Supporting implementation of occupational therapy led Falls Hazard Reduction at Home: A scoping review

Accidental falls among older people pose a significant threat to both morbidity and mortality. Falls Hazard Reduction at Home (FHR@Home) when delivered by occupational therapists has been demonstrated as an effective fall prevention intervention. Despite the evidence, FHR@Home is not routinely implemented in practice. This scoping review seeks to explore existing literature to support implementation of FHR@Home by answering the question: 'What is known about implementation strategies used to support home and community environmental falls prevention intervention in health care?'

This review used the Joanna Briggs Institute (JBI) methodological guidance for the conduct of scoping reviews. A comprehensive search was conducted across electronic databases, government websites, and web-based search engines. Studies were included if they incorporated FHR@Home as part of their intervention and explicitly referenced implementation science or knowledge translation concepts. Data were extracted from the included studies and reported implementation strategies were mapped using the Expert Recommendations for Implementing Change (ERIC) taxonomy and their associated clusters. A separate thematic analysis process was also conducted.

There was no consumer and community involvement.

Nineteen studies met the inclusion criteria. All ERIC implementation strategy clusters are reported on in the studies. Strategies relating to engagement and education of stakeholders appear more often in the literature. Three themes were identified as having influence on implementation outcomes: (1) Home as a practice context; (2) Collaboration is key to success; and (3) Balance of assumed knowledge, experience and fidelity.

The findings underscore the need for further research to explore how implementation strategies can better support occupational therapists in delivering FHR@Home, particularly in ways that respect the consumer's sense of home while maintaining fidelity to evidence-based protocols. Expanding the literature in this area will be beneficial to improve uptake and sustainability of FHR@Home practices.