From generation to implementation of evidence: a comparative analysis of 3 RCTs on cognitive decline

Abstract Background The implementability of healthcare interventions is crucial for their successful integration into routine practice. Within Italy's Next Generation EU program, the Age-It project promotes healthy aging through technology-supported approaches. This study assessed the implementation readiness of three RCT protocols developed within Age-It to prevent cognitive decline in older adults through multi-component interventions. Methods A structured thematic analysis was conducted using the Implementation Outcomes Framework by Proctor et al. (2011), covering eight domains: acceptability, adoption, appropriateness, feasibility, fidelity, cost, penetration, and sustainability. An ad hoc coding matrix guided data extraction. Protocol documents were analyzed in NVivo using a mixed deductive-inductive approach. Each domain was also scored (0 = not addressed, 1 = partially, 2 = fully) for quantitative comparison. Results The protocols targeted three settings: (i) community-dwelling individuals (IN TeMPO), (ii) hospitalized patients (OPTIMAge-IT), and (iii) residents of long-term care facilities (I COUNT). Each trial spans 12 months and enrolls 300 participants, based on a screening of 900 adults aged 60+ in 19 national centres. In terms of implementation outcomes, the OPTIMAge-IT protocol received the highest score, with 13 out of 16 points and an average of 1.62 across the 8 assessed criteria. It demonstrated comprehensive planning in domains such as feasibility, fidelity, and adoption. IN TeMPO scored 7 (mean 0.88), with strengths in appropriateness and acceptability but lacked detail on sustainability and cost. I COUNT, showed an exploratory approach with limited planning for penetration, cost, and acceptability. Conclusions Differences in implementation planning highlight the need to align RCT design with evidence-based public health practice. Structured implementation strategies are essential for real-world impact in aging care. Key messages • Comparative analysis of RCT protocols reveals variability in implementation planning, stressing the need for structured, evidence-based strategies to guide future health policy and practice. • Significant gaps in planning for sustainability and implementation cost highlight barriers to scaling up aging interventions within national health systems.