Preventing Falls Among Older Adults in Primary Care: A Mixed Methods Process Evaluation Using the RE-AIM Framework

Abstract

Background and Objectives Falls are a leading cause of injuries and injury deaths for older adults. The Centers for Disease Control and Prevention’s Stopping Elderly Accidents Deaths and Injuries (STEADI) initiative, a multifactorial approach to fall prevention, was adapted for implementation within the primary care setting of a health system in upstate New York. The purpose of this paper is to: (a) report process evaluation results for this implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and (b) examine the utility of RE-AIM for assessing barriers and facilitators. Research Design and Methods This evaluation used mixed methods. Qualitative evaluation involved semi-structured interviews with key stakeholders and intercept interviews with healthcare providers and clinic staff. Quantitative methods utilized surveys with clinic staff. Process evaluation tools were developed based on the AIM dimensions of the RE-AIM framework. The study was conducted over a 2-month period approximately 18 months post-implementation and complements previously published results of the program’s reach and effectiveness. Results Primary barriers by RE-AIM construct included competing organizational priorities (Adoption); competing patient care demands (Implementation); and staff turnover (Maintenance). Primary facilitators included having a physician champion (Adoption); preparing and training staff (Implementation); and communicating about STEADI and recognizing accomplishments (Maintenance). Discussion and Implications Results revealed a high degree of concordance between qualitative and quantitative analyses. The framework supported assessments of various stakeholders, multiple organizational levels, and the sequence of practice change activities. Mixed methods yielded rich data to inform future implementations of STEADI-based fall prevention.

Contextual determinants influencing the implementation of fall prevention in the community: a scoping review

“…Data-extraction of descriptive data showed that in seven studies ( 38 – 40 , 43 , 46 , 48 , 49 ), only health care professionals (e.g., physical therapists, general practitioners, pharmacists, allied health assistances, occupational therapists) were included. In the other studies, there was a combination of health care and social care professionals (e.g., informal care, social service workers) ( 41 , 47 ) and/or other professionals (e.g., clinical support staff, fitness leaders, practice site leaders, volunteers) ( 42 , 44 , 45 , 50 – 52 ). Furthermore, eleven studies ( 38 – 40 , 42 – 45 , 48 – 50 , 52 ) focused primarily on primary care as setting; the other four studies ( 41 , 46 , 47 , 51 ) concentrated on a broader community-based setting.…”

“…In the other studies, there was a combination of health care and social care professionals (e.g., informal care, social service workers) ( 41 , 47 ) and/or other professionals (e.g., clinical support staff, fitness leaders, practice site leaders, volunteers) ( 42 , 44 , 45 , 50 – 52 ). Furthermore, eleven studies ( 38 – 40 , 42 – 45 , 48 – 50 , 52 ) focused primarily on primary care as setting; the other four studies ( 41 , 46 , 47 , 51 ) concentrated on a broader community-based setting. Ten studies ( 39 – 41 , 44 – 49 , 52 ) used qualitative approaches only, such as semi-structured interviews and focus groups, whereas five studies ( 38 , 42 , 43 , 50 , 51 ) applied mixed methods with a qualitative and quantitative approach (e.g., surveys and documents).…”

“…Furthermore, eleven studies ( 38 – 40 , 42 – 45 , 48 – 50 , 52 ) focused primarily on primary care as setting; the other four studies ( 41 , 46 , 47 , 51 ) concentrated on a broader community-based setting. Ten studies ( 39 – 41 , 44 – 49 , 52 ) used qualitative approaches only, such as semi-structured interviews and focus groups, whereas five studies ( 38 , 42 , 43 , 50 , 51 ) applied mixed methods with a qualitative and quantitative approach (e.g., surveys and documents). Of all included studies, three were conducted in Norway ( 39 , 44 , 45 ), three in Australia ( 40 , 49 , 51 ), three in the Netherlands ( 43 , 48 , 50 ), two in Canada ( 46 , 47 ), two in Switzerland ( 38 , 41 ) and two in the United States of America ( 42 , 52 ) ( Table 1 ).…”

“…According to the results of seven studies ( 38 , 42 – 44 , 48 , 49 , 52 ) and two CMs a,d , a degree of “complexity” of the intervention influences implementation. In the study by Worum, et al (2019) ( 44 ), participants highlighted that information on the intervention program is often perceived as complex, with terminological challenges and differently defined guidelines.…”

“…Determinants about the “cost” of the intervention derived from both literature ( 38 , 42 , 48 ) and three CMs a,c,d . This refers to the—sometimes significant—financial contribution which is required for participation in FPIs, which can be a major barrier to some older adults.…”