Evidence map›Paper›PMID 31779624›Full record

Trial reportBMC health services research2019

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 and 7 more

Erratum issuedAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC health services research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors.

Rebecca L MorrisSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. rebecca.morris@monash.edu.
Keith D HillRehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia.
Ilana N AckermanSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Darshini AytonSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. darshini.ayton@monash.edu.
Glenn ArendtsUniversity of Western Australia, Perth, Australia.
Caroline BrandSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Peter CameronSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Christopher D Etherton-BeerUniversity of Western Australia, Perth, Australia.
Leon FlickerUniversity of Western Australia, Perth, Australia.
Anne-Marie HillSchool of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
Peter HunterSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Judy A LowthianSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Renata MorelloSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Samuel R NymanDepartment of Psychology and Ageing & Dementia Research Centre, now at Department of Medical Science and Public Health, Bournemouth University, Dorset, UK.
Julie RedfernUniversity of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, the George Institute for Global Health, Sydney, Australia.
De Villiers SmitSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Anna L BarkerSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

Funding

National Health and Medical Research Council 1052442National Health and Medical Research Council 1067236National Health and Medical Research Council APP1056802National Institute for Health Research CDF-2015-08- 030
6 · The paper itself

Abstract

backgroundRESPOND 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.

methodsA 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.

resultsRESPOND 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.

conclusionsRESPOND 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 registrationThis study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000336684 (27 March 2014).

Indexed as

Accident PreventionAccidental FallsAgedAged, 80 and overEvaluation Studies as TopicFemaleFocus GroupsHumansMalePatient-Centered CareProgram EvaluationTelephoneemergency departmentFalls preventionfracturesolder adultsprocess evaluation, complex intervention, mixed methods

Identifiers

PMID31779624
PMCPMC6883679

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.