Implementing Osteoporosis Screening in Hong Kong: A CFIR-Guided Qualitative Study of Multi-Stakeholder Perspectives.

OBJECTIVE

This study aimed to explore perceptions of the potential implementation of osteoporosis screening among stakeholders, including service recipients, physicians, and policymakers, in Hong Kong.

METHODS

This qualitative study involved one-on-one, in-depth interviews with key stakeholders relevant to osteoporosis screening in Hong Kong. Interviews explored perceptions of the feasibility and implementation of osteoporosis screening. The updated Consolidated Framework for Implementation Research (CFIR) was employed to guide the development of the interview guide and data analysis, focusing on five domains: Innovation, Outer Setting, Inner Setting, Individuals, and Implementation Process.

RESULTS

A total of 35 participants were included, comprising 12 service recipients, 19 physicians, and 4 policymakers. Within the Innovation domain, the relative advantages of osteoporosis screening were widely recognized by service recipients and physicians, its evidence-based nature was emphasized by physicians. However, policymakers and some physicians raised concerns about the absence of local evidence. In the Outer Setting, financial concerns were consistently identified across stakeholder groups, whereas subsidies and affordable access were viewed as key facilitators of implementation. Within the Inner Setting, service recipients and policymakers reported insufficient dissemination of information, while physicians highlighted the primary barriers related to resource constraints within the clinical setting. At the Individual level, risk awareness and motivation for disease management facilitated participation among service recipients, while policymakers highlighted insufficient awareness about screening and the disease as a barrier. In the Implementation Process domain, service recipients emphasized community-based promotion, physicians highlighted the importance of multi-stakeholder collaboration and professional education, and policymakers identified limited coordination, unclear referral pathways, and difficulties in reaching vulnerable populations as barriers.

CONCLUSION

This study identified perceived facilitators and barriers to implementing osteoporosis screening in Hong Kong, with the absence of local evidence, financial concerns, resource constraints, and low public awareness as major challenges despite recognized benefits. Overcoming these requires coordinated efforts across sectors, including policy support, public-private partnerships, and culturally tailored education to enhance access and participation. Future research should build on these findings to develop context-specific implementation strategies for osteoporosis screening in Hong Kong.

TRIAL REGISTRATION: Not applicable.