EBI | 1 | Low reliability |
Collaboration issues | 6 | Â |
 Hard to establish collaboration agreements | 2 | Medium reliability |
 Lack of strategies for community mobilisation | 1 | Low reliability |
 Lack of integration of services | 1 | Low reliability |
 Hard to find potential academic partners | 1 | Low reliability |
 Assistance in strategies for the development of EBIs | 1 | Low reliability |
Others | 3 | Â |
 Competition with other afterschool activities | 1 | Low reliability |
 Development and analysis of public policies | 1 | Low reliability |
 Inability to fund programme partners because of local agency policies | 1 | Low reliability |
Key for reliability ratings* | ||
 High reliability | The identified factor is consistently supported by several studies of medium quality and from one high-quality study, or the study is supported by at least two high-quality studies. | |
 Medium reliability | The identified factor is supported from several medium-quality studies, or the factor is identified from at least one high-quality study. | |
 Low reliability | The identified factor is supported by several studies of low quality and/or single studies of medium quality. | |