Implementation Research Research Articles

Abstract Objectives While school-based mindfulness programs (SBMP) have been shown to improve youth mental and behavioral health, their implementation in low-income schools remains poorly understood. This scoping review aimed to synthesize existing evidence on the barriers and facilitators to SBMP implementation in PreK-12, low-income schools in the United States, applying the Consolidated Framework for Implementation Research (CFIR) to map extracted evidence and identify actionable strategies for SBMP research and practice. Method The searches were conducted in PsycINFO, ERIC, PubMed, and Web of Science. Study characteristics were summarized and qualitative data on implementation barriers and facilitators were extracted and analyzed using the CFIR. Results Seven articles met the inclusion criteria and were included in the qualitative synthesis. A total of 53 implementation factors were mapped onto the CFIR, with 34 (64%) identified as facilitators and 19 (36%) as barriers. All studies discussed implementation factors related to the inner setting, such as classroom noise and peer pressure. Most (n = 5, 71%) identified factors related to innovation characteristics, individual characteristics, and the implementation process. Only two studies (n = 2, 29%) reported outer setting factors, such as collaboration with community organizations to support implementation. Conclusions Findings highlight the complexity of implementing SBMPs in low-income settings, emphasizing the need for researchers and schools to assess potential barriers and facilitators across different CFIR domains and to integrate these considerations into implementation planning for SBMPs. Implications for mindfulness research in low-income school settings are discussed. Preregistration This study was not preregistered.

BackgroundAs the burden of non-communicable diseases continues to rise, general practices in primary care face increasing challenges in delivering high-quality care while managing workload constraints. Interprofessional care models, supported by practice-tailored protocols, offer a promising approach to optimizing task shifting and enhancing care coordination. However, the transition towards protocol-based interprofessional care remains complex and understudied.ObjectiveThis study explores the experiences of general practices in developing and implementing practice-tailored protocols to facilitate interprofessional care. Using the Consolidated Framework for Implementation Research (CFIR), we identify key barriers, facilitators and strategies that support this transition.MethodWe conducted a qualitative study in Flanders, Belgium, using semi-structured interviews with 33 healthcare providers from 18 general practices. Participants represented various disciplines, including general practitioners, nurses, dietitians and reception staff. A hybrid qualitative analysis was applied, beginning with an inductive analysis based on Braun and Clarke’s thematic approach, followed by a deductive phase guided by the CFIR-framework.ResultsThe findings highlight several key factors influencing the development and implementation of practice-tailored protocols in general practices. Participants emphasized that clear task allocation and communication structures within protocols improved care coordination. External factors, such as financial constraints and high workloads, posed challenges, whereas collaborations with external healthcare providers facilitated interprofessional teamwork. Internal practice dynamics, including a shared vision, mutual trust, and structured team meetings, were identified as crucial enablers. At the individual level, motivation to adopt protocols varies, with some physicians expressing reluctance due to concerns about shifting patient relationships and increasing complexity in their caseloads. The implementation process benefited from a stepwise approach guided by a team leader, clear goal setting, continuous evaluation and peer learning.ConclusionThe transition towards protocol-based interprofessional care is a complex but mandatory evolution in primary care. While practice-tailored protocols can enhance efficiency and collaboration, their success depends on a structured implementation strategy, effective practice management, and team alignment. Addressing challenges such as gaining trust and provider resistance are critical. Future research should explore scalable support mechanisms and policy adaptations to facilitate widespread adoption of interprofessional care models in primary care settings.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13424-y.

Implementation research in forensic mental health: a scoping review

Abstract The subnational level of federal states constitutes a critical arena for understanding the implementation of international rules, with subnational entities often exercising significant discretion. This paper studies the subnational implementation of a European Union (EU) data protection instrument in Switzerland, a salient case of EU external governance (EU rules extending beyond EU borders). Switzerland is interesting for observing subnational implementation, representing a highly decentralised system, where subnational entities have broad implementation competences. This case study reveals unexpectedly low implementation levels. Drawing on in‐depth document analysis and 28 stakeholder interviews, this paper evaluates the influence of multilevel institutional settings, civil servants' agency and policy‐specific factors on implementation outcomes. The findings reveal that institutional constraints and policy issue specificities outweigh the role of actor agency, challenging dominant perspectives in implementation research. This study contributes to understanding the dynamics of EU rule implementation beyond its borders and within multilevel governance systems.

Contextual factors affecting implementation of Medicaid billing for community-based pharmacist services in Virginia: A qualitative study.

Abstract The notorious Rossi’s ‘Iron Law of Evaluation’ – that the expected net impact of any large-scale social programme is zero – reminds us that expectations about policy interventions rarely survive real-world delivery. Behavioural Public Policy (BPP) faces many implementation challenges. Implementation Science (IS), which studies how evidence-based practices are adopted, delivered and sustained, offers BPP a toolkit for overcoming the knowledge–action gap. We show how IS frameworks like CFIR (Consolidated Framework for Implementation Research) and RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) diagnose contextual barriers – leadership, workflow fit, resources – and supply metrics of fidelity, adoption, cost and sustainment. Next, we outline three hybrid trial types from IS that co-test policy impact and implementation: Type 1 emphasises behavioural effects while sampling implementation data; Type 2 balances both; Type 3 optimises implementation while tracking outcomes. Cluster-randomised and stepped-wedge roll-outs create feedback loops that enable mid-course adaptation and speed scale-up. Cases illustrate how spotting delivery slippage early averts costly failure; they reveal how early IS integration can turn isolated behavioural wins into scalable, system-wide transformations that genuinely endure long. We situate these recommendations within the literature on scalability and the ‘voltage effect’, clarifying how common drops from pilot to scale can be anticipated, diagnosed and mitigated using IS outcomes and process data.

Developing a Multilevel Polypill Implementation Bundle for Patients With Heart Failure With Reduced Ejection Fraction.

Most hospitals in British Columbia have fewer than 200 beds, yet the clinical pharmacy services provided and factors influencing their delivery in this context are unknown. To describe on-site clinical pharmacy services and associated contextual barriers and enablers in small BC hospitals. Between January and April 2022, an internet-based survey questionnaire was deployed to all pharmacy licence holders at BC hospitals with fewer than 200 beds (n = 23 licence holders representing 58 hospitals). Site characteristics, clinical activities, and barriers to and enablers of clinical pharmacy services (according to the Consolidated Framework for Implementation Research [CFIR]), as well as free-text responses, were captured. Of the 23 licence holders invited to participate, 18 (78%) responded, representing 37 (64%) of the small hospitals. Provision of clinical pharmacy services was reported at 27 (73%) of the 37 hospitals. Resolution of drug therapy problems and patient education were delivered at all of these hospitals. Conversely, the comprehensive patient care bundle and discharge medication reconciliation were never performed at 15 (56%) and 11 (41%), respectively, of these 27 hospitals. Of the 9 CFIR barriers, insufficient external networking and insufficient resources were reported by 17 (94%) and 16 (89%), respectively, of the 18 respondents. Funding and staffing barriers were reported, using free text, by 14 (78%) and 13 (72%), respectively, of the 18 respondents. Of the 21 CFIR enablers, the following 5 were reported by all respondents: agreement that clinical services are supported by adequate evidence, that such services will improve quality, that they will meet patient needs, that they will satisfy patients, and that a strong need exists for these services. On-site clinical pharmacy services were delivered at most small BC hospitals; however, opportunities exist to expand clinical services. Pharmacy leaders should implement change strategies that overcome contextual barriers and enhance enablers.

Perioperative patient safety aims to minimise risk and reduce adverse events throughout the surgical journey. Despite investments in national and international initiatives, sustaining these efforts remains a challenge. Contextual factors such as national policies and legal requirements play a key role in ensuring long-term success. This qualitative study examines the national patient safety policies and frameworks in five European countries and investigates contextual factors to understand how these policies may affect the implementation and sustainability of perioperative patient safety initiatives. Semi-structured interviews were conducted with decision-makers from Ministries of Health, regulatory or accreditation bodies, professional medical or scientific societies, managerial hospital staff, and academic patient safety experts from Spain, the Netherlands, Portugal, Estonia, and the Czech Republic. A desktop search for relevant policy and regulatory frameworks around perioperative patient safety informed the development of the semi-structured interview guide. Generated data were coded using an a priori framework adapted from the updated Consolidated Framework for Implementation Research (CFIR) and a framework for assessing health systems'quality improvement and patient safety initiatives. Using content analysis, codes were thematically analysed to delineate and compare the perioperative patient safety landscapes of the five countries. In total, 28 high-level decision-makers were interviewed. Based on the insight from interviewees, a patient safety policy profile was generated for each of the five countries, capturing the key features of their frameworks and strategies. While all countries have developed policies to improve patient safety, the scope and structure of these frameworks vary widely. Some countries have established centralized systems with detailed national action plans and robust oversight mechanisms, whereas others rely on more fragmented approaches with responsibilities distributed across various organizations. Common challenges identified include the inconsistent integration of patient safety education into medical curricula and cultural barriers, such as a fear of blame that affects reporting practices. Interviewees provided several propositions how project-based patient safety initiatives could be embedded in national contexts. These propositions differed considerably between countries. This study highlights the diverse and evolving nature of patient safety policy landscapes across five European countries. The varying scope, structure, and implementation of patient safety frameworks emphasize the need for context-specific approaches to promote the sustainability of perioperative patient safety initiatives. As the field continues to advance, it is important to tailor approaches that aim to sustain patient safety initiatives.

Home fortification products (HFPs), including multiple micronutrient powders and small-quantity lipid-based nutrient supplements, are specialized, nutrient-filled products added to foods with the aim of filling critical nutrient gaps. Despite their potential, there is limited documentation of the use of HFPs in humanitarian settings. The aim of this scoping review was to explore the evidence base and feasibility of implementing HFP programming in humanitarian settings specifically among young children 6-59 months of age and pregnant and lactating women. Electronic databases (PubMed, Embase, and CINAHL) were searched in December 2024, yielding 70 articles after duplicates were eliminated. Two research assistants independently selected articles that met inclusion criteria and analyzed them thematically. A total of eight studies (six quantitative, one qualitative, and one mixed methods) were included. The limited studies examined indicate that the use of HFPs is more feasible when carried out in the context of ongoing humanitarian programming, including general food distribution, growth monitoring, and behaviour change communication. Adherence and acceptability monitoring, along with sensitization and education efforts, also contributed to successful HFP programming. Hindering the use of HFPs were logistical issues, including delays in obtaining the products, sharing of HFPs across household members, and a lack of trust in both implementers and HFPs. HFPs appeared to have mixed results regarding improving health outcomes, such as growth, anaemia, and morbidities, though effects were difficult to isolate. Overall, this review demonstrates that HFPs are feasible to implement and potentially beneficial; however, more studies, including implementation research and effectiveness trials, are needed to better determine whether and how HFP programming should be implemented in humanitarian settings.

IntroductionCOVID-19 pandemic restrictions accelerated the use of mHealth interventions to maintain continuity of care for youth living with HIV (YLH). Evaluation of mHealth implementation during the pandemic can inform optimization of use among healthcare workers (HCWs) beyond emergencies. This study identified key influences on perceived acceptability, feasibility, and reach of phone delivery of an HIV care transition intervention, the Adolescent Transition Package (ATP), a booklet detailing themes on HIV disclosure and transition readiness, and relevant assessment tools, to support care transition for Kenyan YLH.MethodsWe conducted 50 semi-structured interviews with a purposively selected subset of frontline (HCWs) from intervention sites participating in the Adolescent Transition to Adult Care for Adolescents living with HIV (ATTACH) study evaluating the ATP between June 2020 and January 2021. In this hybrid effectiveness-implementation cluster randomized trial, we nested a mixed methods study. We conducted and recorded interviews, and transcribed verbatim. Applying the Consolidated Framework for Implementation Research (CFIR), we conducted a directed content analysis to evaluate determinants of acceptability, feasibility and reach of ATP phone delivery. We also documented all attempted and completed calls, including call characteristics such as duration, and summarized these data using descriptive statistics.ResultsOut of 1,444 call attempts, 82% successfully reached YLH being contacted. Providers successfully discussed the ATP during 79% of calls where YLH were reached. Determinants influencing perceived acceptability, feasibility, and reach of phone delivery of the ATP were concentrated in intervention characteristics, inner and outer setting CFIR domains. Overall, HCWs felt phone calls were acceptable and feasible for reaching most youth. However, limited ability to assess client comprehension and inability to share ATP booklet pictures in real-time negatively influenced acceptability. Within the inner setting, few phones at the clinic, missing or inaccurate contact information, the composition and organization of clinic teams, and HCW self-efficacy drove perceptions of feasibility. HCWs’ recognition of limited phone ownership and incomplete disclosure to others in the home environment were recognized outer setting barriers to reach and acceptability. In contrast, the ease of implementation, convenience, and flexibility afforded by calls positively influenced perceived acceptability and feasibility, and reach. Views on implementing calls beyond the pandemic were mixed, HCW noting that long-term access to clinic phones would be essential for sustained feasibility.ConclusionDelivery of the ATP by phone was an acceptable and feasible strategy to reach YLH during COVID-19. Phone call feasibility was limited by low phone ownership but enhanced when there were strong collaborations and communication between clinic staff. Acceptability of the phone call strategy was driven by its ease, efficiency and capacity to reach many YLH but challenged by the inability to assess and ensure client comprehension. Future mHealth initiatives may improve the implementation of calls by addressing phone access, comprehension and privacy-related constraints to maximize benefits.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13305-4.

Abstract Hydrogen peroxide (H2O2) is a widely used green oxidant in industrial, environmental, and medical applications, yet its conventional anthraquinone‐based production is energy‐intensive, centralized, and environmentally taxing. Electrochemical H2O2 synthesis via the two‐electron oxygen reduction reaction (2e ORR) and the two‐electron water oxidation reaction (2e WOR) offers a sustainable and decentralized alternative that enables on‐site generation under mild conditions. Realizing efficient and scalable H2O2 production requires the development of electrocatalysts and systems that deliver high selectivity, activity, and stability. In this review, a comprehensive summary of recent advances in electrochemical H2O2 generation is provided, with a focus on strategies to enhance selectivity. The fundamental reaction mechanisms and analytical techniques used to quantify H2O2 are first discussed. Recent progress across three critical areas: catalytic material design, regulation of the interfacial microenvironment, and optimization of electrolyzer configurations, is then discussed. Finally, key challenges that currently hinder large‐scale implementation and outline future research directions to advance the development of practical H2O2 electrosynthesis technologies for industrial and environmental applications are identified.

The use of research evidence to influence policy decisions and practice is crucial for improving health service delivery and outcomes. Effective influence requires timely dissemination and translation of evidence to practitioners and policymakers at all decision-making levels. Traditional literature on research dissemination strategies has primarily focused on the Global North, often reflecting funding structures from that region. Yet there is a wealth of research, especially operational research as well as quality improvement (QI) initiatives that have been central to programs in the Global South where health resources are often limited. This article examines the challenges and opportunities of turning research and quality improvement work into policy and practice in resource-limited settings. It draws on insights from the authors’ roles as panelists and moderators at the 3rd Annual Research and Quality Improvement Symposium, hosted by Partners In Health and the Ministry of Health of Sierra Leone on November 19, 2024. Barriers to effective dissemination of scientific evidence include limited collaboration among partners, funding constraints, visa issues and travel restrictions. Additionally, inequities in research authorship, gender disparities and language barriers hinder evidence dissemination. Building strong collaborations between policymakers and researchers presents valuable opportunities to bridge these gaps. Innovative methods such as digital platforms can also enhance dissemination despite resource limitations. Further, decolonizing global health research and ensuring equitable access to resources are critical for effective evidence sharing. Advocating for local conferences and leveraging funding mechanisms from the Global South can further support researchers in these contexts. To enhance healthcare quality in resource-limited settings, innovative strategies for sharing and implementing research and quality improvement initiatives are essential. Local researchers can utilize local knowledge, technology and partnerships to effectively disseminate findings that meet community needs. Strategic communication and collaboration among stakeholders are vital for translating research into policies that positively impact health outcomes.

Background Patient and Public Involvement (PPI) is a fundamental part of health research. The role of PPI in implementation research, which considers the transfer of evidence into practice, is often less well defined than in studies focussing on recruitment of individual patients and clinical outcomes, and there is limited guidance available. This paper uses an implementation research project, the Study of Implementation of Midwifery Continuity of Carer (SIMCA), to illustrate the types of activities, benefits, challenges and lessons learned to contribute to the development of this growing area. Methods The main aim of the PPI work in SIMCA was to embed the service user and community perspective in the study across all phases of the research, from preparation through execution and dissemination. Members of two organisations, one international and one community based, were core members of the study management team and PPI-driven activities were conducted throughout the study, incorporating both process and content focussed input. Results The key contributions of PPI to the study were identified as i) bringing experience and representation ii) providing connectivity between the team and the wider community iii) providing service user perspectives on study-related tasks iv) a developmental impact on the study team, improving awareness and challenging the dominant academic perspective. Several challenges are described, for example the ambiguity of the role. Discussion The SIMCA study has been used to illustrate the significant contributions that PPI can make to an implementation study and to the study team culture, in particular the value of having different perspectives within the team to ensure the study does not become too far removed from lived experience. Dilemmas related to the blurring between PPI and data collection and the need for more theoretical understanding of PPI in implementation research to make the findings more generalisable.

Non-Communicable Diseases (NCDs) are now a leading cause of mortality and morbidity globally, and mental illness is a significant part of it. In India, the treatment gap for common mental disorders is over 80%. In order to bridge this gap, mental health treatment models recommend task-shifting to non-specialists and integration of mental health care into general healthcare services. Other NCDs are being managed effectively by non-specialist healthcare workers (HCWs) at primary care, and mental illness and substance misuse are highly comorbid with other NCDs; hence, integrating mental health care within the NCD services and care framework seems logically feasible and effective. However, country-specific characteristics pose a significant challenge to the implementation of integrated care for mental disorders and NCDs. The primary objective of this study includes the development and implementation of a service delivery model that would result in at least 70% coverage of screening, linkage to care, and management of common mental disorders and substance use disorders (MSUD) among persons seeking care for NCDs at public health facilities. Secondary objectives include assessment of the feasibility of adoption of the implementation model by the health care system and to evaluate the cost of the mental health service strengthening intervention package from the health system’s and the patient’s perspectives. It will be a multi-site implementation research study, employing a mixed-methods quasi-experimental, within-site, three-phase, single-arm, interrupted time series design. The implementation model comprises screening, treatment, and linkage of mental health services integrated into NCD care in at least three blocks in each of the seven selected districts of the seven selected states of India, which are geographically far apart. The expected outcome would be to increase the proportion of patients screened and managed for MSUDs among persons seeking care for NCDs at the public health facilities. The results of this implementation research will provide a roadmap for scaling up of integrated MSUDs services within general healthcare.Trial registrationClinicalTrials.gov CTRI/2024/08/072748.

ABSTRACT Advancements in computer technology have revolutionized extended reality (XR) experiences, including augmented reality (AR), virtual reality (VR), mixed reality (MR), and 360° photography and videography. These technologies have found widespread adoption in various educational contexts, from K-12 schools to universities. However, community and technical colleges in the United States have been slower to adopt these innovative instructional modalities. This study was conducted in two phases to investigate factors influencing the adoption of XR technologies at two-year institutions. In the first phase, Advanced Technician Education (ATE) program participants were surveyed (n = 44) on barriers to adoption of XR at two-year institutions. In the second phase, participants from two-year colleges (n = 18) were interviewed guided by the Consolidated Framework for Implementation Research (CFIR) to identify their perceptions and the challenges faced in implementing XR-enabled instruction. Most survey respondents (20.5%) reported a lack of XR knowledge as a reason for not integrating XR into their curricula, followed by the cost of XR hardware and content (10.3%). Lack of knowledge about XR was rated as a “moderate” barrier and hardware and content costs were both rated as “significant” barriers for XR implementation. The qualitative findings identified enhanced visualization, experiential learning, high student engagement, and institutional support for technology implementation as facilitators to XR adoption. In contrast, limited availability of XR educational content, restricted development opportunities of XR content, integration challenges of XR technologies with existing learning management systems, resource constraints, and training needs of educators were reported as hindering the implementation of XR technologies at two-year colleges.

This paper explores an innovative new framework that addresses system-level complexity in long-term care research through the lens of culture change. We first discuss the current findings and gaps in culture change research and explore how a lack of system-level research may have slowed culture change adoption. After a review of potential system-level theories, we identify a conceptual framework that integrates the theoretical constructs of the Consolidated Framework for Implementation Research (CFIR) and Complex Adaptive Systems (CAS) for a more advanced conceptual modeling of culture change implementation. To illustrate the integration of CFIR and CAS as a conceptual framework to research culture change at a system-level, we create a crosswalk using two prominent implementation tools that support culture change: the Preferences for Everyday Living Inventory and the Artifacts of Culture Change 2.0. We argue for the value of this novel conceptual framework in highlighting the complexity of systems in long-term care research.

Natural Language Processing allows extracting unstructured text data from electronic health records (EHR), but historically required extensive coding and expertise. Amazon Comprehend Medical (ACM) offers a scalable solution for mining EHR data without extensive natural language processing expertise. This case study examined barriers and facilitators to implementing ACM in an academic medical center. We reviewed correspondence regarding ACM implementation between study investigators and respective experts within the medical center. We qualitatively coded the correspondence for barriers and facilitators using the Consolidated Framework for Implementation Research (CFIR) framework as a guide. Key findings included the involvement of non-traditional stakeholders in the approval process and unexpected limitations of anticipated facilitators. The study revealed that implementing novel technologies like ACM in academic medical settings requires careful consideration of safety protocols, which may slow adoption. Our findings can guide research teams in navigating the implementation of similar technologies, balancing innovation with necessary safeguards.

Background & objectivesLength of Stay (LoS) is a critical quality metric and focus of improvement efforts in healthcare. Successfully managing LoS depends on understanding the drivers of variation amenable to change. This study aims to (1) characterize physician-level variation in LoS; (2) identify physician actions associated with LoS; and (3) explore the individual-, team-, and hospital-level factors influencing this variation to generate hypotheses for further study.MethodsThis mixed-methods comparative case study approach examined six General Internal Medicine (GIM) departments in Toronto, Ontario. Physician-level variation in LoS was calculated using a random-intercept negative binomial regression model and sensitivity analysis. Semi-structured interviews and ethnographic observations were conducted and analyzed using the AACTT Framework (Action-Actor-Context-Target-Time), the Consolidated Framework for Implementation Research (CFIR), and the Theoretical Domains Frameworks (TDF). Hospitals with the lowest and highest physician-level variation in LoS were compared.ResultsPhysician-level variation in LoS ranged from 1.7 to 7.0%, which—though modest numerically—represents meaningful differences in physician decision-making not explained by patient complexity, and no significant hospital-level effect was observed. Qualitative analysis from 12 observations and 67 interviews (32 GIM physicians and residents, 35 nurses and other health professionals) identified eight discrete physician actions influencing LoS, along with five individual-level factors and five team- and hospital-level factors. The nature of these factors was different when comparing hospitals with the lowest and highest variation. Organizational culture and perceptions of the patient population shaped physician perceptions of their professional role, while GIM departmental culture, structural characteristics, and communication networks informed physician beliefs about team capabilities and consequences of action (or inaction).ConclusionThis study highlights the complex interplay between physician actions and factors influencing physician-level variation in LoS. Interventions that target physicians but do not attend to team and hospital factors are likely insufficient to achieve sustained improvements in LoS. Aligning individual-level feedback and environmental restructuring with organizational values and needs of the patient population may offer a more promising approach to sustained improvement.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13304-5.

Background. Although Lifestyle Redesign® is an important preventive occupational therapy approach fostering meaningful routines to support health and well-being, little data exists to support its implementation in new sociocultural contexts. Purpose. To explore facilitators and barriers to a future implementation of the French-Canadian Lifestyle Redesign® (Remodeler sa vie®) in occupational therapy practice, as perceived by occupational therapists (OTs), occupational therapy students, decision makers and community partners. Method. Guided by the Consolidated Framework for Implementation Research, this action-research study involved 58 purposefully selected participants trained in the approach. Eleven focus groups were conducted using three semi-structured interview guides and facilitation tools. Findings. Participants (86.2% women, aged 20 to 72; mean = 43.2, SD = 12.5) identified 36 influential factors, with public sector OTs facing the most barriers. Key facilitators included the approach's strong evidence base, its relevance to aging populations, key actors' openness and engagement, and new social trends. Barriers stemmed from the approach's complexity, resource constraints, socio-political challenges, implementation efforts and uncertainty about older adults' engagement in this approach. Equitable access to the approach was a common concern. Conclusion. By addressing the factors influencing the implementation of Remodeler sa vie®, this study advances knowledge on integrating preventive approaches to promote healthy aging in Canada and internationally.