Implementation of a national aging-in-place reform: a qualitative study exploring facilitators and barriers from the perspectives of employees in six Norwegian municipalities.

backgroundDespite many older individuals in Norway experiencing fulfilling lives, the effectiveness of local solutions for quality aging in place is inconsistent across different municipalities. To address this, White Paper No. 15, A Quality Reform for Older Adults, was introduced in Norway in 2019, targeting the challenges associated with aging in place and maintaining quality of life, irrespective of health status or location. The reform was based on recommendations from stakeholders: staff, older adults, relatives, volunteers, researchers, and leaders. This study explored how barriers, facilitators, and context interact in implementing a national aging-in-place reform and how these dynamics can inform actionable strategies for successful and context-sensitive implementation as experienced by municipal employees.

methodsThis qualitative study, utilizing a process evaluation design and the Consolidated Framework of Implementation Research (CFIR), forms part of a larger reform evaluation. This study focuses on six Norwegian municipalities of varying sizes, from three counties in central, south, and north Norway, selected due to their focus on institutional or home care and their demographics. Data was collected through focus group discussions with municipal employees (N = 36), who represent a wide range of professional backgrounds and experiences.

resultsThe final analysis resulted in five main themes, structured in line with the CFIR framework: i) Policy Translation: Making Sense of the Reform in Local Context, ii) National Framing: Navigating Through Pandemic and Diversity, iii) Local Governance: The Need for a Common Implementation Platform, iv) Stakeholder Dynamics: The Importance of Interplay of Different Actors, and v) Sustainability Uncertainty: Lack of Clear Reform Responsibility. The themes provide an overview of facilitators and barriers during the reform implementation.

conclusionsThe study found that despite municipalities' diverse engagement with the reform's focus areas, there is potential for more effective implementation. Municipal employees agreed with the reform's ideas but struggled with its innovative aspects, indicating a need for clearer guidelines through top-down strategies. Facilitators were identified, but barriers such as the COVID-19 pandemic, municipal diversity, and funding issues created challenges. Insufficient leadership and inter-sector collaboration were primary obstacles. These findings are crucial for future reform implementation and service quality improvement.