| Contextual factors | Contextual factors (14 studies):Sociocultural environment Natural disasters or seasonal trends Lack of financial resources Poor physical environment of the intervened setting (school) Parent and socioeconomic-related issues Social environment does not endorse healthy behaviours to prevent and control NCDs New responsibilities for participants as caregiver for parents/children Work schedule No money to pay transport Relocation Poverty
| Contextual factors (one study): |
| Health system | Health systems (17 studies):Low funding and poor organisation of the health system Poor infrastructure (periods without electricity) Limited access to physicians Limited health insurance Low evidence of based practices Poor follow-up of patients and lack of quality in medical records Absence of protocol for disease management Low contrareference of patients Poor integration of health workers in the intervention team Poor infrastructure in the health facility for conducted intervention Delay in receiving the results and the quality of the examinations Weak monitoring systems Need for context-adapted guidelines
Low availability of medicines (four studies)
Low availability of equipment’s and supplies (six studies) | Health system (seven studies):Strong primary healthcare structure for NCD and good funding Effective referral systems and availability of resources Network of healthcare centres Organisation between health services Good availability of resources
Good availability of drugs (two studies): |
| Human resources | Human resources (14 studies):Lack of health personnel and few health specialists Low availability of trained health professionals High workload of healthcare workers due to the intervention Staff turnover Poor training of health providers
| Health resources (two studies): |
| Attitude | Attitudes (five studies):
Poor involvement due to low-risk perception to get sick or to have severe disease (six studies)
Low trust in the project (three studies) | Buy-in from the health workers and other intervened groups (four studies):‘Health providers consider the integrated screening relevant’ Physician’s duties were delegated to the nurse and patients have become motivated to participate in the classes, ‘They developed a sense of belonging to the project…’
Community engagement or social support (10 studies):Support from neighbours Peer leaders value the emergence of emotional support Group and individual contacts provided opportunities for encouragement and attention to emotional and motivational issues ‘Improve the patients' self-esteem and to overcome internal stigma which in turn reduced social isolation’
Good attitude of the staff and good communication skills (four studies) |
| Policy and organisation factors | Policy factors (five studies):Deficiencies in the regulatory sector between legal norms and health policies Absence of a primary healthcare-level policy Policies without guidance or a proper implementation Change of local government Policies without local evidence and high turnover of decision makers
Poor coordination between stakeholders (five studies) | Political support or support from decision-makers (eight studies):Medicines were included in the list of essential drugs Health centres are supported by district health authorities and their development partners Political and technical stakeholders were very positive towards the programme
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| Others | Other specific barriers related to each project: | Positive impact in process evaluation outcomes (seven studies):Positive experiences of patients Patients accept the intervention The technological tool was acceptable to community and doctors Rigour in implementation and good reach Providers felt that they had observed changes in patient behaviour
Positive characteristics of some intervention components (six studies) |