Factors Influencing Equitable Participation in a Provincially Implemented Older Adult Exercise Program in Canada: Qualitative Analysis Using the Health Equity Implementation Framework

Background: Group-based exercise programs for older adults produce substantial health benefits, yet they often fail to reach equity-deserving populations in representative proportions. An understanding of local and systemic factors surrounding exercise programs is needed to guide strategies to reduce these gaps. Purpose: Our purpose was to understand the local and system-wide factors that influence equitable participation in the Forever . . . in motion (FIM) older adult exercise program in Saskatchewan, Canada. Methods: Seventeen people who served as program implementers and/or exercise leaders in the FIM program participated in semi-structured interviews. Guided by the Health Equity Implementation Framework (HEIF), codebook thematic analysis involved coding into categories of the HEIF and then inductively eliciting themes relevant to equity-focused implementation. Results: Innovation characteristics such as low-cost, adaptive group exercise in community settings and online options for attending training courses or exercise classes helped promote equity, as did leader and implementer characteristics and contextual factors that centered on community collaboration. Other HEIF domains negatively impacted equitable participation, including participant barriers relating to social determinants of health, lack of knowledge in the leader and implementer, and contextual factors such as a lack of equity-focused goals or metrics or varied levels of implementation support across jurisdictions. Three themes were identified: A Disjointed Provincial System , Inclusion is Poorly Understood and Actioned , and Goals and Measures Lack an Equity Focus . Conclusion: Implementation frameworks such as the HEIF can help health-promotion professionals develop a comprehensive understanding of determinants of inequities and guide strategies to address equity-related gaps.