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Open Access Research article

Process factors explaining the ineffectiveness of a multidisciplinary fall prevention programme: A process evaluation

Michel HC Bleijlevens18*, Marike RC Hendriks238, Jolanda CM van Haastregt48, Erik van Rossum458, Gertrudis IJM Kempen48, Joseph PM Diederiks6, Harry FJM Crebolder78 and Jacques ThM van Eijk18

Author Affiliations

1 Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO box 616, 6200 MD Maastricht, The Netherlands

2 Department of Health Organisation Economics and Policy, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO box 616, 6200 MD Maastricht, The Netherlands

3 Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, PO Box 5800 6202, AZ Maastricht, The Netherlands

4 Department of Health Care and Nursing Science, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO box 616, 6200 MD Maastricht, The Netherlands

5 Faculty of Health and Technology, Professional University Zuyd, Nieuw Eyckholt 300, 6400 AN Heerlen, The Netherlands

6 Department of Healthcare studies, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO box 616, 6200 MD Maastricht, The Netherlands

7 Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO box 616, 6200 MD Maastricht, The Netherlands

8 School for Public Health and Primary Care (Caphri), Faculty of Health, Medicine and Life Sciences, Maastricht University, PO box 616, 6200 MD Maastricht, The Netherlands

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BMC Public Health 2008, 8:332  doi:10.1186/1471-2458-8-332

Published: 24 September 2008

Abstract

Background

Falls are a major health threat to older community-living people, and initiatives to prevent falls should be a public health priority. We evaluated a Dutch version of a successful British fall prevention programme. Results of this Dutch study showed no effects on falls or daily functioning. In parallel to the effect evaluation, we carried out a detailed process evaluation to assess the feasibility of our multidisciplinary fall prevention programme. The present study reports on the results of this process evaluation.

Methods

Our fall prevention programme comprised a medical and occupational-therapy assessment, resulting in recommendations and/or referrals to other services if indicated. We used self-administered questionnaires, structured telephone interviews, structured recording forms, structured face-to-face interviews and a plenary group discussion to collect data from participants allocated to the intervention group (n = 166) and from all practitioners who performed the assessments (n = 8). The following outcomes were assessed: the extent to which the multidisciplinary fall prevention programme was performed according to protocol, the nature of the recommendations and referrals provided to the participants, participants' self-reported compliance and participants' and practitioners' opinions about the programme.

Results

Both participants and practitioners judged the programme to be feasible. The programme was largely performed according to protocol. The number of referrals and recommendations ensuing from the medical assessment was relatively small. Participants' self-reported compliance as regards contacting their GP to be informed of the recommendations and/or referrals was low to moderate. However, self-reported compliance with such referrals and recommendations was reasonable to good. A large majority of participants reported they had benefited from the programme.

Conclusion

The results of the present study show that the programme was feasible for both practitioners and participants. Main factors that seem to be responsible for the lack of effectiveness are the relatively low number of referrals and recommendations ensuing from the medical assessments and participants' low compliance as regards contacting their GP about the results of the medical assessment. We do not recommend implementing the programme in its present form in regular care.

Trial registration

ISRCTN64716113