Barriers and Facilitators to Adopting a Risk Assessment and Management Decision Support Approach For Safety Concerns of Older Adults: a Multimethods Study

Background The Living with Risk: Decision Support Approach (LwR:DSA) was developed to address the lack of structured approaches for assessing and managing risk among healthcare professionals (HCPs) supporting older adults with perceived safety concerns. Early use of the LwR:DSA demonstrated potential to expand person-centred, balanced discussions of risk; however, strategies to support its adoption in hospital and community settings remain unclear. This study aimed to describe LwR:DSA adoption and identify multilevel barriers and facilitators influencing its adoption so that the tool and implementation strategies could be appropriately tailored. Methods A multimethod implementation study was conducted. Quantitative survey data were analysed descriptively, and qualitative interview data were analysed using reflexive content analysis guided by the five domains of the Consolidated Framework for Implementation Research (CFIR). Findings were integrated and categorized across the five CFIR domains to identify multilevel determinants influencing adoption. Results Of 26 participants, eighty percent adopted the LwR:DSA at least once during an eight-week implementation period and identified 20 determinants across all CFIR domains. Six constructs acted solely as facilitators, one as a barrier, and thirteen as mixed determinants. Key determinants of LwR:DSA adoption were knowing with whom to use the LwR:DSA (Outer Setting), knowing how to integrate into practice, using the LwR:DSA as a team, having supportive leadership, working in an innovative workplace with good relationships with colleagues (Inner Setting), finding the LwR:DSA easy to use (Innovation), having an in-depth foundational knowledge related to the LwR:DSA (HCPs) and using champions (Implementation Process). Conclusions Application of the CFIR provided a comprehensive understanding of multilevel factors influencing LwR:DSA adoption across hospital and community settings. These determinants can be leveraged to inform the selection and tailoring of implementation strategies to enhance uptake and sustainability. Embedding these determinants within future implementation efforts offers a practical pathway to strengthen person-centred, risk-informed decision-making practices across geriatric care contexts.