Identify potential barriers

Think about the potential barriers that may be encountered along the way and prepare your reaction to these barriers.

Some barriers to implementing your tobacco intervention you may encounter include:

  • cost – develop a budget and estimate costs of creating the supportive relationships intervention and maintaining it over time. Challenges may also be faced regarding the lack of funding or other types of support from institutions, organizations or communities.;
  • resources and personnel – whether your partnership has the needed personnel and resources identified above. Substantial amount of personnel time is required for all phases of these types of interventions, including:
    • Planning and preparation phases – how to get access to participants, how to build supportive interactions into participants’ everyday lives and how to address participants’ readiness to change their lifestyle behaviors.
    • Implementation and evaluation phases – how to keep participants active in the intervention and how to track participants and their tobacco use behaviors over time.
    • Maintenance phases – how to keep participants from relapsing (or discontinuing tobacco prevention cessation behaviors) and how to allocate resources to sustaining the intervention activities over time;
  • accessibility – ensure that most, if not all, individuals from the population will be exposed to the intervention strategies at one time or another;
  • availability – ensure that people have access to smoke-free establishments, or that opportunities for tobacco cessation are available to most, if not all, individuals from the population;
  • support - for children and families, parents and spouses have a strong influence on individuals’ tobacco use behaviors (e.g., role modeling, purchases, recreation and entertainment preferences). Parents’ tobacco behaviors often influence their children’s responses to interventions.
  • cultural competency - people from racial or ethnic groups may understand and learn from information and resources that reflect their own culture. Language barriers or literacy may limit the reach of intervention materials. The types of support and the giver of that support that are appropriate may vary by culture.
  • susceptibility - many people are unaware that they are at risk for diseases related to tobacco use or that they already have these diseases, so it may be difficult to encourage them to change their behaviors;
  • social, economic, and environmental factors - these can have a strong influence on the intervention (e.g., poverty, chronic unemployment, access to smoke-free businesses, access to medical care) Other priorities also may get in the way of making lifestyle changes (e.g., stress, illness, family, or relationship problems).

While all interventions will encounter unique barriers, you can learn from others’ experiences. Barriers that have been encountered in other supportive relationship interventions and steps to prepare for these barriers are summarized below:

  • Some programs have found that the recruitment strategies and materials they developed needed to be modified to suit the needs of the particular individuals or families they were working with in terms of culture, language, reading level, or other characteristics.
  • Some have also found that while support has increased, their efforts have been unsuccessful because of an absence of policies, environments, promotions, or programs supporting healthy behaviors.
  • Transportation may not be available to participants to activities.
  • It is also important to consider that families have multiple responsibilities and stressors that inhibit their ability to take part in activities. Interventions may need to consider parental work schedules, religious holidays, and other commitments in developing their schedule of activities. Therefore, it may be helpful to incorporate intervention activities into existing family patterns and schedules and provide programs that meet the needs of individuals of multiple ages. This may mean having the support interventions at worksites, schools, or in community settings where participants may naturally gather.
  • It is also helpful to remember that simply providing information to participants may not translate into utilization of the materials. It may be necessary to clearly explain how these materials may be helpful and to describe specifically how to use them. Opportunities for dialogue and ongoing encouragement are strengths of supportive relationships interventions.
  • In providing telephone support, staff may not be comfortable in making supportive phone calls to participants’ homes. Training may be helpful in providing staff with reinforcements or strategies to overcome their discomfort.
  • In some groups or communities, there may be social barriers to tobacco prevention. Supportive interventions work with community members and organizations to develop strategies to encourage support for lifestyle behavior changes. 
  • In faith-based organizations, pastors may not want to be involved in certain aspects of the intervention or believe that it is inappropriate to share health messages across the pulpit.
  • Another barrier is that in many small communities, worksites, or faith-based settings, it may be difficult to maintain confidentiality, particularly in smaller congregations or rural communities that may have fairly dense social networks. In rural communities, it may be difficult for people outside the community to be effective in delivering interventions.
  • It is difficult to determine which individuals may respond better to different types of supportive relationships intervention strategies (e.g., physician counseling, buddy systems, faith-based organization events).
  • Although health care providers generally believe in the importance of counseling, patients or clients may not get all the support they need in the limited time they may spend with the health care provider. In addition to having limited time during an office visit, health care providers may not have training in behavior change strategies. 
  • Physician perceptions that many patients do not follow their recommendations may limit their desire to engage in supportive interventions. They may also feel constrained from providing this type of support because of inadequate reimbursement for counseling. It may be helpful to expand the provision of this type of formal support to others in the medical care system (e.g., nurses, occupational therapists). 
  • Because many of the challenges to implementing a supportive relationship intervention are relatively minor, communities, schools, worksites, faith-based organizations, families, and others can be easily encouraged to engage in this type of intervention despite their level of readiness.
  • It is not too difficult to incorporate these interventions into existing infrastructure for health education in communities, schools, worksites and other venues.
  • Environments, including facilities and equipment, and materials are not too expensive, reasonably easy to create, and require little maintenance.

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