Barriers and enablers of a community-based integrated frailty and intrinsic capacity management for older adults: a rapid qualitative approach

Introduction: Many evidence-based healthcare innovations do not produce anticipated outcomes due to failure in accounting for contextual factors. We engaged potential implementers of a community-based integrated frailty and intrinsic capacity management for older adults in Singapore (the Innovation) to elicit potential implementation barriers and enablers. Theory/Methods: The updated Consolidated Framework for Implementation Research (CFIR) and its Outcomes Addendum (OA) was adopted as the conceptual framework to assess pre-implementation acceptability, appropriateness, feasibility, and adoptability of the Innovation. We used a rapid qualitative inquiry approach with concurrent data collection and analysis, to allow timely iteration and sharing of findings to stakeholders. Qualitative data was retrieved from five Focus Group Discussions (FGDs) (n=22 participants) conducted between July and August 2023 with clinicians, nurses, therapists, and community partners. We utilised a combination of RREAL (Rapid Research, Evaluation and Appraisal Lab) sheets, RITA (rapid identification of themes from audio recordings), and mind-mapping techniques for rapid data synthesis and analysis. Framework analysis was applied to structure and explore qualitative data with a mixed deductive-inductive approach. Results: Acceptability towards the Innovation was mostly due to its evidence-base, emphasis on patient-centeredness, and relative advantages in terms of its comprehensiveness and enhanced access to specialised care. The Innovation was perceived as an appropriate approach to optimise functional ability in the community with its focus on preventive health. However, the anticipated complexity and resource intensity of it were seen as potential barriers, with differing perceived priority to the Innovation across participants. Additionally, the lack of proactive health seeking behaviors and adherence from recipients were seen as potential barriers for older adults with poor health literacy, lack of self-management, and a quick-fix mentality. Capability, capacity, communication, and care coordination are important for feasibility. Successful implementation requires strategies to address the gaps in the knowledge, skills, and experience in delivering geriatric care in the community; intersectoral partnership and collaboration with shared resources and effective resource allocation; and early patient/caregiver engagement and education. Synergy with the wider policy directive was also suggested for efficiency of processes and more effective resource allocation. Discussion: Participants were generally agreeable to the theoretical benefits of the Innovation. The FGDs revealed potential barriers related to acceptability and feasibility of implementation due to its complexity, resource intensity, and incompatibility with older adults’ health seeking behaviors and attitudes. The likelihood of implementers deciding to deliver the Innovation were influenced by their perceived barriers and enablers to its acceptability, appropriateness, and feasibility. Conclusion: Adoptability of the Innovation likely depends on intrinsic and extrinsic motivating factors, alignment with priorities, and the minimization of trade-offs by providing sufficient support systems and collaborative networks to implementers. Lessons learned: Early stakeholder engagement allows us to refine implementation strategies to address the CFIR-identified barriers, have alignment in goals and increase buy-in. Limitation: We have not included views from older adults. Suggestions for future research: Future research might include selection and the evaluation of implementation strategies with involvement of relevant stakeholders using community-engaged research methods.