Table 2.

Barriers and facilitators specific to fracture prevention

Barrier	Supporting Quotation
Language barrier between staff and residents/family	“Perhaps language barriers? […] knowing the complexity and the range of residents and families whereas staff may not speak the language.”
Lack of access to required software	“So in my home, we don’t use PointClickeCare [software]. So lack of access to the actual software or information systems.”
Lack of expertise in the use of technology	“Sometimes [technology] can also be a barrier.”
	“It can. Yeah. If it's not implemented correctly. It also depends on the level on the level of expertise with technology that the staff has.”
Training to a limited population	“We could do a lot of work to put together the CAP, and we do a lot of training to a very small proportion of people on what those CAPs mean, but the individuals that are really implementing theses at a clinical level, they never see these values.”
Lack of physician involvement	“Any time physicians are involved and are a key player in an intervention, they are not…they don’t have the same vested interest because they’re not really involved in quality improvement in our villages, because they have their own separate private practice.”
Facilitator
Checkpoints – another time to carry out the intervention if it was missed due to time constraints	“Maybe they also need more than one point of care. So, if it’s missed because of the lack of time and resources. You never know what’s happening in a day. There should be another checkpoint.”
Sharing best practices across the care home sector	“A system that allows your support homes to share best and leading practices with other homes. As an alternative to compliance inspectors, facilitators of knowledge exchange and translation across the sector.”
Technology	“...definitely technology. Some technology that can help facilitate implementation.”
Value proposition	“Every time I knew there was something they were going to be losing, I try to find, what are they gaining? So we have a conversation here, can't do this for us, but you can do this for us.”
Existing avenues to implement change in LTCs	“I think a facilitator is that long-term care is really used to changing and there are a lot of the existing avenues that you can use to implement change, like best practice spotlights, all of the medication reduction that we've done related to antipsychotic use…residents and family councils, like there are huge number of avenues that you can access if you're trying to make a change and we're really used to change.”