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

Rebecca L Morris1, Keith D Hill2,3, Ilana N Ackerman4

  • 1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. rebecca.morris@monash.edu.

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|November 30, 2019
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Summary

The RESPOND program, a telephone-based falls prevention initiative for older adults, was found to be person-centered and effective in reducing falls and fractures. However, a lower-than-planned dose may explain its lack of impact on fall injuries and hospitalizations.

Keywords:
Falls preventionemergency departmentfracturesolder adultsprocess evaluation, complex intervention, mixed methods

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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.