Integrated frailty and intrinsic capacity care model for communitydwelling older adults in Singapore: a rapid qualitative study of anticipated implementation barriers and enablers using the Consolidated Framework for Implementation Research and its Outcomes Addendum

Mimaika Luluina Ginting ^1* Grace Sum ¹ Sinead Zhen Wang ² Yew Yoong Ding ^1,3,4 Laura Tay ^1,5

• ¹ Geriatric Education & Research Institute, Singapore, Singapore
• ² SingHealth Polyclinics, Singapore, Singapore
• ³ Department of Geriatric Medicine & Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
• ⁴ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
• ⁵ Geriatric Medicine Department, Sengkang General Hospital, Singapore, Singapore

Introduction: Older adults are at risk of experiencing multimorbidity and care dependency due to declines in their physiological reserves. Optimizing intrinsic capacity and functional ability of individuals is important to enable healthy ageing. We engaged potential implementers of an integrated community-based frailty and intrinsic capacity care model adapted from the World Health Organization Integrated Care for Older People framework, to assess the anticipated implementation barriers and enablers within Singapore's healthcare context. Methods: The updated Consolidated Framework for Implementation Research (CFIR) and its Outcomes Addendum was adopted as the conceptual framework. Qualitative data were generated through focus group discussions (FGDs). We used a rapid qualitative inquiry approach with combination of Rapid Research, Evaluation and Appraisal Lab sheet, the Rapid Identification of Themes from Audio recordings, and mind-mapping techniques for data synthesis, analysis, and interpretation. Framework approach was applied to structure and explore qualitative data for triangulation across FGDs. Results: Five FGDs were conducted with 22 potential implementers (doctors, nurses, physio/occupational therapists, community partners) between July and August 2023. We identified 24 CFIR determinants covering five domains (innovation, outer setting, inner setting, individuals, implementation process). Enablers were intersectoral collaboration (partnership and connections), trialability (innovation trialability), alignment with overarching goal (mission alignment), and removal of hurdles and sufficient support (tailoring strategies). Barriers were complexity (innovation complexity), affordability (innovation cost), trade-offs (relative priority), synergy among multiple programs (compatibility), resource intensity (available resources), fragmented understanding of care model across providers (communication), physical spaces' design (physical infrastructure), limited time and resources (innovation deliverers' opportunity), and gaps in clients' capability (capability), and non-compliance (motivation). Policy contexts and directives (policies and laws), theoretical benefits (innovation evidence-base), comprehensiveness and patient-centeredness (design), enhanced service access (relative advantage), proposed tasks allocation (work infrastructure), information access (information technology infrastructure), capability building (access to knowledge and information), innovation deliverers' capability, motivation, and accessibility (innovation recipients' opportunity) were both barriers and enablers. Discussion: The findings demonstrated agreement with the innovation and suggested implementation readiness in clinical and service levels. However, addressing key barriers and leveraging on enablers are necessary for successful adoption and implementation.