Pre-implementation barriers and facilitators to implementing a physical activity guideline for community-dwelling older adults with mild cognitive impairment: a qualitative stakeholder study

Physical activity (PA) may help delay the progression of mild cognitive impairment (MCI), but implementing clinical practice guidelines for PA in community settings can be challenging. This qualitative pre-implementation study examined barriers and facilitators to the future implementation of the PAG-CD in participating community settings in Shenyang, China, from multiple stakeholder perspectives. We used a qualitative descriptive design from October to December 2025. Guided by the Consolidated Framework for Implementation Research 2.0 (CFIR 2.0), semi-structured interviews were conducted with 33 stakeholders from one residential community and two community health service centers in Shenyang, China, including older adults with MCI, caregivers, community healthcare professionals, and community workers. Data were analyzed using content analysis that combined deductive and inductive approaches. Across 19 CFIR 2.0 constructs, 24 barriers and 25 facilitators were identified. Major barriers included limited fit of standardized recommendations to individual needs; shortages of personnel and professional resources and heavy workloads; short-term interorganizational collaboration and insufficient ongoing professional support; lack of shared accountability mechanisms and concerns about safety-related liability; and insufficient health information feedback and lack of continuous, traceable documentation. Major facilitators included stakeholders’ recognition of the authority of the guideline developers and their positive perceptions of the guideline’s evidence base; functional stratification and content simplification; family monitoring and support and trust in community healthcare professionals; and digital communication and video-based support. This study identified multilevel barriers and facilitators during the pre-implementation phase of the PAG-CD in the participating community settings in Shenyang, China. Interviews with older adults with MCI and caregivers highlighted individual and family conditions relevant to physical activity participation, whereas healthcare professionals and community workers identified issues relevant to PAG-CD implementation, including guideline fit, resource constraints, interorganizational collaboration, role delineation, risk management, and feedback mechanisms. Based on these findings, the research team proposes several preliminary implementation considerations, including stratified adaptation based on the functional status and exercise-related risks of older adults with MCI, stable interorganizational collaboration with clearly defined roles, and implementation support through implementer training, standardized risk-management procedures, and low-burden feedback mechanisms.