Barriers and facilitators to implementing electronic Comprehensive Geriatric Assessment (eCGA) in integrated medical and older adults care institutions: a qualitative study guided by the Consolidated Framework for Implementation Research (CFIR)

Comprehensive Geriatric Assessment (CGA) is central to evidence-based care for older adults; however, its implementation in resource-limited primary care settings is often constrained by the enduring gap between clinical evidence and real-world implementation. This challenge is particularly salient within China’s rapidly expanding sector of Integrated Medical and Older Adults Care Institutions (IMOCIs). Understanding the determinants of implementation in this distinct and underexplored setting is therefore important for improving care delivery. We conducted a descriptive qualitative study involving semi-structured interviews with 15 healthcare professionals from 10 IMOCIs in Hunan Province, China. Electronic Comprehensive Geriatric Assessment (eCGA) refers to an app-based digital tool that operationalizes the CGA protocol. Participants were interviewed after approximately one month of early eCGA implementation. Data were analyzed using framework analysis guided by the Consolidated Framework for Implementation Research (CFIR). Qualitative findings were complemented by a researcher-rated sentiment classification of participant-level responses for each determinant-level theme. A central finding emerged: while eCGA was widely perceived as offering a clear relative advantage, it remained difficult to embed into routine practice. We identified 24 determinant-level themes, comprising 14 facilitators and 10 barriers, organized across 18 relevant CFIR constructs. Relative advantage received consistently positive evaluations, whereas major barriers clustered around innovation complexity and high cost in time and personnel. Insufficient external policies and incentives constituted a persistent systemic constraint. At the organizational level, a positive learning culture and strong willingness to collaborate were evident; however, role boundaries , multidisciplinary team structures , and procedural standards were not yet fully established. At the practice level, healthcare professionals frequently adopted selective or modular assessment strategies to enhance feasibility within constrained workflows. From the perspective of healthcare professionals involved in early implementation, eCGA showed clear perceived value but was not yet fully embedded in routine care within China’s primary-level IMOCIs. Sustainable implementation may require coordinated technological, organizational, workforce, and policy support, including workflow redesign, capacity building, multidisciplinary role-sharing, and appropriate financial and policy incentives. Not applicable.