Organizational perspectives on fall prevention exercise services in Ontario: a qualitative analysis

Approximately 30% of all older adults fall every year, contributing to major healthcare costs. Although high quality evidence suggests exercise can prevent falls, we do not know the contextual factors influencing their delivery. Our work aims to better understand the context of service delivery from the perspective of organizational representatives in Ontario to inform future interventions that improve the dissemination and implementation of evidence-based exercise services in the community. We conducted a qualitative description by performing interviews with representatives of organizations that deliver fall prevention exercise services in Ontario. We informed our semi-structured interview guide using the Consolidated Framework for Implementation and conducted a thematic analysis from a post-positivist perspective. We found that organisations delivered exercise in three ways: (1) kinesiologists to support trained instructors; (2) hiring kinesiologists to provide exercise services directly; or (3) outsourcing providers with varying qualifications (such as kinesiologists, personal trainers, or yoga instructors). We also present three major themes: funding, capacity, and location were key concerns that limited access to services; networking between organizations existed and was perceived as helpful; and good intentions but major roadblocks to collaboration. In conclusion, funding, location, and capacity shape service delivery in Ontario, limiting provider access and space availability. While networking helps, barriers influence the ability for organizations to collaborate with other organizations. Future research should explore more innovative funding models and organization context in more detail, especially for rural service providers.