Clinical Interventions in Aging (May 2024)
Factors Influencing the Implementation of a Fall Prevention Exercise Program for Community-Dwelling Older Adults: A Qualitative Study Guided by the PRECEDE-PROCEED Model
Abstract
Rebecca Hui Shan Ong,1 Milawaty Nurjono,1 Hong Choon Oh,1– 3 Christopher Tsung Chien Lien,4 Junisha Jumala,5 Raymond Choon Chye Teo,6 Peiying Gan,7 Karen Lai Ming Kan,8 Lina Farhana Rosle,8 Moi Kim Wee,8 Shou Lin Low4 1Health Services Research, Changi General Hospital, Singapore; 2Centre for Population Health Research and Implementation, Singapore Health Services, Singapore; 3Health Services & Systems Research, Duke-NUS Medical School, Singapore; 4Geriatric Medicine, Changi General Hospital, Singapore; 5Rehabilitative Services, Changi General Hospital, Singapore; 6Singapore Sport & Exercise Medicine Centre, Changi General Hospital, Singapore; 7Community Nursing, Changi General Hospital, Singapore; 8Community and Mental Health, Changi General Hospital, SingaporeCorrespondence: Rebecca Hui Shan Ong, Health Services Research, Changi General Hospital, 2 Simei Street 3, 529889, Singapore, Tel +65 6788 8833, Fax +65 67826049, Email [email protected]: Multiple falls preventions exercise programs have been rolled out globally, however, few studies have explored the factors necessary for their implementation. This study aimed to investigate the factors influencing the implementation of “Steady Feet” (SF), a 12-week community fall prevention exercise intervention, for older adults living in Singapore.Material and Methods: This study utilized purposive sampling to recruit two participant groups: (i) older adults who declined or withdrew from the program and (ii) providers of the program (eg, instructors). We conducted 22 semi-structured interviews, recordings were transcribed and translated, followed by thematic analysis. Data collection and analysis were informed by the PRECEDE-PROCEED framework, focusing on predisposing, enabling, and reinforcing factors.Results: Findings revealed two predisposing, four enabling, and two reinforcing themes. Predisposing themes encompassed (i) knowledge, attitudes, and practices of older adults towards exercises and falls prevention, and (ii) perceptions and attitudes of providers towards SF. Both older adults and providers identified several enabling elements in implementing SF, emphasizing the significance of (i) accessibility, availability, and affordability. Providers highlighted (ii) tools and structural support for continual engagement, (iii) minimizing variations in capabilities through a competency development program, and (iv) fostering synergistic partnerships. Positive reinforcement included (i) the role of providers in engaging and promoting participation, (ii) family support, social networks, and (iii) incentives for older adults. Conversely, both groups highlighted negative reinforcements, including (iv) communication issues and (v) repetitive exercises, while providers specifically identified (vi) labor constraints as a deterrent for implementation.Conclusion: Findings indicate that effective implementation necessitates a multifaceted approach. Promoting participation involves engaging instructors, emphasizing social bonds and family involvement, offering incentives, and providing subsidized or free classes. A competency development program proved effective in reducing variations in providers’ capabilities. Strengthening community partnerships, with management support, was crucial for ensuring the availability and accessibility of falls prevention programs.Keywords: falls prevention, community-dwelling, older adults, exercise, qualitative, precede-proceed
