Facilitators and barriers to health promotion interventions in the National Defence Forces of Ethiopia: a grounded theory study

Abstract

The Ethiopian military implements health promotion interventions to improve and maintain fitness, health, and military readiness. However, distinct organizational features of military forces can affect the health of their members. This study aimed to explore facilitators and barriers to implementing health promotion interventions within Ethiopian military settings and develop a conceptual model based on the findings. A grounded theory approach was used in this qualitative study. We identified 26 participants among health experts engaged in health promotion and disease prevention interventions in Ethiopian military health facilities and health departments. Data were collected using face-to-face interviews with key open questions, which were recorded, transcribed verbatim in Amharic, and translated into English. The English transcripts were analyzed using open, axial, and selective coding with a constant comparative method, leading to the identification of a core category and the development of a conceptual model. ATLAS.ti was used to manage and code the data. This study involved 26 experts (21 males and 5 females) working on health promotion interventions in a military context. Five key categories emerged as facilitators: organizational, structural, professional, collaborative, and military factors. Barriers were grouped into three categories: organizational, professional, and military factors. Key facilitators included information sharing, the proximity of health personnel at lower levels, sharing best experiences, trainings, working with a shared understanding and with partners, the chain of command, living in mass, and being young. Major barriers included resource constraints, staff turnover, the demanding nature of military work, living in mass, deployment in desert environments, and peer influence. The successful implementation of health promotion interventions in military settings is influenced by the dynamic interaction of organizational, structural, professional, collaborative, and military factors. This study identified key facilitators and barriers to health promotion interventions in the military context. The chain of command and the presence of health personnel at lower levels emerged as key facilitators, while resource constraints were important barriers. These findings, along with the conceptual model developed, provide valuable guidance for policymakers and practitioners involved in health promotion efforts within the Ethiopian military context.