BACKGROUND: Implementation of evidence-based falls prevention recommendations within community health care settings is variable and suboptimal.
OBJECTIVE: Evaluate the effectiveness of a tailored implementation strategy on adherence to falls prevention recommendations in Norwegian municipalities.
DESIGN: Hybrid type 3 cluster randomised trial.
PARTICIPANTS: Twenty-five city districts/municipalities, with 13 intervention and 12 control clusters and 487 health care professionals (HCPs).
INTERVENTION: Clinical intervention: national recommendations for falls prevention for older adults. Tailored implementation strategy: leadership commitment, competence enhancement, resource teams and implementation support.
OUTCOMES: Primary: self-reported adherence to the recommendations (questionnaire). Secondary: feasibility of the recommendations (Feasibility of Intervention Measure), experience of the implementation process (Normalisation Measure Development Questionnaire), fidelity to recommendations and strategy, and fall-related injuries. Assessments were conducted at baseline (T0), post-intervention at 9 months (T1) and at follow-up 15 months after baseline (T2).
RESULTS: HCPs adherence showed mean difference of 1.3 points (95% CI -0.2-2.9, P = .099) at T1 and 1.8 points (95% CI 0.2-3.5, P = .025) at T2, in favour of intervention versus control, along with higher scores on implementation experience at T2 (mean difference of 2.2 points; P = .033). No difference was found for feasibility or fall-related injuries. Fidelity to the recommendations was higher in the intervention clusters, for seminar attendance and implementation support.
CONCLUSION: A tailored strategy improved HCP reported adherence to and experience of implementing falls prevention recommendations. The limited effectiveness on clinical outcomes might be due to limited fidelity by HCPs in delivery of the falls prevention interventions or time needed to fully embed workforce wide implementation.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
The studied intervention improved HCP reported adherence to and experience of implementing falls prevention recommendations in municipality healthcare in Norway. However, this did not translate into lower fall-related injury rates during the study period. From a Public Health perspective, the greatest contribution of this study is actually the focus on implementation. We should be reminded that national (or global) guidelines do require local adaptation, and that implementation research is needed to actually understand possible barriers and impacts. In this specific case, it is not clear whether the intervention might bring long-term benefits to the target population, but it is a step in the right direction of trying to understand why.
, McMaster University