From research to practice: a pilot implementation study of a falls self-efficacy tool in a community hospital

Inpatient falls are serious adverse events that contribute to functional decline and adverse outcomes. Overconfidence in mobility, and reluctance to seek assistance, are often difficult for staff to detect in the absence of a structured tool. The Multidimensional Falls Efficacy Scale (MdFES) was developed to assess patients' confidence across fall prevention, recovery, and self-protection domains. This pilot implementation feasibility study evaluated the early adoption of the MdFES in a community hospital, using the Proctor Implementation Outcomes framework to examine patient and nurse perspectives.

A mixed-methods pilot was conducted in Singapore community hospitals involving 90 patients and 32 nurses. Quantitative data were collected across multiple implementation outcomes-including acceptability, appropriateness, feasibility, cost, and fidelity-using structured questionnaires, with results reported as mean ± SD. Qualitative data from open-ended responses were thematically analysed to identify barriers and facilitators to MdFES implementation.

Patients reported high acceptability [Acceptability of Intervention Measure (AIM)] = 17.48 ± 2.66) and appropriateness [Intervention Appropriateness Measure (IAM)] = 17.54 ± 2.75), with 80% agreeing with their MdFES results and an average completion time of 3.12 ± 2.23 min, indicating low perceived burden. In contrast, nurses reported moderate acceptability (AIM = 12.72 ± 2.11), appropriateness (IAM = 13.19 ± 3.17), and feasibility [Feasibility of Intervention Measure (FIM)] = 13.47 ± 2.66), citing language barriers, cognitive limitations, and workflow constraints as key challenges. Fidelity was affected, with frequent rewording and translation required. Qualitative themes highlighted the need for translated versions, simplified wording, and workflow integration.

This pilot feasibility study demonstrates that the MdFES is acceptable and meaningful to patients, while revealing modifiable feasibility challenges for nurses. These early findings provide essential insights to guide workflow adaptations, stakeholder engagement, and contextual modifications required before proceeding to a larger-scale, multi-centre implementation study.