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Table 3 Barriers and facilitators in workplace health promotion activity implementation according to CFIR constructs

From: Barriers and facilitative factors in the implementation of workplace health promotion activities in small and medium-sized enterprises: a qualitative study

CFIR Domain and constructs

Facilitators

Barriers

I. Intervention characteristics

 A. Intervention source

・Voluntary motivation to promote employees’ health and externally provided referral which was matched their needs [Interviews]

 

 B. Evidence strength and quality

・The employer’s perception of the effectiveness of the activities [Interviews]

 

 C. Relative advantage

・Recognition of its relative advantages over other topics within NCD prevention [Interviews]

 

 F. Complexities

・Recognition of its easiness to adopt [Interviews] [Focus groups]

 

II. Outer setting

 A. Needs and resources of those served by the organization

・Embedded system to understand employees’ needs [Interviews]

・Resistance of smokers in case of tobacco control activities [Interviews] [Focus groups]

 B. Cosmopolitanism

・Networking with other companies [Interviews]

 

 C. Peer pressure

・Existence of companies in a competitive relationship [Interviews] [Focus groups]

 

 D. External policy and incentives

・Legal obligation, the certification of WHP activities [Interviews]

 

III. Inner setting

 A. Structural characteristics

・The smaller company size [Focus groups]

 

 B. Networks and communications

・Formal (e.g., health committees) and/or unformal communication (e.g., feedback shared during daily communication) [Interviews] [Focus groups]

・Relationships of mutual trust between the employer and the employees [Interviews]

 

 C. Culture

・ Family like culture in the workplace [Interviews]

 

 D. Implementation climate

 1. Tension for change

・The sense of urgency for change regarding health promotion of employees [Interviews]

・A lack of motivation or sense of urgency to implement WHP activities now [Interviews]

 2. Compatibility

・Alignment with employees’ business processes [Interviews]

・The time to spend the WHP activities [Interviews]

 3. Relative priority

・Higher prioritization of WHP activities [Interviews]

・ Lower priority compared to customer-focused activities or productivity [Interviews]

 4. Organizational incentives and rewards

・Praising the participants of WHP activities in a meeting [Interviews]

 

 5. Goals and feedback

・Creation of a common understanding of the goals and objectives for WHP activities among all employees [Interviews]

 

 6. Learning climate

・The employer’s perception that the health manager(s) is an indispensable and knowledgeable person in the WHP implementation [Interviews]

 

 E. Readiness for implementation

 1. Leadership engagement

・Communicating the company's philosophy linked to the WHP to all the employees [Interviews] [Focus groups]

・Supporting those who are engaging the implementation [Interviews]

・Limited provision of resources and support from the employer [Interviews]

 3. Access to knowledge and information

・Access to external knowledge and information, such as participation in study sessions and support from JAIH health nurses [Interviews]

・Limited access to external knowledge and information made it difficult [Interviews]

IV. Characteristics of individuals

 A. Knowledge and beliefs about the innovation

・Awareness to conduct WHP activities as part of their regular task [Interviews]

・Employer or health manager’s beliefs that people need to take full responsibility for their own health [Interviews]

 B. Self-efficacy

・Health manager’s self-efficacy as a result of the employer's entrusting him/her with health promotion [Interviews]

 

 D. Individual identification with organization

・Relationships of mutual trust between the employer and the employees [Interviews]

 

 E. Other personal attributes

・Health manager’s skills and authority [Focus groups]

 

V. Process

 1. Opinion leaders

・Involvement of a person who has a strong influential power in the company [Interviews]

 

 2. Formally appointed internal implementation leaders

・Existence of health manager formally appointed by the employer to implement WHP activities [Interviews]

・Absence of health manager formally appointed by the employer to implement WHP activities [Interviews]

 3. Champions

・Involving front-line champions [Focus groups]

 

 4. External change agents

・Support from public health nurses or nutritionists at JHIA [Interviews]

 

 D. Reflecting and evaluating

・Personal reflection by health managers using annual health report by JHIA [Interviews]

 
  1. CFIR Consolidated Framework for Implementation Research, JHIA Japan Health Insurance Association, NCD Non-communicable disease, WHP worksite health promotion