Data_Sheet_1_Engaging community-dwelling older adults in fall prevention programs: a qualitative study on strategies promoting participation in fall prevention programs among community-dwelling older adults.pdf

IntroductionFall rates and fall-related injuries among community-dwelling older adults (≥65 years) are expected to increase rapidly, due to the aging population worldwide. Fall prevention programs (FPPs), consisting of strength and balance exercises, have been proven effective in reducing fall rates among older adults. However, these FPPs have not reached their full potential as most programs are under-enrolled. Therefore, this study aims to identify promising strategies that promote participation in FPPs among community-dwelling older adults.
MethodsThis is an exploratory qualitative study. Previously, barriers and facilitators for participation in FPPs by older adults had been identified. Next, six strategies had been designed using the Intervention Mapping approach: (1) reframing; (2) informing about benefits; (3) raising awareness of risks; (4) involving social environment; (5) offering tailored intervention; (6) arranging practicalities. Strategies were validated during semi-structured interviews with community-dwelling older adults (n = 12) at risk of falling. Interviews were audio-recorded, transcribed, and analyzed following a qualitative thematic methodology, with a hybrid approach.
ResultsAll strategies were considered important by at least some of the respondents. However, two strategies stood out: (1) reframing ‘aging’ and ‘fall prevention’: respondents preferred to be approached differently, taking a ‘life course’ perspective about falls, and avoiding confronting words; and (2) ‘informing about benefits’ (e.g., ‘living independently for longer’); which was mentioned to improve the understanding of the relevance of participating in FPPs. Other strategies were considered important to take into account too, but opinions varied more strongly.
DiscussionThis study provides insight into potential strategies to stimulate older adults to participate in FPPs. Results suggest that reframing ‘aging’ and ‘fall prevention’ may facilitate the dialogue about fall prevention, by communicating differently about the topic, for example ‘staying fit and healthy’, while focusing on the benefits of participating in FPPs. Gaining insight into the strategies’ effectiveness and working mechanisms is an area for future research. This could lead to practical recommendations and help professionals to enhance older adults’ participation in FPPs. Currently, the strategies are further developed to be applied and evaluated for effectiveness in multiple field labs in a central Dutch region (Utrecht).

引言 随着全球人口老龄化进程加剧，社区居住的老年人群（≥65岁）的跌倒发生率及跌倒相关损伤预计将快速攀升。跌倒预防项目（Fall Prevention Programs, FPPs）以力量与平衡训练为核心内容，已被证实可有效降低老年人的跌倒风险。然而，由于多数项目招募不足，此类FPPs尚未充分发挥其应用潜力。因此，本研究旨在探索可有效提升社区居住老年人参与FPPs积极性的可行策略。

方法 本研究为探索性定性研究。前期已明确老年人参与FPPs的阻碍因素与促进因素。本研究采用干预映射（Intervention Mapping）方法设计了6项策略：(1) 视角重构；(2) 收益告知；(3) 风险警示；(4) 社会环境参与；(5) 个性化干预提供；(6) 实操事项协调。随后，针对12名存在跌倒风险的社区居住老年人开展半结构化访谈，以验证上述策略的可行性。访谈内容采用音频录制、转录文本，并结合混合研究范式的定性主题分析法进行编码分析。

结果 所有策略均得到至少部分受访者的认可。其中两项策略尤为突出：(1) 对‘衰老’与‘跌倒预防’的视角重构：受访者期望采用差异化沟通方式，以‘生命历程’视角看待跌倒问题，避免使用具有对抗性的表述；(2) 收益告知（例如‘延长独立生活年限’）：该策略被认为可提升受访者对参与FPPs相关性的理解。其余策略虽也被认为具有重要参考价值，但受访者的意见分歧相对更大。

讨论 本研究明确了可用于提升老年人参与FPPs积极性的潜在策略。研究结果显示，通过采用差异化的沟通方式（例如以‘维持健康体魄’替代传统表述），重构‘衰老’与‘跌倒预防’的认知视角，可有效推动跌倒预防相关的对话交流，并聚焦于参与FPPs的核心收益。未来研究可进一步探索上述策略的实际效果与作用机制，以期形成可落地的实践建议，助力专业人员提升老年人参与FPPs的意愿与行为。目前，该套策略已进入进一步开发阶段，将在荷兰中部地区（乌得勒支）的多个实地实验室中开展应用与效果评估。