Accepted for/Published in: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Oct 15, 2025
Date Accepted: Sep 15, 2026
Barriers and Facilitators in the Implementation of Digital, Blended, and Analog Evidence-based Osteoarthritis Care: An International Qualitative Expert Interview Study
ABSTRACT
Background:
Non-invasive, multimodal and evidence-based care programs for patients with osteoarthritis (OA) are effective in improving treatment outcomes and reducing the burden of disease. However, the sustainable implementation of such programs in healthcare systems remains a challenge, especially when digital and analog components are combined or the program is to be introduced in multiple countries. Knowledge of the components that promote or hinder implementation is crucial to enable broader acceptance in different healthcare systems and under different conditions.
Objective:
This study aimed to explore factors that facilitate or hinder the implementation of non-invasive care programs for patients with OA. The aim was to identify transferable strategies for successful implementation across national and regional contexts as well as different health conditions and digital, analog as well as blended care approaches.
Methods:
A qualitative study design was used. Twelve experts involved in three evidence-based OA care programs from six countries participated in semi-structured interviews. The interviews focused on multimodal programs, including mixed care, purely digital , and purely analog formats, as well as programs implemented within single or multiple countries. The data were analyzed thematically to identify key implementation factors and evaluate mechanisms of knowledge transfer and international collaboration.
Results:
Major barriers included limited funding and reimbursement structures, insufficient political support, and legal or regulatory constraints. Facilitators included strong leadership, effective interdisciplinary collaboration, structured planning, and contextual adaptation. While international collaboration can reduce initial workload and enhance program quality, it remains underutilized.
Conclusions:
Successful implementation of conservative OA care programs requires sustained funding or investment, stakeholder engagement, and political support. Integrating digital and analog components can enhance scalability and accessibility. The use of structured implementation frameworks and international exchange may foster broader adoption and sustainability. Clinical Trial: Not applicable
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