Table 2.

Barriers to and facilitators of intervention implementation concerning the level of intervention delivery.

Level of Intervention Delivery	Barrier		Facilitator
Micro-level	6	Lack of health literacy in society is recognised as a determinant of health [15,16]	12	Targeted strategy to increase awareness, treatment, and control in individuals [17] healthcare professionals’ awareness of challenges, patients gaining greater awareness [15,16]
	8	Unclear professional boundaries, low compensation level, insufficient knowledge and capabilities [18]	11	Optimising the prevention, recognition, and care of hypertension requires a paradigm shift to team-based care [17]
	8	Disregarding patient’s preferences for different health outcomes [19]	7	Meaningful patient involvement [20] patient self-management, patient-centered approach [5,9]
	5	Community perception—lack of awareness of diabetes risk factors [21]	6	Patient’s Health Information Seeking Behaviours—increase empowerment/focus on control, and satisfaction [22]
	8	Competences, motivation, and workload professionals [23]	1	Reduction of unhealthy behaviours and risk factors such as tobacco use and obesity [24,25]
	1	Unhealthy behaviours and risk factors such as tobacco use and obesity [24,25]	11	Engaging patients and stakeholders around multiple chronic conditions could improve the relevance of clinical practice guidelines [26], care management [5] interdisciplinary team approach [5]
	8	Not sufficient training for healthcare providers [5]	1	Physical Activity and Sedentary Behaviour, Activities of daily living, and health outcomes [22]
			9	Support from the caregiver, awareness of the caregiver [27]
Meso- level	8	Insufficient provisions of preventive services within primary healthcare and inappropriate referrals to ambulatory care [28]	14	Sustainability and scalability of pilot actions [20]
	4	Experiencing uncertainty among staff when implementing new programmes—multi-sectoral partnerships for chronic disease prevention [1]	13	Information technology [5]
	2	Unsupportive organisational and institutional environment [18]	4	Toolbox for the design and implementation of selective prevention initiatives [29]
	4	Unclear description of care pathways, addressing specific groups and the areas of health promotion [30]	5	Identification of a significant disease cluster [31]
	4	Obstacles to inpatient hospital access [32]	11	Applying managed care models [33] Developing and structuring cross-sector relationships [34] Well-established coordination and collaboration, collaborations across the boundaries of organisations [23,35]
	11	Lack of proper communication and information [23]	11	Increasing staff involvement at the social context level may minimise barriers due to a lack of communication and cooperation [36]
	10	Hospital specialists and clinic GPs disagree on Clinical Practice Guidelines [32]	11	A vertically integrated service model could optimise the care and shift the care from hospital to primary care [37]
	11	Not engaging the community in the process of developing and introducing any new programmes [38]	6	Inter-professional practice and education to address gaps in care [27]
	4	Limited resources including funding and the number of staff [21,23]	11	Good teamwork: shared space, common vision and goal, clear definitions of roles and leadership [7]
Macro-level	6	System-level leadership to ensure that curricula for healthcare workers’ training contain information on the importance of health literacy in their clinical practice, health system administrators provide signage and educational materials that are at appropriate literacy levels and representative of the languages and cultures of patients [15]	10	Regular exercising and reducing sedentary behaviours through policies to inform national health policies and strengthen surveillance systems that track progress towards national and global targets [39]
	10	Prevention has not collated the tacit knowledge of diverse actors in a structured way—lack of concept mapping [40]	14	The administrative evidence-based practice facilitates the role of public health departments in implementing the most effective programmes and policies [41]
	5	Understanding pathways for scaling-up public health interventions [42]	11	Collective sharing of challenges and opportunities and learning across countries [43]
	5	Most initiatives focus on individual-level capacity and not system-level capacity [8]	11	Co-creation [44]
	4	Fragmentation and misalignment of healthcare systems [35] Lack of framework to help strengthen systems [6]	12	Population-level evaluation and systematic media follow-up [30]
	4	Popularity and funding availability as opposed to effectiveness [45]	10	Political support, alignment with current healthcare trends, ongoing technical improvements, and capacity building [46]
	10	Conventional care prioritises maternal and child health, neglecting adult chronic diseases [30]	14	New models should be built on a bottom-up and dynamic approach based on local needs, resources, and initiatives [29]
	4	Lack of human resources to respond to a growing demand for healthcare services for adult patients [32]	11	All national and local partners and stakeholders should be involved from the beginning of the planning phase, and partnerships should be kept active throughout the process [30]
	4	Lack of necessary equipment to control chronic diseases such as diabetes and hypertension [32]	11	Highlighting the importance of administrative evidence-based practice to the public health leadership level may enhance practice [41,47]
	4	Shortages of free medication to treat chronic patients [32]	10
	10	Lack of functional accessibility and gender bias [32]
	10	Improper implementation—ending effective programmes prematurely or continuing ineffective ones [48]		Government leadership: government-led, leadership-oriented implementation is the core for the prevention and control of chronic diseases [49]
	10	Pre-emption [50]