Table 3 Exemplar quotes and description of key themes

Facilitators

 Leadership

Leading projects to ensure the community needs are meet in the implementation

Or even if we’re not doing a service, even if we do a community approach if it was around kai and nutrition and stuff, what are the factors that lever to leverage changing collectives even if it is organic in community led. (M1)

 Whanaungatanga

Building trusting relationships to support effective implementation and learning from others

I think there’s a few things I’d probably in the first instance, making sure that the – I don’t know if it’s a resource or a tool but one of the enablers is whanaungatanga, like the relationship with the whānau (extended family), the community, the activator’s probably the primary resource because if you don’t have that connection, you’re not getting in. (M2)

 Sharing information

Sharing existing programmes and experiences with others to help everyone benefit

To have a resource readily available to see what others are doing, as well as to make it like some sort of networking tool as well so that organisations or whoever are keeping up-to-date on what they’re doing out in the community and stuff like that. (M5)

 Digestible Information

Providing information in a way that makes sense for providers and communities helps to support implementation

All of our resources come back-to-back in English and te reo, so that whānau can have both. They can translate it for themselves. They can see what each thing says. We always make sure that our resources are real simple and not convoluted messaging – just really straight forward but we’ll talk to it. (M4)

Barriers

 System constraints

Health system privileges researcher perspectives and medical solutions rather than focusing on social determinants and community perspectives

GPs are trained to treat a problem, to fix it, to put something on it, to band aid it up and fix it. But what we know is that’s not sustainable for whānau. That’s literally band aiding it. It's not solving the issue. It's a bit like when someone goes to MSD and they’re short of kai so we’ll give them a food pack. Cool, you have fixed the problem for today, but you actually haven’t addressed the issue that this whānau is not able to sustainably feed themselves.(M4)

 Lack of funding

Not having fundings limits the ability of providers to effectively develop and implement programmes

Resources, kaimahi [workers], a wāhi a place to run it. Being able to pay the kaimahi properly. Value their Kaupapa [ideas, approach]. Having access to kaimirimiri [massage therapist] so it’s a lot of networking, … We learn through wānanga [extended workshops] while sitting and talking and showing our pūrākau [stories], so creating a safe space that whānau can sit in and be able to do that is really crucial to help the information and the kōrero [conversation] flow. (M3)

 Cultural constraints

Not understanding the different needs, beliefs and language barriers within cultural communities limits programme effectiveness

It needs to have consistency in values, tikanga and all those sort of things. If we were to combine the two for instance, when we had to do all the Covid vaccinations and that, we had limited space. They wanted to use one of the rooms that had a kitchen in it. I said, “We shouldn’t really be mixing kai and blood and skin samples,” and all sorts of things they were doing. They hadn’t thought of that. (M8)

 Lack of engagement with communities

Not having connections and relationships with the community limits effectiveness of implementation

In our knowledge, nobody has ever come to the iwi (tribe) to ask how the health services are being rolled out in our area. Nobody has come to ask us that. We think that is a failure of any system. (M9)