Context makes a difference: a qualitative study exploring how to implement a multifactorial falls prevention...

Falls are a major problem in community-dwelling older people. Multifactorial falls prevention interventions are recommended as intervention. However, poor implementation impacts successful outcomes of multifactorial falls prevention interventions. The context is critical to understand variation in implementation and clinical outcomes. This study aims to analyze and describe determinants at all levels of the context that influence the implementation of a multifactorial falls prevention intervention in the community in Flanders (Belgium).

This study consists of semi-structured interviews with 6 key persons, 3 focus group interviews with healthcare professionals (n = 16), 1 focus group with local policy makers (n = 6) and 4 semi-structured interviews and 1 focus group (n = 3) with older people. The Integrated Checklist of Determinants of Practice (TICD checklist) was used to develop the interview guide and to make sure that there was enough understanding of the contextual determinants at the different domains. The interviews and focus groups were verbatim transcribed and analyzed using the Qualitative Analysis Guide of Leuven (QUAGOL). To clarify themes, data were coded in NVivo 12™.

We identified 4 key themes related to successful implementation of a multifactorial falls prevention intervention in the community setting: (1) stakeholder involvement and participation, (2) Fostering awareness, beliefs, knowledge, and skills for falls prevention, (3) working proactively and (4) communication, collaboration, coordination and financing care. This study identified 33 determinants of the TICD checklist and all 7 domains were represented.

Understanding the existing structures, norms, policies and contextual factors allows us to proactively tailor the implementation strategies and a multifactorial falls prevention intervention to the community context.