Table 4 Themes arranged by the CICI-HNA framework to inform commissioning decisions

Implementation context

• • Socioeconomic divide [3–18]

• Linguistic divide/barrier [3–19]

• Health hazards and opportunities in local geography [5-1, 5-2]

• Legal/regulatory barriers for tenants to modify their homes [5-3]

• Culture of communal responsibility that addressed key falls risk factors is no longer strong [5-4]

Provider and organisation

• Positive professional attributes: approachable [1, 2]; aware of community initiatives [3–24]; proactive and person-centred care [3–14]; good relationship with intervention participants [4–9]

• Negative professional attributes: reactive approach [1–26]; partial attention to risk factors [1–6]; commandeering attitude [3–25]

• Facility/equipment: specialist Falls Clinics [1–3]; safe and well-located venues [3–23]

• Positive intervention characteristics: low cost [3–20]; well-staffed [4–16]; enjoyable [3–8]; high social participation [4, 5]; suitable and tailored difficulty [3–13]; safe [3–10]; good timing [3–21]

Health and fall-related motives

• Motivation to maintain health facilitates risk screening and uptake [1–6]

• Previous experience of fall motivates uptake [3-1]

• Experience of the physical ageing process motivates uptake [3-2]

• Experience of intervention reducing falls risk and improving wider health motivates adherence [4-2, 4-3]

• Lack of falls risk and ageing awareness impedes risk screening and uptake [1–15]

Priority setting challenges

• Prioritising access for socially deprived and ethnic minority subgroups [3–19]

• Prioritising access for vulnerable groups: complex comorbidities; cognitively impaired; socially isolated [6-1, 6-2, 6-3]

• Where possible, needs of marginalised groups should be met without denying services to non-marginalised groups [3–27]

Funding and policy

• Health promotion in earlier life course stages [2-1]

• Use of routine data to facilitate risk identification [1]

• Alleviating time constraints in care routine practice [1–7]

• Funding to remove private intervention costs [3–20], sustained over the long term [4–17]

• Auxiliary implementation strategies: information to informal caregivers [2]; community marketing [3–6]; peer health champions [3–5]

Psychosocial motives

• Psychosocial benefits of interventions motivating uptake and adherence: enjoyability [3–8]; social participation [4, 5]

• Good professional-participant relationship facilitates adherence [4–9]

Need/eligibility

• Consider needs of chronically ill, frail and with comorbidities (who may be aged < 65) [4–10]

• Identify appropriate interventions for cognitively impaired [6-2]

• Consider targeting those living in vulnerable circumstances such as socially isolation [6-3]

Intersectoral policy

• Improve public spaces: safer and more health-promoting [5-1, 5-2]

• Change incentives for landlords to modify homes [5-3]

• Make transport cheaper and more accessible [3–23]

• Support community organisations and initiatives [5-4]

External influences on demand

• Older persons are receptive to auxiliary implementation strategies, including community marketing and peer recommendations [3–6]

• Older persons are particularly receptive to professional recommendations [3–14]