Common Implementation Challenges

There are a range of different issues and challenges that need to be addressed for successful program implementation. Some of these challenges are particularly unique to rural communities. Common challenges are described below, along with suggestions on how to address these challenges:

• Resources and sustainability: Funding, technological, and human resources are typically limited in rural communities. It can be particularly difficult to generate enough start-up funds to sustain the program as it begins. Having a network of stakeholders and partners in the community may be beneficial for providing resources and support for a program.
• Geographic limitations: Geography can present challenges to implementing rural community health programs. Geographic challenges include weather, distance, and isolation. Depending on the type of program, activities, setting, and frequency of participation, these challenges can become significant. Programs may need to tailor their design and approach to account for lengthy travel distances and times, availability of transportation, and opportunity to offer the program remotely or through other technologies.
• Recruiting staff: Rural communities that are implementing rural health programs that require physicians, dietitians, or physical therapists for example have faced barriers to recruiting appropriately trained staff. Some programs work with volunteer or retired practitioners, or students.
• Hard-to-reach populations: The priority population may be highly mobile. For example, one rural health program was striving to provide care to two hard-to-reach populations: Hispanic poultry workers and migrant farm workers. These populations travel from camp to camp during different times each year, making it challenging to reach them. Several rural health programs use mobile vans to provide traveling health services.
• Cultural and social issues: A number of challenges to program success arise out of unique cultural and social norms that influence expectations about the program and its likelihood of success. Examples of these types of issues include:
  
  • Deeply rooted traditions and cultures around food
  • Lack of trust for medical professionals and outsiders
  • Social beliefs around certain behaviors
  It is critical for program implementers to make a conscious effort to recognize and understand the population their program will serve, so they can develop appropriate strategies. Involving members from the population of interest throughout the whole process can help achieve cultural competency, encourage participation, and reduce social stigmas. Implementers also may need to adapt materials, such as information packets, to ensure all program materials are culturally appropriate.
• Language: Rural health programs may serve non-English speaking communities. Such programs need to ensure staff understands the importance of providing services or public health education in a culturally appropriate manner. In addition, programs may need to either employ staff proficient in Spanish or other languages.
• Keeping the community motivated: Regardless of the community and populations targeted in the program efforts, an awareness of health concerns needs to exist and individual and organizational commitments are necessary toward making the changes needed to address those concerns. It’s important for program planners to understand that success will depend on conducting education and outreach efforts to determine community members’ expectations about program impact and to motivate them to achieve better health outcomes.

Resources to Learn More

Establishing and Maintaining Public Health Infrastructure in Rural Communities
Document
This case study analyzes the opportunities and challenges experienced in establishing a rural public health infrastructure. It considers facilitators and barriers to the process, as well as highlighting recommended practices.
Author(s): Meit, M. & Hernandez, N.
Organization(s): NORC Walsh Center for Rural Health Analysis
Date: 2/2012

Financing Rural Public Health Activities in Prevention and Health Promotion
Document
The article discusses the influence of state and local level public health infrastructure and their effect on the flow of federal resources, from federal agencies, through states, and to communities.
Author(s): Meit, M., Hamlin, B., & Piya, B.
Organization(s): NORC Walsh Center for Rural Health Analysis
Date: 7/2008