# Implementation of Reference Framework for Preventive Care for Older Adults: Cross-sectional Qualitative Study

## TL;DR

This study explores how Hong Kong primary care physicians perceive a new framework for preventive care for older adults and identifies barriers and facilitators to its adoption.

## Contribution

The study offers novel insights into physician perspectives on implementing a preventive care framework in Hong Kong's unique socio-cultural and pandemic-impacted healthcare context.

## Key findings

- Physicians acknowledged the framework's evidence-based design but noted barriers like resource limitations and complexity.
- Government support and policy initiatives were seen as facilitators, while clearer integration into workflows was needed.
- Tailored updates and technological enhancements were suggested to improve usability and relevance in clinical practice.

## Abstract

The Hong Kong Government developed the Reference Framework for Preventive Care for Older Adults (RF) to provide evidence-based recommendations for preventive care in the primary care setting. However, no study has systematically evaluated the adoption and awareness of this framework among primary care physicians (PCPs).

This study aimed to explore PCPs' perceptions of the RF and identify barriers and facilitators to its adoption in primary care settings.

This cross-sectional qualitative study involved interviews with 40 PCPs in Hong Kong to assess their views on the RF’s adoption and implementation. The Consolidated Framework for Implementation Research (CFIR) was used to guide the analysis, focusing on five domains: intervention characteristics, outer setting, inner setting, individual characteristics, and implementation process.

Relative advantage (65%, n = 26), innovation design (45%, n = 18), and access to knowledge and information (70%, n = 28) were the facilitators that mostly discussed by interviewee. By contrast, interviewees also raised concerns regarding policy and legal (n=29, 73%) and availability of resources (n=29, 73%) in the implementation of the RF. In general, participants acknowledged the RF's evidence-based foundation and comprehensive design, appreciating its potential to improve care for older adults. However, barriers included the complexity and limited personalization of the RF, competing clinical priorities, time constraints, and resource limitations. Government support and policy initiatives facilitated engagement, but clearer integration into existing workflows and stronger promotion were needed. Tailored updates, user feedback, and technological enhancements were seen as essential for improving the RF’s usability and ensuring its relevance in clinical practice.

This study highlights that while the RF has potential to improve preventive care in Hong Kong’s primary care setting, its adoption is constrained by systemic, organizational, and individual barriers. To ensure its successful integration, flexible implementation, institutional support, tailored incentives, and enhanced clinician and patient engagement are essential. These findings offer practical implications for policymakers and healthcare practitioners to refine and promote the RF in routine consultations, and underscore the need for future research to test theory-informed implementation strategies. Furthermore, this study offered novel contributions to the CFIR literatures in systematically investigate physician perspectives on RF for the older adult population within the distinct socio-cultural and structural context of Hong Kong, COVID-19 pandemic impact to the current healthcare system and actionable implementation strategies for Asian populations. Applying the findings from this study, the CFIR-ERIC Matching Tool could be used to address the specific barriers identified in this study and improving implementation outcomes across various healthcare settings.