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Process factors explaining the ineffectiveness of a multidisciplinary fall prevention programme: a process evaluation.

Bleijlevens MH, Hendriks MR, van Haastregt JC, van Rossum E, Kempen GI, Diederiks JP, Crebolder HF, van Eijk JT - BMC Public Health (2008)

Bottom Line: Main factors that seem to be responsible for the lack of effectiveness are the relatively low number of referrals and recommendations ensuing from the medical assessments and participants' low compliance as regards contacting their GP about the results of the medical assessment.We do not recommend implementing the programme in its present form in regular care.ISRCTN64716113.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO box 616, 6200 MD Maastricht, The Netherlands. m.bleijlevens@socmed.unimaas.nl

ABSTRACT

Background: Falls are a major health threat to older community-living people, and initiatives to prevent falls should be a public health priority. We evaluated a Dutch version of a successful British fall prevention programme. Results of this Dutch study showed no effects on falls or daily functioning. In parallel to the effect evaluation, we carried out a detailed process evaluation to assess the feasibility of our multidisciplinary fall prevention programme. The present study reports on the results of this process evaluation.

Methods: Our fall prevention programme comprised a medical and occupational-therapy assessment, resulting in recommendations and/or referrals to other services if indicated. We used self-administered questionnaires, structured telephone interviews, structured recording forms, structured face-to-face interviews and a plenary group discussion to collect data from participants allocated to the intervention group (n = 166) and from all practitioners who performed the assessments (n = 8). The following outcomes were assessed: the extent to which the multidisciplinary fall prevention programme was performed according to protocol, the nature of the recommendations and referrals provided to the participants, participants' self-reported compliance and participants' and practitioners' opinions about the programme.

Results: Both participants and practitioners judged the programme to be feasible. The programme was largely performed according to protocol. The number of referrals and recommendations ensuing from the medical assessment was relatively small. Participants' self-reported compliance as regards contacting their GP to be informed of the recommendations and/or referrals was low to moderate. However, self-reported compliance with such referrals and recommendations was reasonable to good. A large majority of participants reported they had benefited from the programme.

Conclusion: The results of the present study show that the programme was feasible for both practitioners and participants. Main factors that seem to be responsible for the lack of effectiveness are the relatively low number of referrals and recommendations ensuing from the medical assessments and participants' low compliance as regards contacting their GP about the results of the medical assessment. We do not recommend implementing the programme in its present form in regular care.

Trial registration: ISRCTN64716113.

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Related in: MedlinePlus

Flow chart of participants.
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Figure 1: Flow chart of participants.

Mentions: The flow of participants through the process evaluation is shown in figure 1. Of the 166 persons allocated to the intervention group, 28 (17%) did not undergo any assessment because they withdrew from the study before the start of the assessments (n = 27) or had a problem with scheduling the assessments (n = 1). A total of 138 participants underwent at least one of the two assessments: 120 underwent both assessments, ten only the medical assessment and eight only the occupational-therapy assessment. Reasons for undergoing only one assessment were personal circumstances (n = 14) and withdrawal from the study before the occupational-therapy assessment was scheduled (n = 4). None of these reasons were related to the programme. All 130 participants who underwent the medical assessment received a self-administered evaluation questionnaire immediately after the medical assessment. The response to this questionnaire was 100%. Of the 138 participants who underwent at least one assessment, thirteen withdrew from the study after completing the medical and/or occupational-therapy assessment. The remaining 125 participants were contacted for a structured interview by phone, about six months after the results of the assessments had been sent to the GPs. Two persons could not be contacted, resulting in a response of 98%. Of these 123 participants, 116 had undergone the medical assessment and 117 had undergone the occupational-therapy assessment.


Process factors explaining the ineffectiveness of a multidisciplinary fall prevention programme: a process evaluation.

Bleijlevens MH, Hendriks MR, van Haastregt JC, van Rossum E, Kempen GI, Diederiks JP, Crebolder HF, van Eijk JT - BMC Public Health (2008)

Flow chart of participants.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2570681&req=5

Figure 1: Flow chart of participants.
Mentions: The flow of participants through the process evaluation is shown in figure 1. Of the 166 persons allocated to the intervention group, 28 (17%) did not undergo any assessment because they withdrew from the study before the start of the assessments (n = 27) or had a problem with scheduling the assessments (n = 1). A total of 138 participants underwent at least one of the two assessments: 120 underwent both assessments, ten only the medical assessment and eight only the occupational-therapy assessment. Reasons for undergoing only one assessment were personal circumstances (n = 14) and withdrawal from the study before the occupational-therapy assessment was scheduled (n = 4). None of these reasons were related to the programme. All 130 participants who underwent the medical assessment received a self-administered evaluation questionnaire immediately after the medical assessment. The response to this questionnaire was 100%. Of the 138 participants who underwent at least one assessment, thirteen withdrew from the study after completing the medical and/or occupational-therapy assessment. The remaining 125 participants were contacted for a structured interview by phone, about six months after the results of the assessments had been sent to the GPs. Two persons could not be contacted, resulting in a response of 98%. Of these 123 participants, 116 had undergone the medical assessment and 117 had undergone the occupational-therapy assessment.

Bottom Line: Main factors that seem to be responsible for the lack of effectiveness are the relatively low number of referrals and recommendations ensuing from the medical assessments and participants' low compliance as regards contacting their GP about the results of the medical assessment.We do not recommend implementing the programme in its present form in regular care.ISRCTN64716113.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO box 616, 6200 MD Maastricht, The Netherlands. m.bleijlevens@socmed.unimaas.nl

ABSTRACT

Background: Falls are a major health threat to older community-living people, and initiatives to prevent falls should be a public health priority. We evaluated a Dutch version of a successful British fall prevention programme. Results of this Dutch study showed no effects on falls or daily functioning. In parallel to the effect evaluation, we carried out a detailed process evaluation to assess the feasibility of our multidisciplinary fall prevention programme. The present study reports on the results of this process evaluation.

Methods: Our fall prevention programme comprised a medical and occupational-therapy assessment, resulting in recommendations and/or referrals to other services if indicated. We used self-administered questionnaires, structured telephone interviews, structured recording forms, structured face-to-face interviews and a plenary group discussion to collect data from participants allocated to the intervention group (n = 166) and from all practitioners who performed the assessments (n = 8). The following outcomes were assessed: the extent to which the multidisciplinary fall prevention programme was performed according to protocol, the nature of the recommendations and referrals provided to the participants, participants' self-reported compliance and participants' and practitioners' opinions about the programme.

Results: Both participants and practitioners judged the programme to be feasible. The programme was largely performed according to protocol. The number of referrals and recommendations ensuing from the medical assessment was relatively small. Participants' self-reported compliance as regards contacting their GP to be informed of the recommendations and/or referrals was low to moderate. However, self-reported compliance with such referrals and recommendations was reasonable to good. A large majority of participants reported they had benefited from the programme.

Conclusion: The results of the present study show that the programme was feasible for both practitioners and participants. Main factors that seem to be responsible for the lack of effectiveness are the relatively low number of referrals and recommendations ensuing from the medical assessments and participants' low compliance as regards contacting their GP about the results of the medical assessment. We do not recommend implementing the programme in its present form in regular care.

Trial registration: ISRCTN64716113.

Show MeSH
Related in: MedlinePlus