Implementing the +ÀGIL Programme: A Participatory Approach to Integrated Care for Older Adults in Primary and Community Settings in Barcelona

As people age, staying active, healthy, and socially connected becomes essential for wellbeing. Aligned with the WHO ICOPE framework (WHO 2017), the +ÀGIL Barcelona programme —led by Primary and Community Care— supports older adults with early signs of frailty in their own environments to maintain intrinsic capacity and live independently for as long as possible. +ÀGIL Barcelona programme is a multidisciplinary initiative driven by Primary and Community Care, aimed at preventing and managing early frailty among community-dwelling older adults (Pérez et al., 2019). It combines personalised, group-based multicomponent interventions, including structured physical exercise, health education on lifestyle habits, with medication optimisation. Previous findings from the programme have demonstrated sustained improvements in intrinsic capacity in older adults living in the community (Ferrara et al., 2023).

 

In this communication, we reflect on the co-design and implementation process of the +ÀGIL programme across three primary care centres in Barcelona, carried out from September 2022 to early 2025. The programme was developed and introduced through a participatory and adaptive approach grounded in co-creation, iterative learning cycles, and shared governance. Accordingly, rather than implementing a pre-defined model, +ÀGIL was developed collaboratively with primary care professionals, community agents, and older adults, adapting to each centre, professional team, and neighbourhood context. This approach sought to ensure alignment with local resources and priorities, enhancing contextual relevance, flexibility and long-term sustainability.

Participatory action research and co-creation methods guided the process. The initial phase focused on co-designing the programme content and delivery model through co-creation workshops and focus groups with primary care professionals, community stakeholders, and older adults, alongside community mapping and more in-depth technical working sessions with primary care teams. Implementation then followed through cycles of testing and adaptation, allowing teams to refine referral pathways, professional roles and materials. A dual governance structure supported implementation at both central and local levels.

+ÀGIL was successfully embedded into routine Primary and Community Care practice, generating progressive uptake and consolidation over time (Mazzarone et al, submitted). A total of 198 older adults showing early signs of frailty participated in the programme during this period. The participatory and adaptive approach enabled each centre to tailor delivery to local needs and resources while maintaining core programme components. Key implementation achievements included establishment of clear referral processes, defined professional roles, co-produced educational materials, integration of community resources, and strengthened collaboration between primary care and neighbourhood organisations.

 

Implementation experience findings emphasised the value of iterative learning cycles, shared governance structures, and learning spaces in fostering ownership and capacity among primary care teams (Sitjà-Rabert, in review). Professionals reported increased confidence in addressing early frailty, improved interprofessional coordination, and enhanced connection with community assets. Older adults expressed high adherence and satisfaction, highlighting accessibility, neighbourhood-based format, and perceived benefits, confidence, and social participation.

Overall, the implementation process demonstrated that co-design, structured governance, and adaptive deployment strategies can support the sustainable integration of a multidomain frailty intervention within Primary and Community Care settings. The programme’s implementation-research approach allows real-world evaluation and continuous adaptation to local contexts