A mixed methods process evaluation of a person-centred falls prevention program

Rebecca L. Morris, Keith D. Hill, Ilana N. Ackerman, Darshini Ayton, Glenn Arendts, Caroline Brand, Peter Cameron, Christopher D. Etherton-Beer, Leon Flicker, Anne Marie Hill, Peter Hunter, Judy A. Lowthian, Renata Morello, Samuel R. Nyman, Julie Redfern, De Villiers Smit, Anna L. Barker

Research output: Contribution to journalArticle

Abstract

Background: RESPOND is a telephone-based falls prevention program for older people who present to a hospital emergency department (ED) with a fall. A randomised controlled trial (RCT) found RESPOND to be effective at reducing the rate of falls and fractures, compared with usual care, but not fall injuries or hospitalisations. This process evaluation aimed to determine whether RESPOND was implemented as planned, and identify implementation barriers and facilitators. Methods: A mixed-methods evaluation was conducted alongside the RCT. Evaluation participants were the RESPOND intervention group (n = 263) and the clinicians delivering RESPOND (n = 7). Evaluation data were collected from participant recruitment and intervention records, hospital administrative records, audio-recordings of intervention sessions, and participant questionnaires. The Rochester Participatory Decision-Making Scale (RPAD) was used to evaluate person-centredness (score range 0 (worst) - 9 (best)). Process factors were compared with pre-specified criteria to determine implementation fidelity. Six focus groups were held with participants (n = 41), and interviews were conducted with RESPOND clinicians (n = 6). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the 'Capability, Opportunity, Motivation - Behaviour' (COM-B) behaviour change framework. Results: RESPOND was implemented at a lower dose than the planned 10 h over 6 months, with a median (IQR) of 2.9 h (2.1, 4). The majority (76%) of participants received their first intervention session within 1 month of hospital discharge with a median (IQR) of 18 (12, 30) days. Clinicians delivered the program in a person-centred manner with a median (IQR) RPAD score of 7 (6.5, 7.5) and 87% of questionnaire respondents were satisfied with the program. The reports from participants and clinicians suggested that implementation was facilitated by the use of positive and personally relevant health messages. Complex health and social issues were the main barriers to implementation. Conclusions: RESPOND was person-centred and reduced falls and fractures at a substantially lower dose, using fewer resources, than anticipated. However, the low dose delivered may account for the lack of effect on falls injuries and hospitalisations. The results from this evaluation provide detailed information to guide future implementation of RESPOND or similar programs. Trial registration: This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000336684 (27 March 2014).

Original languageEnglish
Article number906
JournalBMC Health Services Research
Volume19
Issue number1
DOIs
Publication statusPublished - 28 Nov 2019

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Decision Making
Hospitalization
Randomized Controlled Trials
Hospital Records
Hospital Departments
Health
Wounds and Injuries
Focus Groups
New Zealand
Telephone
Registries
Hospital Emergency Service
Motivation
Clinical Trials
Interviews
Surveys and Questionnaires

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Morris, R. L., Hill, K. D., Ackerman, I. N., Ayton, D., Arendts, G., Brand, C., ... Barker, A. L. (2019). A mixed methods process evaluation of a person-centred falls prevention program. BMC Health Services Research, 19(1), [906]. https://doi.org/10.1186/s12913-019-4614-z
Morris, Rebecca L. ; Hill, Keith D. ; Ackerman, Ilana N. ; Ayton, Darshini ; Arendts, Glenn ; Brand, Caroline ; Cameron, Peter ; Etherton-Beer, Christopher D. ; Flicker, Leon ; Hill, Anne Marie ; Hunter, Peter ; Lowthian, Judy A. ; Morello, Renata ; Nyman, Samuel R. ; Redfern, Julie ; Smit, De Villiers ; Barker, Anna L. / A mixed methods process evaluation of a person-centred falls prevention program. In: BMC Health Services Research. 2019 ; Vol. 19, No. 1.
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abstract = "Background: RESPOND is a telephone-based falls prevention program for older people who present to a hospital emergency department (ED) with a fall. A randomised controlled trial (RCT) found RESPOND to be effective at reducing the rate of falls and fractures, compared with usual care, but not fall injuries or hospitalisations. This process evaluation aimed to determine whether RESPOND was implemented as planned, and identify implementation barriers and facilitators. Methods: A mixed-methods evaluation was conducted alongside the RCT. Evaluation participants were the RESPOND intervention group (n = 263) and the clinicians delivering RESPOND (n = 7). Evaluation data were collected from participant recruitment and intervention records, hospital administrative records, audio-recordings of intervention sessions, and participant questionnaires. The Rochester Participatory Decision-Making Scale (RPAD) was used to evaluate person-centredness (score range 0 (worst) - 9 (best)). Process factors were compared with pre-specified criteria to determine implementation fidelity. Six focus groups were held with participants (n = 41), and interviews were conducted with RESPOND clinicians (n = 6). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the 'Capability, Opportunity, Motivation - Behaviour' (COM-B) behaviour change framework. Results: RESPOND was implemented at a lower dose than the planned 10 h over 6 months, with a median (IQR) of 2.9 h (2.1, 4). The majority (76{\%}) of participants received their first intervention session within 1 month of hospital discharge with a median (IQR) of 18 (12, 30) days. Clinicians delivered the program in a person-centred manner with a median (IQR) RPAD score of 7 (6.5, 7.5) and 87{\%} of questionnaire respondents were satisfied with the program. The reports from participants and clinicians suggested that implementation was facilitated by the use of positive and personally relevant health messages. Complex health and social issues were the main barriers to implementation. Conclusions: RESPOND was person-centred and reduced falls and fractures at a substantially lower dose, using fewer resources, than anticipated. However, the low dose delivered may account for the lack of effect on falls injuries and hospitalisations. The results from this evaluation provide detailed information to guide future implementation of RESPOND or similar programs. Trial registration: This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000336684 (27 March 2014).",
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author = "Morris, {Rebecca L.} and Hill, {Keith D.} and Ackerman, {Ilana N.} and Darshini Ayton and Glenn Arendts and Caroline Brand and Peter Cameron and Etherton-Beer, {Christopher D.} and Leon Flicker and Hill, {Anne Marie} and Peter Hunter and Lowthian, {Judy A.} and Renata Morello and Nyman, {Samuel R.} and Julie Redfern and Smit, {De Villiers} and Barker, {Anna L.}",
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Morris, RL, Hill, KD, Ackerman, IN, Ayton, D, Arendts, G, Brand, C, Cameron, P, Etherton-Beer, CD, Flicker, L, Hill, AM, Hunter, P, Lowthian, JA, Morello, R, Nyman, SR, Redfern, J, Smit, DV & Barker, AL 2019, 'A mixed methods process evaluation of a person-centred falls prevention program' BMC Health Services Research, vol. 19, no. 1, 906. https://doi.org/10.1186/s12913-019-4614-z

A mixed methods process evaluation of a person-centred falls prevention program. / Morris, Rebecca L.; Hill, Keith D.; Ackerman, Ilana N.; Ayton, Darshini; Arendts, Glenn; Brand, Caroline; Cameron, Peter; Etherton-Beer, Christopher D.; Flicker, Leon; Hill, Anne Marie; Hunter, Peter; Lowthian, Judy A.; Morello, Renata; Nyman, Samuel R.; Redfern, Julie; Smit, De Villiers; Barker, Anna L.

In: BMC Health Services Research, Vol. 19, No. 1, 906, 28.11.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A mixed methods process evaluation of a person-centred falls prevention program

AU - Morris, Rebecca L.

AU - Hill, Keith D.

AU - Ackerman, Ilana N.

AU - Ayton, Darshini

AU - Arendts, Glenn

AU - Brand, Caroline

AU - Cameron, Peter

AU - Etherton-Beer, Christopher D.

AU - Flicker, Leon

AU - Hill, Anne Marie

AU - Hunter, Peter

AU - Lowthian, Judy A.

AU - Morello, Renata

AU - Nyman, Samuel R.

AU - Redfern, Julie

AU - Smit, De Villiers

AU - Barker, Anna L.

PY - 2019/11/28

Y1 - 2019/11/28

N2 - Background: RESPOND is a telephone-based falls prevention program for older people who present to a hospital emergency department (ED) with a fall. A randomised controlled trial (RCT) found RESPOND to be effective at reducing the rate of falls and fractures, compared with usual care, but not fall injuries or hospitalisations. This process evaluation aimed to determine whether RESPOND was implemented as planned, and identify implementation barriers and facilitators. Methods: A mixed-methods evaluation was conducted alongside the RCT. Evaluation participants were the RESPOND intervention group (n = 263) and the clinicians delivering RESPOND (n = 7). Evaluation data were collected from participant recruitment and intervention records, hospital administrative records, audio-recordings of intervention sessions, and participant questionnaires. The Rochester Participatory Decision-Making Scale (RPAD) was used to evaluate person-centredness (score range 0 (worst) - 9 (best)). Process factors were compared with pre-specified criteria to determine implementation fidelity. Six focus groups were held with participants (n = 41), and interviews were conducted with RESPOND clinicians (n = 6). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the 'Capability, Opportunity, Motivation - Behaviour' (COM-B) behaviour change framework. Results: RESPOND was implemented at a lower dose than the planned 10 h over 6 months, with a median (IQR) of 2.9 h (2.1, 4). The majority (76%) of participants received their first intervention session within 1 month of hospital discharge with a median (IQR) of 18 (12, 30) days. Clinicians delivered the program in a person-centred manner with a median (IQR) RPAD score of 7 (6.5, 7.5) and 87% of questionnaire respondents were satisfied with the program. The reports from participants and clinicians suggested that implementation was facilitated by the use of positive and personally relevant health messages. Complex health and social issues were the main barriers to implementation. Conclusions: RESPOND was person-centred and reduced falls and fractures at a substantially lower dose, using fewer resources, than anticipated. However, the low dose delivered may account for the lack of effect on falls injuries and hospitalisations. The results from this evaluation provide detailed information to guide future implementation of RESPOND or similar programs. Trial registration: This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000336684 (27 March 2014).

AB - Background: RESPOND is a telephone-based falls prevention program for older people who present to a hospital emergency department (ED) with a fall. A randomised controlled trial (RCT) found RESPOND to be effective at reducing the rate of falls and fractures, compared with usual care, but not fall injuries or hospitalisations. This process evaluation aimed to determine whether RESPOND was implemented as planned, and identify implementation barriers and facilitators. Methods: A mixed-methods evaluation was conducted alongside the RCT. Evaluation participants were the RESPOND intervention group (n = 263) and the clinicians delivering RESPOND (n = 7). Evaluation data were collected from participant recruitment and intervention records, hospital administrative records, audio-recordings of intervention sessions, and participant questionnaires. The Rochester Participatory Decision-Making Scale (RPAD) was used to evaluate person-centredness (score range 0 (worst) - 9 (best)). Process factors were compared with pre-specified criteria to determine implementation fidelity. Six focus groups were held with participants (n = 41), and interviews were conducted with RESPOND clinicians (n = 6). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the 'Capability, Opportunity, Motivation - Behaviour' (COM-B) behaviour change framework. Results: RESPOND was implemented at a lower dose than the planned 10 h over 6 months, with a median (IQR) of 2.9 h (2.1, 4). The majority (76%) of participants received their first intervention session within 1 month of hospital discharge with a median (IQR) of 18 (12, 30) days. Clinicians delivered the program in a person-centred manner with a median (IQR) RPAD score of 7 (6.5, 7.5) and 87% of questionnaire respondents were satisfied with the program. The reports from participants and clinicians suggested that implementation was facilitated by the use of positive and personally relevant health messages. Complex health and social issues were the main barriers to implementation. Conclusions: RESPOND was person-centred and reduced falls and fractures at a substantially lower dose, using fewer resources, than anticipated. However, the low dose delivered may account for the lack of effect on falls injuries and hospitalisations. The results from this evaluation provide detailed information to guide future implementation of RESPOND or similar programs. Trial registration: This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000336684 (27 March 2014).

KW - emergency department

KW - Falls prevention

KW - fractures

KW - older adults

KW - process evaluation, complex intervention, mixed methods

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