Barriers and Facilitators in the Implementation of Digital, Blended, and Analog Evidence-Based Osteoarthritis Care: International Qualitative Expert Interview Study

Background: Evidence-based nonsurgical osteoarthritis (OA) care programs improve patient outcomes and may reduce the burden of disease. Despite their demonstrated effectiveness, their implementation into routine health care remains limited across health care systems. Understanding factors that facilitate or hinder implementation is essential to support broader adoption and long-term sustainability worldwide. Objective: This study aimed to explore factors that facilitate or hinder the implementation of evidence-based nonsurgical OA care programs. Specifically, it examined implementation across different health care settings, implementation phases, and analog, digital, and blended care models to identify transferable insights for implementation in different national and regional contexts. Methods: We conducted a qualitative expert interview study with 12 international experts involved in evidence-based OA care programs implemented across 6 countries. Semistructured interviews explored experiences with program development, implementation, and further development of analog, digital, and blended care models. Interview transcripts were analyzed using qualitative content analysis according to Kuckartz, using deductive and inductive category development. Results: Key barriers included limited funding and reimbursement structures, insufficient political support, organizational complexity, and legal or regulatory requirements. Important facilitators comprised strong leadership, interdisciplinary collaboration, structured communication, adaptation to local health care contexts, and the use of existing international program structures. Participants further emphasized that implementation requirements varied across the preparation, initial implementation, and consolidation phases, highlighting the need for phase-specific implementation strategies. Conclusions: Successful implementation of evidence-based nonsurgical OA care programs requires sustainable funding, stakeholder engagement, context-specific adaptation, and structured implementation planning across all implementation phases. Existing international program structures and collaboration may facilitate implementation across health care systems while reducing development efforts. Future implementation initiatives should consider phase-specific requirements and local contextual factors to improve long-term adoption and sustainability.