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Background As the older population grows rapidly, the incidence of falls and fall-related injuries is rising, underscoring the urgent need for systematic, evidence-based fall prevention.Objective This study aimed to examine the implementation of the World Falls Guidelines for falls prevention in a region of Sweden, with particular attention to the implications of anchoring and developing a knowledge support tool within policy and practice.Methods A participatory research design was employed, involving five diverse settings: primary care, hospital care, homecare, municipal social services and pensioners' organizations. Data collection included workshops, field notes and written material. Early implementation processes focused on anchoring and developing, aligning with the i-PARIHS framework. The data were analysed using a framework analysis.Results The anchoring process revealed a lack of managerial support at the appropriate organizational level, which hindered cross-sectoral collaboration. Further, the developing process refined the content structure to better address the needs of both professionals and older adults. Seven themes were mapped by using i-PARIHS framework: (i) Innovation-adoption and adaptation, risk assessment; (ii) Recipients-intermediate managerial decision-making; (iii) Context-collaboration and resources, documentation and information sharing and accessibility and outreach and (iv) Facilitation-project or process.Conclusion Successful implementation requires anchoring and organizational alignment across all levels, with particular emphasis on the engagement of intermediate management. While the primary challenges emerge at the organizational (meso) level, they are closely interconnected with both micro-level and macro-level influences. Coordinated efforts across all levels are therefore essential for effective implementation strategies.