Perceptions of frail older adults and professionals on adherence to a multidomain community programme to prevent disability: a descriptive qualitative study of + AGIL Barcelona.

PURPOSE: Sustained adherence is essential for the effectiveness of community-based multidomain interventions aimed at preventing disability in older adults with initial frailty. This study explores the perspectives of older adults and primary care professionals involved in the + AGIL Barcelona programme to understand the factors that facilitate or hinder sustained adherence and provide evidence for improving its implementation and scalability.

METHODS

A qualitative descriptive study was conducted in three primary care centres in Barcelona implementing the + AGIL programme. Participants were purposively selected to ensure information-rich perspectives. Six homogeneous focus groups were conducted with older adults meeting criteria for initial frailty (n = 22; mean age 82 years) and primary care professionals (n = 18), facilitated by two experienced qualitative researchers. Discussions were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis. Rigour was ensured through independent coding, reflexive discussion, consensus, and data saturation confirmation.

RESULTS

Adherence emerged as a multidimensional and context-dependent process shaped by professional, personal, and community-related factors. Empathetic communication, individualised exercise prescription, and group cohesion acted as key facilitators for motivation, autonomy, and the adoption of new healthy routines. Conversely, caregiving responsibilities, socioeconomic vulnerability, and limited access to community resources hindered the maintenance of behaviours over time. Organisational continuity and stronger healthcare-community coordination were perceived as essential for sustainability.

CONCLUSION

Adherence to multidomain interventions depends not only on programme content but also on delivery processes and contextual embedding within participants' lived realities. Strengthening behavioural support and healthcare-community integration is vital to enhance long-term sustainability and scalability in primary care settings.