Fall prevention programs for culturally and linguistically diverse groups: program provider perspectives

Objectives: Older people from culturally and linguistically diverse (CALD) backgrounds are one of the fastest growing and rapidly ageing population segments in Australia. This qualitative study aims to explore the experiences, needs and challenges that individual program providers encountered in implementing and delivering a fall prevention program for CALD groups and meeting the linguistic, cultural and contextual needs of the program participants. Design: Semi-structured in-depth interviews were conducted with a convenience sample of 24 program providers implementing, delivering or supporting fall prevention programs including Stepping On for CALD groups. Interview transcripts were analysed using thematic analysis. Results: Two major themes emerged: (1) extra layers of complexity are needed in program planning, delivery, recruitment and enabling participation of older people from CALD background and (2) program leaders ‘going the extra mile’ influences success of the program. Complexity included accommodating the linguistic and sociocultural needs in planning the programs, knowing and using the ‘right way’ to reach and deliver the program to CALD groups and understanding the nuances of facilitating program participation. While it was important to ensure the acceptability and accessibility of the program for the older people from diverse CALD communities, it was the drive and determination of the program leader and their striving for cultural relevance that made the program possible. Sustainability and wider implementation requires unique support and additional resources. Conclusion: These findings can be used by program providers, policy-makers and health researchers to improve the capacity of fall prevention programs to better respond to the growing diversity in needs and preferences among older populations in Australia and internationally

Evaluation of a staff behaviour change intervention to increase the use of ward-based practice books and active practice during inpatient stroke rehabilitation: a phase-1 pre-post observational study.

OBJECTIVE:The aim of this study was to evaluate a staff behaviour change intervention to increase the use of ward-based practice books and active practice by stroke inpatients. DESIGN:This is a pre-post observational study. SETTING:This study was conducted in a inpatient rehabilitation unit in Australia. SUBJECTS:Stroke inpatients participated in the study. INTERVENTION:A staff behaviour change intervention was designed to support staff to implement practice books. The intervention included staff training on motivation and coaching, and weekly audit and feedback for six months. The environment was restructured to bring staff together weekly at the bedside to review audit data and share skills. MAIN MEASURES:Medical record audit and behavioural mapping were used to compare the number of stroke participants with/using a practice book pre- and post-intervention. Pre- and post-intervention, the percentage of observations where a stroke participant was actively practising, repetitions of practice recorded and type of supervision were compared. RESULTS:A total of 24 participants were observed (n = 12 pre, n = 12 post). Post-intervention, the number of participants with practice books increased from one to six (OR = 11, 95% CI = (0.9, 550.7)), but this change was not statistically significant (P = 0.069). Five participants recorded repetitions in their practice books post-intervention, three were observed using practice books. There was no change in median repetitions recorded (rpbs = 0.00, 95% CI = (-0.4, 0.4), P = 1.000) or observed active practice (rpbs = -0.02, 95% CI = (-0.4, 0.4), P = 0.933). Active practice was often fully supervised by a therapist. CONCLUSION:A staff behaviour change intervention has the potential to increase the number of stroke survivors receiving ward-based practice books but did not increase active practice

Masculinity and preventing falls: insights from the fall experiences of men aged 70 years and over

Purpose: To explore men’s fall experiences through the lens of masculine identities so as to assist health professionals better engage men in fall prevention programs. Methods: Twenty-five men, aged 70–93 years who had experienced a recent fall, participated in a qualitative semi-structured interview. Men’s willingness to engage in fall prevention programs taking account of individual contexts and expressions of masculinity, were conceptualised using constant comparative methods. Results: Men’s willingness to engage in fall prevention programs was related to their perceptions of the preventability of falls; personal relevance of falls; and age, health, and capability as well as problem-solving styles to prevent falls. Fall prevention advice was rarely given when men accessed the health system at the time of a fall. Conclusions: Contrary to dominant expectations about masculine identity, many men acknowledged fall vulnerability indicating they would attend or consider attending, a fall prevention program. Health professionals can better engage men by providing consistent messages that falls can be prevented; tailoring advice, understanding men are at different stages in their awareness of fall risk and preferences for action; and by being aware of their own assumptions that can act as barriers to speaking with men about fall prevention.Implications for rehabilitation Men accessing the health system at the time of the fall, and during rehabilitation following a fall represent prime opportunities for health professionals to speak with men about preventing falls and make appropriate referrals to community programs. Tailored advice will take account of individual men’s perceptions of preventability; personal relevance; perceptions of age, health and capability; and problem-solving styles

Perspectives of Australian GPs on tailoring fall risk management : a qualitative study

Falls among older people are highly prevalent, serious and costly, and translation of evidence about falls prevention needs to occur urgently. GPs can identify older people at risk of falling and put preventative measures in place before a fall. Because GPs are key to identifying older people at risk of falls and managing falls risk, this study explored how GPs adapted to the iSOLVE (Integrated SOLutions for sustainable falls preVEntion) process to embed evidence-based falls prevention strategies within primary care, and whether and how they changed their practice. A theoretically informed qualitative study using normalisation process theory was conducted in parallel to the iSOLVE trial to elicit GPs' views about the iSOLVE process. Data were coded and a thematic analysis of interview transcripts was conducted using constant comparison between the data and themes as they developed. In all, 24 of 32 eligible GPs (75%) from general practices located in the North Sydney Primary Health Network, Australia, were interviewed. Six themes were identified: (1) making it easy to ask the iSOLVE questions; (2) internalising the process; (3) integrating the iSOLVE into routine practice; (4) addressing assumptions about patients and fall prevention; (5) the degree of change in practice; and (6) contextual issues influencing uptake. The iSOLVE project focused on practice change, and the present study indicates that practice change is possible. How GPs addressed falls prevention in their practice determined the translation of evidence into everyday practice. Support tools for falls prevention must meet the needs of GPs and help with decision making and referral. Fall prevention can be integrated into routine GP practice through the iSOLVE process to tailor fall risk management

Influences on general practitioner referral to allied health professionals for fall prevention in primary care

Objective: To explore influences on referral for fall prevention from general practitioners (GPs) to allied health professionals (AHPs) to better equip AHPs engage with GPs regarding fall prevention. Methods: Qualitative, semi‐structured interviews with GPs (n = 24), practice nurses (n = 3) and AHPs (n = 15) and field notes were analysed inductively using constant comparative methods. Results: Three main themes regarding influences on GP referral to AHPs for fall prevention were identified as follows: GPs' knowledge of AHPs; The “reliable and good” AHP; and Patient feedback‐Patient choice. Three‐way communication and trust between GP, patient and AHP underpinned each of these themes. Conclusions: Strategies for encouraging GP referral include AHPs personally contacting GPs to explain their services; writing to GPs about every patient seen; and being aware that interprofessional relationships are based on trust and take time to develop. GPs and AHPs are encouraged to communicate directly rather than relying on patients to convey verbal information