Adapting Evidence-Based Falls Prevention Programs for Remote Delivery - Implementation Insights through the RE-AIM...

Area of Science:

• Public Health
• Gerontology
• Health Services Research

Background:

• COVID-19 exacerbated health risks for older adults, particularly those with chronic conditions, increasing falls risk and social isolation.
• Physical distancing mandates necessitated the transition of in-person evidence-based falls prevention programs (EBFPPs) to remote delivery models.
• Remote EBFPP delivery is crucial for maintaining health, preventing falls and injuries, reducing hospitalizations, and combating social isolation among older adults and persons with disabilities.

Purpose of the Study:

• To evaluate the adaptation and implementation process of four EBFPPs transitioned to remote delivery.
• To identify best practices for remote EBFPP implementation using the RE-AIM framework.
• To examine program adaptations, reach, and implementation outcomes (acceptability, feasibility, fidelity, costs) with a focus on equity.

Main Methods:

• Qualitative implementation evaluation involving semi-structured interviews (N=22) with program administrators, staff, and leaders.
• Purposive sampling of organizations to ensure variation in type, location, and reach to underserved populations (e.g., BIPOC, rural, individuals with disabilities).
• Utilized the FRAME (Wiltsey-Stirman, 2019) and Proctor et al. (2011) frameworks to analyze adaptations and implementation outcomes.

Main Results:

• Remotely delivered EBFPPs underwent planned, fidelity-consistent adaptations, prioritizing participant safety in content and delivery.
• Technology access and support were essential for engagement, improving over time, though the digital divide persisted as a barrier.
• Remote delivery increased access for some groups (caregivers, rural dwellers, persons with disabilities) but was more resource-intensive and costly than in-person programs.

Conclusions:

• Remote EBFPPs demonstrated acceptability and feasibility, with successful adaptations maintaining fidelity.
• While expanding reach to underserved populations, particularly disability communities, the digital divide requires ongoing attention.
• Findings offer critical insights for funders and organizations on adapting EBFPPs for effective and equitable remote delivery.