Table 2 Identified barriers and facilitators to interventions targeting youth across the five domains of Nilsen, 2015’s Determinant Framework [17]
Barriers | Facilitators |
|---|---|
1. Characteristics of the implementation object | 1. Characteristics of the implementation object |
1.1Â Barriers to intervention acceptability among youth -Incompatibility of intervention content with the needs of youth [33, 43] -Long duration of the intervention [33, 35] -Complexity of the intervention [35] | 1.1 Facilitators to intervention acceptability among youth -Compatibility of intervention content with the needs of youth [35,36,37] |
1.2Â Barriers to intervention acceptability among community members -Incompatibility of intervention content with the needs of community members [44] | 1.2 Facilitators to intervention acceptability among implementers -Relative advantage of the intervention [32] Total facilitators: 2 |
1.3 Barriers to youth’s participation in the intervention -Age requirements that excluded other youth [33] -Restricted days and times of the intervention [34] |  |
1.4Â Barriers to risky sexual behavior reduction among youth -Limited intervention content (e.g., intervention content addresses individual factors such as knowledge without addressing structural factors such as poverty, unemployment) [32, 44] Total barriers: 7 | Â |
2. Characteristics of the users/adopters | 2. Characteristics of the users/adopters |
2.1Â Barriers to intervention acceptability among youth -Adult/old implementers [37] | 2.1 Facilitators to intervention acceptability among youth -Approachability/friendliness implementers [33, 37] -Experience of implementers [37] |
2.2 Other barriers to intervention success -Implementers’ lack of knowledge related to intervention content [44] -Poor education or training of implementers [44] -Implementers’ lack of exemplary or positive behavior [44] Total barriers: 4 | 2.2 Other facilitators to intervention success -Training of implementers [32] -Implementers’ knowledge related to intervention content [44] Total facilitators: 4 |
3. Characteristics of the end users | 3. Characteristics of the end users |
3.1 Barriers to risky sexual behavior reduction among youth -Low perceptions of risk of sexually transmitted infections including HIV [33, 38, 42,43,44] -Fear of relationship breakdown [33, 38, 42, 43] -Desire for pregnancy/children [42, 43] -Being stubborn/hard hardheaded [42, 43] -Belief that one is incapable of change [42, 44] -Negative attitudes towards condom use [32, 44] -Poor decision-making skills [44] -Lack of self-confidence [42] -Concern for privacy [33] -Fear of side effects of contraceptives [44] -Having high sensation seeking [41] -Being under the influence of alcohol/drugs [42] -Being reliant on avoidance strategies [42] -Being unprepared [42] -Preferring not to adopt an HIV prevention method (e.g., condoms use) [43] -Limited sexual health knowledge [44] -Negative experiences associated with using contraceptives [43] -Desire to meet basic material needs [44] | 3.1 Facilitators to risky sexual behavior reduction among youth -Fear of pregnancy/sexually transmitted infections including HIV [32, 37, 43] -Having strong ambitions/being future oriented [39, 44] -Being knowledgeable [42] -Having good problem-solving skills [42] -Having high self-confidence [42] -Intentions/readiness to change [36] -Negative experiences in a relationship [39] -Being self-reliant [39] -Having high self-motivation [39] -Having high self-respect [42] -Having high sense of responsibility [42] -Low socio-economic status (e.g., lack of money to pay for sex) [44] |
3.2 Barriers to youth’s participation in the intervention -Fear of stigma [44] | 3.2 Facilitators to youth’s participation in the intervention -Perceived benefits of the intervention [37] Total facilitators: 13 |
3.3 Other barriers to intervention success -Being stubborn/hardheaded/uncooperative [44] -Having limited knowledge (e.g., about the intervention [44] -Low literacy [44] Total barriers: 23 | Â |
4. Characteristics of the context | 4. Characteristics of the context |
4.1 Interpersonal | 4.1 Interpersonal |
4.1.1 Barriers to risky sexual behavior reduction among youth -Partner’s refusal to use an HIV prevention method (e.g., condom use, HIV testing [32, 33, 38, 39, 42] -Lack of financial support from the family [38, 39, 43] -Lack of child-parent communication on sexual issues [36, 38] -Relationship issues (e.g., current boyfriend and unstable relationships) [41, 42] -Parent’s refusal of an HIV prevention method (e.g., HIV testing [32] -Partner’s negative attitudes towards condom use [38] -Poor role models [38] -Lack of restrictive parenting [38] -Partner suspect fidelity if the other partner request protected sex [42) -Partner’s desire for pregnancy [42] -Partner is under the influence of drugs [42] -Partner’s preferences not to adopt an HIV prevention method (e.g., condom use) [39] | 4.1.1 Facilitators to risky sexual behavior reduction among youth -Partner’s consent to use an HIV prevention method (e.g., condom use [42, 43] -Restrictive parenting [38, 44] -Positive peer influence [38] -Teacher advice [38] -Parental advice [39] -Stable relationships [42] -Partner does not suspect fidelity if the other partner request protected sex [42] -Family/parental religious beliefs (e.g., raised in a family with religious beliefs against engaging in risky sexual behavior) [44] |
4.1.2 Other barriers to intervention success -Lack of support for critical thinking among youth [44] | Â |
4.2 Community | 4.2 Community |
4.2.1 Barriers to risky sexual behavior reduction among youth -Gender-biased norms [36, 38, 39, 43, 44] -Myths about contraceptives [32, 44] -Norms discouraging discussion of sexual issues between parents and children [32, 44] -Limited resources/services in the community (e.g. programs for youth, condoms) [32, 33] -Cultural beliefs [44] | 4.2.1 Facilitators to risky sexual behavior reduction among youth -Norms encouraging healthy sexual behavior (e.g., abstinence and delaying of sexual debut) [44] -Religious beliefs discouraging risky sexual behavior [38] |
4.2.2 Barriers to youth’s participation in the intervention -Violence in the community/neighborhood [34] -Incarceration [34] |  |
4.3 Organizational or institutional | 4.3 Organizational or institutional |
4.3.1 Barriers to risky sexual behavior reduction among youth -Limited resources (e.g., condoms, human resources) [44] -Inaccessibility of services (e.g., condoms, healthcare facilities) [44] -Poor quality of services (e.g., lack of confidentiality) [44] | 4.3.1 Facilitators to intervention acceptability among youth -Accessibility and friendliness of the intervention venue [33] Total facilitators: 12 |
4.3.2 Barriers to youth’s participation in the intervention |  |
4.3.3 Other barriers to intervention success -Limited resources (e.g., financial and human resources) [44] -Restrictions on depicting of condoms in schools [44] -Poor quality of services (e.g. lack of confidentiality, inappropriate clinical advice) [44] -Inaccessibility of services (e.g., healthcare facilities [44] | Â |
4.4 Structural | Â |
4.4.1 Barriers to risky sexual behavior reduction among youth -Poverty [32] -Unemployment [32] -Limited economic opportunities [44] -Women’s subordinate status [44] -Cost of services (e.g. secondary education) [39] -Inaccessibility of services (e.g. schools) [39] -Gender-based violence [39] |  |
4.4.2 Other barriers to intervention success -Poverty [44] -Limited demand for services (e.g., condoms) [44] -Cost of services (e.g., condoms) [44] Total barriers: 42 | Â |
5. Characteristics of the strategy of facilitating implementation | 5. Characteristics of the strategy of facilitating implementation |
5.1 Barriers to intervention acceptability among youth -Use of non-participatory facilitating methods [32] | 5.1 Facilitators to intervention acceptability among youth -Use of same sex youth group [36, 37] -Use of different or mixed facilitating methods [35] -Implementation of intervention with fidelity [37] |
5.2 Other barriers to intervention success -Failure to implement the intervention with fidelity [44] -Use of non-participatory facilitating methods [44] -Use of corporal punishment [44] -Sexual abuse [44] Total barriers: 5 | 5.2 Facilitators to youth’s participation in interventions -Mobilization of community members to influence youth to attend the intervention [32] -Integration of intervention with other services [32] -Provision of detailed intervention information to parents [32] -Using outreach activities [32] -Building of a trusting relationship with young people [32] -Use of same age or peer implementers [32] -Provision of incentives [32] |
| Â | 5.3 Other facilitators to intervention success -Dissemination of intervention information to community members [32, 36, 37] -Implementation of intervention with fidelity [40, 44] -Use of participatory facilitating methods [44] -Decreased corporal punishment [44] -Collaboration among different stakeholders in delivering the intervention [32] Total facilitators: 15 |
Grand total barriers: 81 | Grand total facilitators: 46 |