A mixed methods process evaluation of a person-centred falls prevention program

Area of Science:

• Gerontology
• Public Health
• Health Services Research

Background:

• The RESPOND program is a telephone-based falls prevention intervention for older adults discharged from hospital emergency departments (EDs).
• A prior randomized controlled trial (RCT) demonstrated RESPOND's effectiveness in reducing falls and fractures but not fall injuries or hospitalizations.

Purpose of the Study:

• To evaluate the implementation fidelity of the RESPOND program.
• To identify barriers and facilitators influencing the program's delivery and uptake.

Main Methods:

• A mixed-methods process evaluation was conducted alongside the RCT.
• Data collection included intervention records, hospital data, session recordings, questionnaires, focus groups, and clinician interviews.
• The Rochester Participatory Decision-Making Scale (RPAD) assessed person-centeredness, and the COM-B framework analyzed implementation barriers and facilitators.

Main Results:

• The program was delivered at a median dose of 2.9 hours over 6 months, less than the planned 10 hours.
• Most participants (76%) received their first session within one month of discharge.
• Clinicians delivered the program in a person-centered manner (median RPAD score 7/9), with 87% of participants satisfied; positive health messages facilitated implementation, while complex health and social issues posed barriers.

Conclusions:

• RESPOND was implemented as a person-centered intervention, achieving falls and fracture reduction at a lower dose and resource use than anticipated.
• The reduced intervention dose may explain the lack of significant impact on fall injuries and hospitalizations.
• Findings offer insights for optimizing future implementation of RESPOND and similar falls prevention programs.