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Table 1 This table summarizes the major (more than one source) identified barriers and facilitators, structured along their domain and (sub-)themes. Findings with major support (5+ sources, 12.1% of total) are marked in bold

From: Systematic review: a systems innovation perspective on barriers and facilitators for the implementation of healthy food-store interventions

DomainsThemes(Subthemes) Main findings
Outer SettingProduct supplyChallenges in product supply (20–33)±+, suppliers are unreliable (24, 30, 34, 35)±+, geographic isolation (34, 35)±, demand fluctuations (30, 36)±
Consumer characteristicsHigh demand unhealthy products (20–24, 27–29, 31, 36–40)±+, lower demand healthy products (20, 23, 33, 36, 41)±, unhealthy products more profitable (20)±, healthy perceived as expensive (23, 24, 38, 40, 42)±+, customers prefer unhealthy products (23, 28)±+, customers uninterested in health (23, 36, 40, 42, 43)±+ and customers lack health knowledge (23, 42)±+
Community relations− Robberies and safety concerns (21, 40)±
+ Strong retailer-community relations (23, 27, 31, 40, 41, 46)±+
Competition− Competitors steal customers (36, 37, 41)±+
+ Lack of competition facilitates success (31, 35, 41)±
Legislation− Governmental taxes (59)±
+ Health promotion legislation (46)+
Media− Stocking follows media exposure (29, 34)±
Inner SettingCulture(Commerce)
Commercial interests (26–28, 30, 32, 33, 48–50)
+ Open for innovation and experimentation (24, 26, 31, 33, 47, 51)±+
(Health promotion)
Not feeling responsibility for community health (23, 27, 28, 31, 33)±+, no affinity with health promotion (21, 31)±
+ Feeling responsibility for community health (20, 23, 24, 27, 28, 33, 35, 42, 43, 47, 52)±+, affinity with health promotion (27, 47)±+
Structure(Physical)
Space constraints (27, 37, 40, 42, 45, 48, 49)±+, limited storage/cooling facilities (21, 22, 28, 29, 34–36, 38, 40)±+, store renovations (24, 26, 27, 43, 50)±+
(Operational)
Unhealthy products restocked by suppliers (21, 40, 44, 49, 54)±+, inconsistent product stocking (24, 44, 53)±+, supplier contracts (22, 38, 45)±+, difficulties returning unsold products (17, 34)±, constraints set by retailer (21, 27, 28, 49)±+, campaigns (42, 45, 50)+
(Financial)
Products go to waste (20, 22, 28, 30, 33–36, 40, 41, 44, 52)±+, limited financial resources (42, 47)+
(Knowledge and capacity)
Lack relevant expertise (23, 24, 31, 36, 42, 44, 47)±+, limited time (23, 31, 42–45, 48, 50)±+, staff turnover (26, 39, 50, 53)±+
+ Applicable business experience (23, 28, 31, 47, 51)±+
PracticesStock in small quantities (20, 22, 25, 26, 31, 33, 34, 37, 39, 40, 55)±+
+ Flexible in establishing supply (30, 39)±+, waste limitation tactics (20, 31, 41)±
ActorsPersonality traits+ Pragmatism (31, 42, 51, 52)±+, desire to help (42, 47, 51)±+, tenacity (31, 51)±
Psychological reactions− Frustrations regarding intervention (29, 41, 42)±+, psychological stress (27, 39, 56)±+
+ satisfaction from positive feedback (25, 31)±
InterventionGeneral characteristics(context-intervention fit)
Does not fit the context (28, 42, 45–47)+.
+ Fits the context (27, 28, 37, 39, 42, 47, 48, 57)±+, fits customer needs (24, 37, 41, 45, 47)±+, fits retailer needs (37, 47)±+
(flexibility)
− Inflexible design (27, 37, 42)±+
+ Adaption to context (30, 35, 37, 48, 52, 53)±+, awareness of context complexity (27, 57)±+
(complexity)
+ Simple to implement (42, 47)+
Components of the intervention(support)
− Difficulties maintaining provided equipment (29, 48)±, lack of intervention support (42, 52)±+
+ Financing start-up and running costs (20, 22, 29, 35, 37, 44, 48, 52)±+, provide promotion materials (28, 29, 42, 47, 52)±+, monetary incentives (27, 37)±+
+ Building retailer-supplier relationships (22, 26, 37, 40, 49, 55)±+, subsidising stocking of products (20–22, 27, 31, 39, 49, 55, 56)±+
+ Consultation regarding health promotion and business skills (24, 29, 35–37, 42)±+, staff training (28, 35, 43)±+
(promotion)
− Faulty placement materials (28, 52)±, retailers refuse negative promotion (28, 45)+, insufficient (re)supply of materials (42, 52)±+, materials lack durability (45, 52)±+
+ High quality materials (24, 28, 42, 45, 47, 48)±+
(staff training)
+ Improved engagement staff (35, 37)±+, improved skills for implementation intervention (29, 35, 48)±
(customer education)
+ Regarded as vital by retailers (20, 22, 37, 40)±+, improved demand promoted products (22, 37)±+
(pricing)
− Regarded as unviable and potential risk (23, 49)±+
Costs and benefits(costs and risks)
High running-costs (21–23, 28–30, 33, 35, 37, 39–42, 44, 47, 49, 59)±+, high initial investment (22, 44)±, substantial time investment (23, 28, 29, 31, 42, 44, 53)±+, substantial effort or impractical (28, 30, 35, 42, 45)±+, commercial risks (21, 23, 28, 33, 37, 39, 56, 58, 59)±+
+ Low or minimal effort (24, 27, 28, 45)±+
(commercial benefits)
Commercial benefits do not outweigh risks and costs (22, 28, 30)+
+ Increased profits and sales (22, 24, 26, 28–30, 45, 47, 55)±+, more customers (22, 28, 30, 55)±+, improved customer satisfaction (28, 30, 45)±+, improved public image (28, 31, 45, 47, 55)±+, establishment of partnerships (35, 37, 47, 57)±+, general “positive outcomes” (27, 47)±+
(health benefits)
Doubts regarding changing customer behaviour (24, 27, 33, 42, 52)±+, lack of observable impact (35, 45)±+, loss of momentum (31, 45, 52)±+
+ Health promotion is inherently valuable (20, 23, 24, 27, 33, 35, 42, 43, 47, 52)±+, visible impact on sales and people (24, 28, 29, 35, 45, 47)±+
ProcessEngagement− Unmotivated retailer (44, 52)±
+ Commitment and support from retailer (24, 25, 27, 31, 42, 50, 60)±+, retail-specific engagement strategies (22, 24, 37, 45, 48)±+, providing staff training (35, 37)±+, build engagement incrementally (35–37)±+, develop intervention ownership (35, 37)±+, culture and language sensitive approach (26, 27, 37)±
Collaboration− Collaboration with competitors (28, 42)+
+ Good relationships collaborators (21, 25, 26, 42, 48, 49)±+, collaborative planning intervention (27, 37, 42, 44, 46)±+, intervention helped developing collaborations (37, 47)±+
CommunicationPoor communication between collaborators (31, 42, 45, 47, 50, 52)±+, lack of clarity on goals and agreements (21, 47, 52)±+, language and cultural barriers (21, 27, 30, 39)±+
+ Clear communication (26, 27, 35, 42, 52)±+
Organisation of activities− Lacking planning and guidelines (42, 47, 52)+
+ Thorough planning and transparency (42, 51, 53)±+
  1. Bullet point:
  2. −: factors interpreted as barriers
  3. +: factors interpreted as facilitators
  4. : factors interpreted as both barriers and facilitators
  5. Superscript:
  6. ±: supported by studies conducted among single stores
  7. +: supported by studies conducted among multi-store organisations