Development of a Complex Intervention for Promoting Participation in Resistance Exercise among Community-dwelling Frail Older Adults in China: A Multi-Method Qualitative Study

Abstract Background and Objectives Regular resistance exercise (RE) showed a promising effect in reducing frailty in older adults. However, the participation of RE among this population remains low. This study was, therefore, aimed at developing a complex intervention tailored to community-dwelling frail older adults in China to promote participation in RE and reduce frailty ultimately. Research Design and Methods Using a multi-methods qualitative study design, this study included two parts: (1) a qualitative study was performed to explore barriers and facilitators for participation in RE among frail older adults through stakeholder interviews. The interview was guided by the comprehensive framework of implementation research; (2) two rounds of expert consultation, guided by the social cognitive theory, were conducted to identify the key barriers and facilitators, and corresponding implementation strategies for promoting participation in RE. A complex intervention was developed accordingly. Results Interviews were conducted with 16 frail older adults (mean age=72.9) and 10 community workers (mean working years=11.2). A total of 10 barriers, 16 facilitators were identified, safety concerns, decline in physical function and lack of knowledge were frequently mentioned barriers, while health needs, social support, and professional guidance were common facilitators. Then 10 experts (mean working years=20.9) were consulted to determine the main barriers and facilitators, and a list of corresponding implementation strategies was developed subsequently. Thus, a tailored complex intervention delivered by community workers in the community setting, including the core component of "group elastic-band RE”, and supplementary components of “community education, feedback, goal setting, and reinforcement guidance" was developed. Discussion and Implications This study constructed a list of key barriers and facilitators as well as corresponding implementation strategies for promoting participation in RE among community-dwelling frail older adults. A tailored complex intervention was developed accordingly, which will facilitate the management of frail older adults in the Chinese community setting.