Factors influencing the implementation of fall-prevention programmes: a systematic review and synthesis of qualitative studies

Abstract

BackgroundMore than a third of people over the age of 65 years fall each year. Falling can lead to a reduction in quality of life, mortality, and a risk of prolonged hospitalisation. Reducing and preventing falls has become an international health priority. To help understand why research evidence has often not been translated into changes in clinical practice, we undertook a systematic review and synthesis of qualitative research in order to identify what factors serve as barriers and facilitators to the successful implementation of fall-prevention programmes.MethodsWe conducted a review of literature published between 1980 and January 2012 for qualitative research studies that examined barriers and facilitators to the effective implementation of fall-prevention interventions among community-dwelling older people and healthcare professionals. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality according to predefined criteria. Findings were synthesised using meta-ethnography.ResultsOf the 5010 articles identified through database searching, 19 were included in the review. Analysis of the 19 studies revealed limited information about the mechanisms by which barriers to implementation of fall-prevention interventions had been overcome. Data synthesis produced three overarching concepts: (1) practical considerations, (2) adapting for community, and (3) psychosocial. A line of argument synthesis describes the barriers and facilitators to the successful implementation of fall-prevention programmes. These concepts show that the implementation of fall-prevention programmes is complex and multifactorial. This is the first systematic review and synthesis of qualitative studies to examine factors influencing the implementation of fall-prevention programmes from the perspectives of both the healthcare professional and the community-dwelling older person.ConclusionsThe current literature on barriers and facilitators to the implementation of fall-prevention programmes examines a variety of interventions. However, the ways in which the interventions are reported suggests there are substantial methodological challenges that often inhibit implementation into practice. We recommend that successful implementation requires individuals, professionals, and organisations to modify established behaviours, thoughts, and practice. The issues identified through this synthesis need to be fully considered and addressed if fall-prevention programmes are to be successfully implemented into clinical practice.

Fall-related experiences of stroke survivors: a meta-ethnography

“…In contrast, Lutz and colleagues simply report that falling was a risk participants were willing to take [31]. This mismatch of falls-risk perception is evident in other syntheses of qualitative studies focussing on falls in older adults [35,36]. McInness and colleagues suggest that while healthcare professionals may focus on physical risk, older people may be more concerned with perceived threats to their identity as able and independent [35].…”

“…McInness and colleagues suggest that while healthcare professionals may focus on physical risk, older people may be more concerned with perceived threats to their identity as able and independent [35]. Child and colleagues describe "hierarchies of expertise" whereby healthcare professionals may assume that older people lack the competency to identify their own falls-risk [36]. Other work has demonstrated that older people place a higher emphasis on maintaining independence as opposed to falls-reduction when choosing to participate in an exercise-based fallsprevention programme [37].…”

“…Multifactorial falls-prevention interventions post stroke have not yet been shown to be effective [38]. Professionals' focus on "risk" may have implications for the uptake of these interventions [36]. It must also be noted that objective "falls-risk" post stroke remains an ill-defined concept as much quantitative research has found that falls are difficult events to predict [9].…”

Quedas no ambiente hospitalar, qualidade e segurança do paciente: metassíntese da literatura.

“…Portanto, é um efeito acumulativo das alterações relacionadas à idade, doenças, meioambiente e pessoal inadequado que predispõem o indivíduo às quedas (13,14) . (17) .…”

Older People’s Perceptions of a Multifaceted Podiatric Medical Intervention to Prevent Falls

“…10 Qualitative studies have revealed that participation in and adherence to falls programs are influenced by several individual, interpersonal, economic, and environmental factors. 9,11 In particular, older people are more likely to engage in and adhere to falls prevention programs if they perceive the interventions to be personally beneficial, consider them to be at an appropriate level for their physical abilities, and consider that the health professionals administering the intervention are sensitive to their needs. 12 Therefore, as the first step in the process of examining the feasibility of translating the findings of this podiatric medical intervention trial into clinical practice, this study was undertaken to explore older people's perceptions of the intervention after they had been involved in the study for 6 months.…”