Early Implementation of Care Opinion Canada in Alberta’s Primary Care Sector: A Qualitative Process Evaluation Using CFIR

Background Online platforms have expanded opportunities for patients to share their healthcare experiences. Care Opinion, which originated in the United Kingdom, offers a moderated platform that enables patients to share stories about their care and allows healthcare providers to respond. Despite international adoption, there is limited empirical evidence on how Care Opinion is implemented across health system contexts. In 2024, Care Opinion Canada was launched in the province of Alberta, initially focusing on primary care. This study explores barriers and facilitators affecting the early implementation of Care Opinion Canada to guide future program development and expansion. Methods A qualitative process evaluation was conducted with 22 individuals involved in implementing Care Opinion Canada in Alberta, including platform leaders ( n  = 7), operations staff ( n  = 6), strategic partners ( n  = 4), and representatives from healthcare organizations ( n  = 5). Data were collected through semi-structured interviews ( n  = 17) and a focus group with members of the Implementation Council ( n  = 5). Data were analyzed using the Consolidated Framework for Implementation Research (CFIR). Results Eighteen themes were identified as determinants of early implementation, including 10 facilitators and 8 barriers. Key platform-related facilitators involved Care Opinion Canada’s launch by a trusted intermediary organization and its perceived benefit over current feedback methods. External contextual factors offered both challenges and opportunities: system-wide refocusing created uncertainty that hindered uptake, while renewed investment in primary care innovation and performance reporting expectations supported adoption. At organizational and individual levels, commitments to patient engagement and learning encouraged implementation, whereas limited staff capacity, financial constraints, concerns about safeguarding healthcare providers, internal communication gaps, personnel turnover, and feedback fatigue served as barriers. Facilitators in the implementation process included adjusting subscription pricing, leveraging early success stories, and maintaining ongoing communication with subscribers; challenges arose when engagement and onboarding needed to be tailored to the organizational context. Conclusions This study highlights key factors influencing the implementation of Care Opinion Canada within Alberta’s primary care sector. Findings emphasize the importance of values alignment, organizational capacity, and adaptive implementation strategies when introducing narrative-based feedback platforms. These insights can guide implementation across Canada and inform future program revisions, with a focus on tailoring the platform to contextual factors.