Beyond Treatment: Understanding the Multifaceted Barriers to Patient Participation in Health Interventions

Health interventions are policies, initiatives, or programs that can change perspectives and behaviors to improve overall health.¹ This publication includes information about (1) impacts of and types of approaches to health interventions, (2) common barriers that may limit participation in community-based interventions, (3) examples of supportive measures to foster success of interventions, and (4) recommendations for strategic planning and sustainability. The information may be useful to various professionals and policymakers involved in health initiatives at the community level, such as health service providers, rural health Extension Agents, and educators from the Expanded Food and Nutrition Education Program (EFNEP), Supplemental Nutrition Assistance Program–Education (SNAP-Ed), and Women, Infant, and Children (WIC).

Health Interventions

“A public health intervention is an organized effort to promote specific behaviors and habits that can improve physical, mental, and emotional health.”¹ Health interventions have been proven to reduce human disease and unhealthy conditions, help children thrive at an early age, and affect overall well-being.² Examples of nationwide intervention achievements by the Centers for Disease Control and Prevention (CDC) between 1900-1990 included infectious disease control, a decline in deaths from coronary heart disease and stroke, and recognition for tobacco use health hazards.¹

Detrimental health issues occurring in communities, especially high-risk communities (e.g., heart disease, obesity, diabetes), can be addressed with various types of interventions, including outreach efforts, screenings, health education and teaching, policy development, and even social marketing.² New novel tactics such as culinary medicine and vegetable (or produce) prescriptions are emerging. Culinary medicine “focuses on the art of food and cooking to prevent or improve health outcomes among chronic patients suffering from lifestyle diseases.”³ Culinary is gaining traction as a curriculum for healthcare and food service professionals and has started to be offered through educational outlets such as the American College of Culinary Medicine (https://culinarymedicine.org/). Vegetable prescriptions are “vouchers or debit cards for free or discounted produce, distributed by healthcare providers.”⁴ Medicaid agencies have been offering vegetable prescriptions to qualified recipients through funding from the US Department of Agriculture USDA National Institute of Food and Agriculture NIFA.⁵

There are also programs that provide health interventions in the form of hands-on nutrition education, such as The Expanded Food and Nutrition Education Program (EFNEP). The EFNEP is offered by the USDA National Institute of Food and Agriculture and is operated out of the country’s land-grant universities, which are located in every state. EFNEP’s target audience is low-income communities, and community members are trained to deliver nutrition education for Clemson University Cooperative Extension Service.

Barriers

Strategic planning is vital for the development of health interventions. Some barriers that can affect the level of community participation include socioeconomic, physical accessibility, health literacy, and cultural.^6,7 Barriers could threaten the success of an intervention, which could waste valuable funding, decrease recognition for what was identified as a community need, and jeopardize future support.

Socioeconomic

On the individual level, higher poverty rates can make it very difficult for participants to pay for services or programs being offered. Also, some people do not have health insurance or a good plan that covers all of their needs. Utilization of health services is often influenced by preexisting characteristics, resources, and needs.^8-9

In addition to the socioeconomic barriers mentioned, people in rural communities face challenges in terms of care and intervention. Rural areas tend to experience a higher prevalence of chronic conditions than urban areas. ⁶ Rural communities also experience higher mortality rates than urban areas. In rural areas, there is limited access to health promotion options and disease prevention and program services that contribute to better health equity.

Physical Accessibility

Sometimes, transportation is limited due to issues with affordability, reliability, or availability of public transportation. Consumers may have unpredictable work hours or may be unemployed. Limited access to healthy foods and safe physical activity options may also exist.⁶ If someone does not have transportation and no way to get places, they will be unable to access options that can help them with access to food and medical care.

Health Literacy

It is important that we work to ensure that patients and their families understand health information and why it is important to make informed decisions about their health. Now, it is very common for most doctors’ offices to have an app that you can use to see health information and communicate with healthcare providers. There is also a continuous need for programs that effectively educate patients about their health conditions and the available interventions. Medical apps take medical information and make it easier for people to understand. Research has shown that apps from doctors can help patients better understand the contents of medical information.

Some other barriers may be related to government, health programs, lack of skills among health professionals, weak coordination among the care team, barriers related to community, and the lack of understanding of goals and benefits.⁷ One of the main barriers to implementing health programs based on community participation is the lack of attractiveness of health programs or the lack of incentives.¹⁰

Health insurance access and health literacy are critical components that encourage the uptake of services.¹¹ Health literacy has not been proven to be a source of overcoming preventative health service use, nor does it show a correlation between promoting the use of preventative health services. ⁹

Cultural

There may also be a lack of the public’s trust in the government systems, which can steer participation away from community health interventions. There can be a disconnect between the specific needs of the community and the healthcare providers.¹² Providers may not understand the cultural and social/economic factors that are impacting health outcomes within a community. It is crucial to have community participation to ensure health programs are effective, equitable, and responsive to the specific needs of the community.¹⁰ It is important to have the proper culture to create the correct cultural platform for implementing collaborative work.¹⁰

Supportive Measures

Social Interactions

Research indicates that positive interactions within social networks are effective in decreasing mortality and disability risks, which can result from isolation.¹³ Health interventions can facilitate interaction and accountability by creating organized support and community groups that can be made up of family, friends, and community members with similar goals and interests. Interactions stemming from health interventions may provide an opportunity for those who may not otherwise have impactful social connections. Research has shown that apps from doctors can help patients better understand the contents of medical information.¹⁴ Support groups also tend to be useful because of gaps they may fill among the people within the group.¹³

Clinical Partnerships

Partnerships within communities such as support services for well-being (e.g., locally based nonprofits, state agencies, etc.) and healthcare networks are key for supporting health initiatives such as interventions.¹⁵ When there are multiple sources for services and no integration between them, it can create problems such as duplication of health-related services, which can deplete vital resources, including funding. The lack of a networking system among systems providing healthcare services is a predominant problem that plagues the United States.¹⁶

Multidisciplinary teams (e.g., social services, nonprofits, health providers, Cooperative Extension Services) addressing various healthcare needs in a community can be effective and ensure efficient use of resources by integrating efforts and communication. In addition to crucial treatment services, expanding initiatives and access to health education through coordinated efforts could decrease the incidence of initial and recurrent health problems.

Connecting with available health-related Cooperative Extension programs is a vital opportunity to enhance clinical partnerships and expand health education as Extension Agents are based statewide.¹⁷ Cooperative Extension Services exist within each state’s land-grant university and successfully achieve impacts that improve health education efforts, especially in rural communities with at-risk populations.¹⁸

Technological

Technology is a broad topic when discussing health interventions. It is imperative that we assess the impact of a person’s ability to access and use digital tools for health management. Most applications and resources are now accessed through the internet, which requires us to consider this more now than ever before. Digital health interventions are increasingly important.

Conclusion

Broad community involvement is crucial for the success and sustainability of health interventions. The more diverse the stakeholders are, the better the chances of meeting the needs of the community and ensuring that programs are effective in the long term. Incorporating a range of professionals, such as healthcare providers, social workers, educators, and others, is vital because health is multifaceted. Each professional brings unique insights and skills that can enhance the intervention. For example, healthcare providers, social workers, and educators bring unique insights and skills to enhance the intervention. By collaborating, these professionals can bridge gaps between clinical care, social support, and education. This approach helps ensure that interventions are tailored to the specific needs of the community, whether it’s related to chronic disease management, mental health support, or preventative care.

Sustainable programs are built on strong community partnerships. When community organizations such as local governments, educational institutions, healthcare providers, and advocacy groups are involved, various resources and strengths are provided. Diversifying funding sources is critical to the long-term success of any community intervention. Relying on one funding stream can leave a program vulnerable to financial instability. Multiple funding streams would include grants, state and federal reimbursement, private partnerships and corporate sponsorships, and fundraising and donations. This allows the program to have financial stability if one finding stream decreases or becomes unavailable.

Finally, health outcomes are influenced by factors such as access to nutritious foods, safe environments, education, and social support. A well-rounded, community-driven health program is more likely to make a lasting impact.

References Cited

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