Decoding why patients follow-or do not follow-fall-prevention instructions using the revised protection motivation...

Patient falls remain a persistent problem in healthcare settings, requiring numerous preventive interventions. However, existing systematic reviews have not demonstrated the effectiveness of these interventions in reducing fall rates and the number of fallers. Successful fall-prevention requires not only healthcare providers' efforts but also patients' active cooperation and engagement. Yet the mechanisms through which patients become motivated to follow nurses' fall-prevention instructions, and the factors influencing their adherence, remain unclear.

This study examined factors associated with patients' motivation and adherence to nurses' fall-prevention instructions in hospital settings, drawing on the revised Protection Motivation Theory.

A cross-sectional design.

Hospitals nationwide in Japan.

A total of 304 patients recruited nationwide in Japan, aged ≥60 years, hospitalised on general wards for at least 24 h, and who had received nurse-provided fall-prevention instructions, participated in the study.

Participants were invited to complete an online survey containing a newly developed protection motivation scale. Data were analysed using partial least squares structural equation modelling.

The revised Protection Motivation Theory showed greater predictive power than the original theory in explaining patients' fall-prevention motivation. Perceived severity of falls (β = 0.185, 95% CI[0.059, 0.307]), perceived effectiveness of the instructions (response efficacy) (β = 0.299, 95% CI[0.113, 0.492]), self-efficacy in performing the recommended actions (β = 0.311, 95% CI[0.124, 0.484]), and a supportive nurse-patient relationship (β = 0.199, 95% CI[0.069, 0.342]) were all significantly and positively associated with patients' motivation to follow nurses' instructions. Among these, self-efficacy (f² = 0.128) and response efficacy (f² = 0.084) showed the largest and second-largest effect sizes, respectively. Adherence to fall-prevention instructions was positively predicted by motivation (β = 0.376, 95% CI[0.208, 0.532]) and self-efficacy (β = 0.270, 95% CI[0.094, 0.443])-again with the largest (f² = 0.148) and second-largest (f² = 0.070) effect sizes-and negatively predicted by perceived response costs (β = -0.114, 95% CI[-0.224, -0.014]) and sex (β = -0.119, 95% CI[-0.211, -0.023]).

To enhance patients' motivation to engage in fall-prevention strategies, nurses should emphasise the potential consequences and seriousness of falls rather than focusing solely on patients' vulnerability. More importantly, strengthening patients' confidence in both the effectiveness of preventive measures and in their own ability to apply them-supported by a positive nurse-patient relationship-may be particularly effective. As patients move into the active implementation stage, nurses should continue to reinforce response efficacy and self-efficacy. Of particular note is that bolstering self-efficacy appears critical, as it may help patients overcome challenges encountered during implementation.

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