Table 1 Examples of how barriers to policy implementation can be identified

Accessing antiretroviral therapy (ART) in Tanzania[3]

ART has been freely available in selected reference hospitals in Tanzania since 2005 as part of the national government's policy to make ART more widely accessible. Making medicines available, however, does not automatically result in patients being able to access them. In order to identify barriers to ART access in a particular setting where the drugs were made available, a team of researchers conducted focus group discussions with community members and in-depth interviews with treatment seekers. The researchers found that "transportation and supplementary food costs, the referral hospital's reputation for being unfriendly and confusing, and difficulties in sustaining long-term treatment would limit accessibility." They noted too that a "fear of stigma framed all [patient] concerns, posing challenges for contacting referrals those who did not want their status disclosed or who had expressed reluctance to identify a "treatment buddy" as required by the programme".

Cholesterol-screening in the United States[2]

American researchers examined the barriers to participation in cholesterol screenings in both adults and children in West Virginia in the United States. Using the theory of 'planned behaviour' as a conceptual framework to provide a model for understanding decision making within particular belief systems and cultures, the researchers postulated that an individual's intention to perform an action is a central factor in determining whether an individual will perform that action. The researchers conducted semi-structured interviews using interview guides designed to elicit information relevant to the key constructs of the theory of planned behaviour. Their findings suggest that environmental, financial, and attitudinal barriers affected levels of participation in these health screenings. These include concerns about the outcomes of testing, the use of needles, privacy, a lack of knowledge in the community, and local traditional cultural beliefs.