Table 1.

Barriers and Facilitators to HIV Prevention and Behavioral Health Services Among Latino Sexual Minority Men and Corresponding Implementation Strategies

CFIR domain and subdomain	Barrier/facilitator	Implementation strategies
1. Intervention characteristics
1.A. Complexity	Burdensomeness vs. simplicity of engaging Too burdensome or time-consuming Easier to engage if convenient, simple Need problem solving skills to access	Routinize services
		Streamline administrative processes
		Reduce number of visits/time to access services
		Offer evening/weekend services
		Offer patient navigation/problem solving
	Financial access and insurance Insurance status and income impact access Free/affordable services easier to access Insurance and reduced cost programs are complex	Reduce consumer costs
		Make services free/affordable
		Reduce the complexity of insurance coverage or reduced cost programs
1.B. Relative advantage	Pros and cons of service use vs. nonuse Perceiving services as helpful or effective Concerns about negative consequences resulting from services (e.g., breach of confidentiality, negative health effects)	Emphasize direct benefits of receiving services
		Emphasize and ensure confidentiality and safety of services
2. Outer setting
2.A. External policy and incentives	Degree of political will or policy support for services Sociopolitical and policy issues affecting service access for LSMM	Create policy and legal changes to enhance access
		Increase funding for services
		Offer LSMM incentives for engaging
2.B. Patient needs and resources	Syndemic problems affecting service use Access to reliable transportation Education Immigration status and competing demands Mental health/substance use	Address transportation issues
		Be clear about eligibility for services
		Reduce complexity/burdensomeness of services
2.C. Peer pressure	Degree to which service use is stigmatized for LSMM HIV, PrEP, mental health, and sexual orientation stigma among peers and family Concealing service use and fears of being outed	Normalize and destigmatize LSMM using services through fun, positive, and destigmatizing outreach and messaging
		Increase destigmatizing public information and stories about LSMM using services
	Self-affirmation vs. self-stigma Internalized stigma vs. affirmation about sexual orientation, gender, mental health	Use destigmatizing outreach methods and normalize service use for LSMM
	Services are normalized Peers are knowledgeable, have positive attitudes, and use services themselves Having a peer assist in obtaining services	Show examples of LSMM peers using services
		Hire staff who represent the LSMM community
	Connectedness to LSMM communities and spaces Being connected to the broader LSMM community Altruistic views toward LSMM community	Conduct outreach through LSMM community events and spaces
		Outreach and public health messaging should appeal to LSMM's community altruism
3. Inner setting
3.A. Access to knowledge and information	Provider knowledge about services and interventions How to deliver services or where to refer	Provide education and training to providers/organizations
	LSMM knowledge about HIV, behavioral health, and services Where and how to get services Knowledge about service options	Provide clear, accurate outreach and public health messaging about services
		Ensure messaging is pervasive throughout community and public spaces
		Outreach using social/sexual networking sites/apps
3.B. Culture	Identity-based affirmation and fit Feeling affirmed and safe vs. stigmatized or judged by provider Cultural relevance of outreach and services	Culturally relevant outreach and services (e.g., cultural references, language)
		Create an LGBTQ-affirming, nonjudgmental organization and make this stance clear via outreach and public information about the organization
	Trust, connection, and personalism Overly clinical, medical, risk-focused Preference for warmth, trust, personalism	Train on personalism and “customer service” skills to engage LSMM
3.C. Relative priority	Prioritization of patient needs Provider thoroughness (vs. dismissiveness) Providers initiate discussion about HIV and BH	Train providers on thorough clinical assessments and initiating conversation about HIV prevention and behavioral health services
3.D. Available resources	Organizational resources Degree to which services exist, are not overburdened, and are physically well maintained in a community	Increase funding in “service deserts”
4. Characteristics of individuals
4.A. Individual stage of change	Readiness for change LSMM vary along the readiness for change continuum, with those in the precontemplative stage least engaged	Outreach to LSMM who are engaged in other medical services
		Increase motivation to engage in services (e.g., motivational interviewing)

BH, behavioral health; CFIR, consolidated framework for implementation research; LGBTQ, lesbian, gay, bisexual, transgender, queer; LSMM, Latino sexual minority men; PrEP, preexposure prophylaxis.