Description
Use the information below to help you know which section of the article to use to answer questions in the template:
Introduction and its subsections have the purpose or WHY the study was done.
Methods section and its subsections contain HOW the study was done.
Results, Discussion, and Conclusions section will have WHAT was found.
See attached Appraisal Guidance FormDownload Appraisal Guidance Form
Details
In week 3 you selected a topic of interest and formulated a question about that topic for your Evidence-Based Practice Assignment.
In week 4 you searched the literature on your week three topic and submitted three articles for approval towards building your Evidence-Based Practice Assignment.
Module 6 readings are a continuation from week 5 that includes chapters 13 and 14 on Appraising Research Evidence and Clinical Practice Guidelines. Please refer to these chapters on how to complete an appraisal using templates provided here in instructions.
For the first template in week 6, you will choose either a Qualitative or a Quantitative Review (Please do not complete both Quantitative and Qualitative Appraisal). Your second article is a Systematic Review Appraisal.
Make sure you receive approval from your instructor in week 4 for the article you use to complete either the Qualitative or Quantitative Review and for the Systematic Review. There are hyperlinks to these templates in the week 6 instructions. Do not create your own document with answers.
Each section of the template is required to be completed as this assignment builds on your Evidence-Based Practice Project. Each template has a citation that must be submitted in APA format. Answers to questions in Synopsis sections are required (see template examples in your book). Each question must have an answer of 1-2 full sentences in length per question. Credibility section Yes/No answers are also required. The Comments area is also required and should be at least 1-3 sentences noting how this article relates to your nursing issue topic from week 3 and what you thought was significant.
You will be using these articles again in your week 9 Evidence Based Practice Project Poster.
Please review the rubric closely and proof your work reviewing instructions before you submit.
The chosen topic and PICOT will be used for your Week 9 Poster Assignment. It guided your article searches in Week 4 which will be used in completing your appraisals in Week 6.
Rubric
Unformatted Attachment Preview
(2023) 18:4
Vandervelde et al. Implementation Science
https://doi.org/10.1186/s13012-022-01257-w
Implementation Science
SYSTEMATIC REVIEW
Open Access
Strategies to implement multifactorial
falls prevention interventions
in community‑dwelling older persons:
a systematic review
Sara Vandervelde1, Ellen Vlaeyen1,2, Bernadette Dierckx de Casterlé3, Johan Flamaing4,5, Sien Valy1,
Julie Meurrens1, Joris Poels1, Margot Himpe1, Goedele Belaen1 and Koen Milisen1,5*
Abstract
Background One-third of the community-dwelling older persons fall annually. Guidelines recommend the use of
multifactorial falls prevention interventions. However, these interventions are difficult to implement into the community. This systematic review aimed to explore strategies used to implement multifactorial falls prevention interventions
into the community.
Methods A systematic search in PubMed (including MEDLINE), CINAHL (EBSCO), Embase, Web of Science (core collection), and Cochrane Library was performed and updated on the 25th of August, 2022. Studies reporting on the
evaluation of implementation strategies for multifactorial falls prevention interventions in the community setting
were included. Two reviewers independently performed the search, screening, data extraction, and synthesis process
(PRISMA flow diagram). The quality of the included reports was appraised by means of a sensitivity analysis, assessing
the relevance to the research question and the methodological quality (Mixed Method Appraisal Tool). Implementation strategies were reported according to Proctor et al.’s (2013) guideline for specifying and reporting implementation strategies and the Taxonomy of Behavioral Change Methods of Kok et al. (2016).
Results Twenty-three reports (eighteen studies) met the inclusion criteria, of which fourteen reports scored high
and nine moderate on the sensitivity analysis. All studies combined implementation strategies, addressing different
determinants. The most frequently used implementation strategies at individual level were “tailoring,” “active learning,”
“personalize risk,” “individualization,” “consciousness raising,” and “participation.” At environmental level, the most often
described strategies were “technical assistance,” “use of lay health workers, peer education,” “increasing stakeholder
influence,” and “forming coalitions.” The included studies did not describe the implementation strategies in detail, and
a variety of labels for implementation strategies were used. Twelve studies used implementation theories, models,
and frameworks; no studies described neither the use of a determinant framework nor how the implementation
strategy targeted influencing factors.
Conclusions This review highlights gaps in the detailed description of implementation strategies and the effective
use of implementation frameworks, models, and theories. The review found that studies mainly focused on implementation strategies at the level of the older person and healthcare professional, emphasizing the importance of
*Correspondence:
Koen Milisen
[email protected]
Full list of author information is available at the end of the article
© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco
mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Vandervelde et al. Implementation Science
(2023) 18:4
Page 2 of 24
“tailoring,” “consciousness raising,” and “participation” in the implementation process. Studies describing implementation strategies at the level of the organization, community, and policy/society show that “technical assistance,” “actively
involving stakeholders,” and “forming coalitions” are important strategies.
Trial registration PROSPERO CRD42020187450
Keywords Community setting, Primary health care, Implementation, Practice guidelines, Falls prevention, Aged
Contribution to the literature
• There is still a knowledge gap in how to implement
multifactorial falls prevention interventions into clinical practice.
• The implementation strategies most frequently used at
individual level were “tailoring,” “active learning,” “personalize risk,” “individualization,” “consciousness raising,” and “participation.”
• The implementation strategies most often mentioned
at environmental level were “technical assistance,”
“use of lay health workers, peer education,” “increasing
stakeholder influence,” and “forming coalitions.”
• The included studies mainly focused on implementation strategies at the level of the older person and
healthcare professional.
• This review recommends using taxonomies and reporting guidelines to select and describe implementation
strategies.
Background
Falls are a major problem in community-dwelling older
persons due to their prevalence and consequences. Onethird of the older persons living at home (65+) fall annually [1]. Each year, there are 684,000 fatal falls and 37.3
million falls that require medical treatment globally [2].
With an aging population, these numbers will continue to
rise [2, 3].
A fall is defined as “an unexpected event in which the
older person comes to rest on the ground, floor or lower
level” [4]. Each fall is associated with an increased risk
of morbidity and mortality and can often lead to physical (e.g., bruises, lacerations, fractures) and psychosocial
(e.g., social isolation, fear of falling, depression) consequences [5]. In the USA, falls are the leading cause of
injury-related death among persons aged 65 and over [6].
Falls and its related injuries have also a substantial impact
on the healthcare cost and the economic burden of society [7]. Consequently, the implementation of effective
falls prevention interventions not only may benefit the
older person, but it can also reduce the economic burden
of society, as shown in literature [8].
Falling is complex, and many factors contribute to
its risk (e.g., mobility impairment, medication use, and
home hazards) [9]. Due to this complexity, many guidelines recommend to use multifactorial falls prevention interventions [9, 10]. These interventions consist
of two or more components tailored to the individual
fall-risk profile of the older person [11]. A person older
than 65 years is at risk of falling if he or she presents
with a fall, reports at least one injurious fall or two or
more noninjuries falls, or reports or displays unsteady
gait or balance [9, 12, 13]. An older person with high
risk of falling receives an assessment of risk factors, i.e.,
an evaluation of risk factors. Based on the individual
fall-risk profile, the person receives an intervention
(e.g., one person can receive exercise in combination
with recommendations for home hazards; another
person can obtain medication advice and supervised
exercise) [11]. A Cochrane review supports the “efficacy” of those multifactorial falls prevention interventions in the community setting; it can reduce the rate
of falls with 23% compared to usual care or attention
control (RaR 0.77, 95% CI 0.67 to 0.87) [11]. Despite the
evidence for the efficacy of these interventions, recent
pragmatic cluster-randomized controlled trials, exploring the “effectiveness” of multifactorial falls prevention
interventions in the community, found that there is
no effect on rate of falls, fall-related injuries, and fractures [14, 15]. It is likely that these differences in results
between efficacy and effectiveness testing are due to a
poor translation and implementation of multifactorial
falls prevention interventions in the community [16].
It is key to address important implementation issues
such as the barriers and facilitators (determinants) and
select suitable strategies at different levels of the context
(i.e., older person, healthcare professional, organization,
community, policy/society) to implement multifactorial
falls prevention interventions in the community setting
(i.e., “home or places of residence that do not provide
residential health-related care”) [11, 17, 18]. Currently,
research on the implementation of multifactorial falls
prevention interventions rarely assesses determinants
and derives appropriate implementation strategies (i.e.,
“a method or technique designed to enhance adoption
of a ‘clinical’ intervention”) [19]. In addition, clear and
Vandervelde et al. Implementation Science
(2023) 18:4
transparent reporting of implementation strategies is
scarce [16, 20].
This systematic review aimed to provide an overview of
the strategies used to implement multifactorial falls prevention interventions in the community.
Methods
The review protocol was designed and reported following the PRISMA 2020 statement [21]. This protocol was
registered in PROSPERO (CRD42020187450) [22]. The
methodology and the main findings of this review were
discussed with a multidisciplinary group of 21 stakeholders (e.g., physiotherapists, geriatrician, pharmacist,
occupational therapist, registered nurses, policy makers,
representatives of older persons, researchers). Purposive
sampling was used to compose the stakeholder group
(e.g., multidisciplinary group, knowledge about falls prevention, experience with implementation projects in the
community). The group met two times to discuss the
research question, the included articles, and the results.
Searches
The search strategy was developed in collaboration with
the Biomedical Library, 2Bergen of the University of Leuven, Belgium. The search strategy consisted of three concepts: “older person,” “falls prevention,” and “community
setting” (Additional file 1). The search was performed in
five databases: PubMed (including MEDLINE), CINAHL
(EBSCO), Embase, Web of Science (core collection), and
Cochrane Library. The original search was performed
from inception until the 18th of May, 2020. On the 25th
of August 2022, the researchers updated the search. One
researcher (SAV) removed all duplicates in EndNote™,
following the de-duplication method of Bramer et al.
(2016) [23]. Based on the inclusion and exclusion criteria,
two independent reviewers (SAV and JP/GB) screened
the titles and abstracts of the records. The reviewers discussed potentially relevant records. After discussion, two
Page 3 of 24
reviewers (SAV and SIV/GB) independently read and
assessed the reports for eligibility. The reviewers once
again discussed the selection process. In addition, the reference lists of the reports, systematic reviews, and metaanalysis were independently reviewed by two researchers
(SAV and MH/GB). Discrepancies were resolved by consulting the research group (KM, BDdC, EV, and JF). The
selection process was performed in the webtool Rayyan™
and mapped following the PRISMA 2020 flow diagram
[21, 24].
Study inclusion and exclusion criteria
An overview of the inclusion and exclusion criteria can
be found in Table 1. Studies reporting on the evaluation of implementation strategies for multifactorial falls
prevention interventions in the community setting were
included [19]. Multiple publications pertaining the same
study were taken into account.
Study quality assessment
Two independent reviewers appraised the included
reports on their quality by means of a sensitivity analysis
(SAV and MH/JM/GB). This analysis took into account
the relevance to the research question and the methodological quality of the reports. Table 2 gives an insight in
how the sensitivity analysis was assessed. This sensitivity analysis was used to detect reports with a high contribution to the review and high methodological quality,
which served as a starting point in the data synthesis
(Table 2) [25, 26].
The research and stakeholder group defined, based on
the research question and the experiences of the first
screening of the reports, five questions to assess the relevance of the reports:
(1) Is the implementation strategy clearly described?
(2) Is the implementation strategy used in the community?
Table 1 Inclusion and exclusion criteria
Inclusion criteria
Exclusion criteria
• Evaluation of implementation s trategiesa for multifactorial falls prevention
interventionsb in community-dwelling older persons
• English, Dutch, and German
• Multiple settings (e.g., hospitals, nursing homes) only included if specific
information on the c ommunityc was available
• Experiences, perceptions, and needs of target group (primary research)
• Recruitment was done in hospitals, intervention needed to be coordinated
in the communityc
• Implementation s trategiesa
° Not described
° Not evaluated in the community settingc
• Editorials, opinion papers, studies only reported as conference abstract,
systematic reviews, meta-analysis
• Other settings (e.g., hospitals, nursing homes)
• Topics: education (also peer education) was the only implementation
strategy, specific population (e.g., frailty, multiple sclerosis, cardiovascular
diseases)
a
Implementation strategy — “A method or technique designed to enhance adoption of a ‘clinical’ intervention” [19]. bMultifactorial falls prevention intervention
— “These interventions consist of two or more components tailored to the individual fall risk profile of the older person” [11]. cCommunity — “Home or places of
residence that do not provide residential health-related care” [11]
Vandervelde et al. Implementation Science
(2023) 18:4
Page 4 of 24
Table 2 Results sensitivity analysis
Study
Report
Relevance
Methodological quality
Sensitivity analysis
Study 1
Clemson et al. (2004) [27]
High
High
High
Ballinger et al. (2006) [28]
High
High
High
Study 2
Mackenzie et al. (2021) [29]
High
High
High
Study 3
Middlebrook et al. (2012) [30]
High
Moderate
High
Study 4
Mora Pinzon et al. (2019) [31]
High
Moderate
High
Study 5
Renehan et al. (2019) [32]
High
Moderate
High
Study 6
Garner et al. (1996) [33]
High
Moderate
High
Hahn et al. (1996) [34]
High
Moderate
High
Kempton et al. (2000) [35]
High
Moderate
High
Barnett et al. (2003) [36]
High
Moderate
High
Barnett et al. (2004) [37]
High
Low
Moderate
Study 7
Milisen et al. (2006) [38]
High
Moderate
High
Study 8
Mackenzie et al. (2020) [39]
High
Moderate
High
Study 9
Fortinsky et al. (2008) [17]
High
Moderate
High
Study 10
Gholamzadeh et al. (2021) [40]
High
Moderate
High
Study 11
Mahoney et al. (2016) [41]
Moderate
Moderate
Moderate
Study 12
Elley et al. (2008) [42]
Moderate
Moderate
Moderate
Study 13
Kramer et al. (2011) [43]
Moderate
Moderate
Moderate
Study 14
Zimmerman et al. (2017) [44]
Moderate
Moderate
Moderate
Study 15
Schlotthauer et al. (2017) [45]
Moderate
Moderate
Moderate
Study 16
Baker et al. (2007) [46]
High
Low
Moderate
Study 17
Kittipimpanon et al. (2012) [47]
High
Low
Moderate
Study 18
Tiedemann et al. (2021) [48]
High
Low
Moderate
High + high, high. High + moderate, high. Moderate + moderate, moderate. High + low, moderate. Low + low, low
(3) Is the evaluation of an implementation strategy for
multifactorial falls prevention interventions in the
community described?
(4) Does the report measure the effectiveness of the
implementation strategy?
(5) Does the report explore the experiences with the
strategy for the implementation of multifactorial
falls prevention interventions?
Based on these items, the relevance of the included
reports was scored low, moderate, or high (Additional
file 2).
The Mixed Method Appraisal Tool (MMAT) was used
to assess the methodological quality of the included
reports [49]. The MMAT is designed to appraise methodological quality in systematic mixed studies reviews.
The methodological quality of five designs can be
appraised: qualitative research, randomized controlled
trials, non-randomized studies, quantitative descriptive studies, and mixed methods studies [49]. The tool
starts with two screening questions: [1] Are there clear
research questions? and [2] Do the collected data allow
to address the research questions? The MMAT indicates
that further appraisal is not feasible when the answer is
“no” or “cannot tell” on one or both screening questions.
After the screening questions, the methodological quality of the included reports was assessed based on the
study design. For each study design, five specific criteria
needed to be rated. The detailed criteria for each design
can be found in additional file 2 [49]. The quality of the
included reports was scored low, moderate, or high.
Data extraction strategy
Two reviewers (SAV and MH/JM/GB) independently
extracted study characteristics as follows: year, citation,
country, source of funding, aim, design, setting, recruitment strategy, sample size, methods of investigation, and
analysis. The reviewers also collected data on the characteristics of the target population: age, gender, type of
healthcare professional, type of patient, family members,
and informal caregiver. In addition, information on the
implementation strategies, the multifactorial falls prevention interventions, and follow-up were collected. The
Template for Intervention Description and Replication
checklist (TIDIeR) was used to describe the multifactorial
falls prevention interventions and implementation strategies [50]. All data were compiled in Microsoft Excel™.
Vandervelde et al. Implementation Science
(2023) 18:4
Data synthesis and presentation
Data were summarized in evidence tables, and a narrative
synthesis was performed following the “Guidance on the
conduct of Narrative synthesis in Systematic Reviews”
[51]. To improve conceptual clarity and comprehensiveness, two independent researchers (SAV and GB) synthesized for each report the implementation strategies
for the different levels of the context (i.e., older person,
healthcare professional, organization, community, policy/society) following the Proctor et al.’s (2013) recommendations for specifying and reporting implementation
strategies and Kok et al.’s (2016) Taxonomy of Behaviour
Change Methods: an Intervention Mapping approach
[18, 52, 53]. The taxonomy of behaviour change methods
makes a distinction between behaviour change methods
at individual and environmental level [53]. The individual
level corresponds to the older person and healthcare professionals. The organization, community, and policy/society are part of the environmental level of the taxonomy.
The classification used in this review conforms to the
Intervention Mapping approach [18]. The taxonomy of
behaviour change methods is part of Intervention Mapping, and it is developed by the same authors [18, 53].
The research group chose to use this taxonomy due to its
clear links to theory and determinants of practice for its
interventions; it states that a behaviour change method
is effective if it meets three conditions: [1] the method
needs to target a determinant that predicts behaviour,
[2] the method must be able to change the determinant,
and [3] the method needs to be translated into a practical
application [53]. In addition, the taxonomy of Per Nilsen
was used to categorize the implementation theories,
models, and frameworks used in the included reports
[54]. The reviewers discussed the synthesis, and discrepancies were resolved by consulting the research group
(KM, BDdC, EV, and JF).
Results
The search strategy resulted in a total of 17,407 records,
totaling 9280 unique records, after the duplicates were
removed. The screening of title and abstract excluded
another 9110 records. The full texts of 170 reports were
read, of which 83 were found eligible. Eleven additional
reports were identified by hand searching fifteen relevant literature reviews and by citation tracking of the
eligible reports. In total, 94 reports described the implementation of single, multicomponent, or multifactorial
falls prevention interventions. Due to the complexity
and the different risk factors that contribute to the risk
of falling, the research group and stakeholder group
decided to make an amendment to the protocol and to
only include reports implementing multifactorial falls
prevention interventions. This resulted in the exclusion
Page 5 of 24
of 45 reports. After screening the included reports, the
researchers and stakeholders noted that some reports (n
= 11) did not describe or evaluate the implementation
strategies. Therefore, it was decided to add the following
new inclusion criteria to the protocol: the implementation strategies needed to be described, reports exploring
the experiences, and perceptions and needs of the target group were only included if it was primary research.
In addition, literature showed that education alone is
not sufficient for behaviour change [55]. As a result, an
additional exclusion criteria was formulated. Due to the
specificity and the complexity of certain diseases like
multiple sclerosis, cancer, and cardiovascular diseases,
the research group decided not to focus on a specific
patient population. Based on all these adaptations, 71
reports were excluded. In total, 23 reports (18 studies)
were included in this systematic review [17, 27–48]. A
full description of the identification, screening, eligibility, and inclusion process is outlined in the PRISMA 2020
flow diagram (Fig. 1).
Study quality assessment
The majority of the reports scored high (n = 18), and five
scored moderate on the relevance to the research question. The methodological quality of the reports was in
general moderate (n = 16); four reports scored low and
three high. No reports were excluded based on the methodological quality. Based on these ratings, the relative
contribution (sensitivity analysis) of the reports could be
appraised (Table 2). In total, fourteen reports scored high
and nine moderate on the sensitivity analysis. Due to the
heterogeneity in terms of study design, setting, multifactorial falls prevention interventions, and implementation
strategies and outcomes, the extent to which data could
be synthesized was limited. Therefore, the results of the
sensitivity analysis could not be taken into account in the
data synthesis (i.e., giving more weight to reports with a
higher score on relevance to the research question and
methodological quality).
Description of studies
Table 3 gives a description of the included studies and
reports. Seven studies (twelve reports) were conducted
in Australia [27–30, 32–37, 39, 48] and seven studies (seven reports) in the USA [17, 31, 41, 43–46]. The
other studies were performed in Belgium [38], New
Zealand [42], Iran [40], and Thailand [47]. The majority
of the reports (n = 15) were older than 5 years [17, 27,
28, 30, 33–38, 41–43, 46, 47]. Seven studies took place
in different settings; in a combination of community
organization, home of the older persons, senior apartment buildings, and senior centers [27, 28, 31, 40, 41,
45, 47, 48], five studies were performed at the home of
Vandervelde et al. Implementation Science
(2023) 18:4
Page 6 of 24
Fig. 1 PRISMA flow diagram
the older person [30, 32, 38, 39, 42], two studies took
place in a community or senior center [43, 46], one
in medical practices [29], and three studies were performed in the community in general [33–37], in home
health agencies [17], and in an assisted living community [44]. In total, eight reports used a mixed method
design [31, 32, 37–39, 44, 45, 47], six had a qualitative design [28–30, 41, 43, 46], three were quantitative
descriptive [17, 33, 36], three were non-randomized
controlled trials [34, 35, 48], and three reports were
randomized controlled trials [27, 40, 42].
Description of multifactorial falls prevention interventions
All included studies implemented multifactorial falls
prevention interventions. There is abundant variation
in the content and manner in which the multifactorial
falls prevention interventions were delivered (e.g., different healthcare professionals involved, supervised versus unsupervised exercise). Table 3 gives an overview
of the fall risk factors on which the study interventions
focused on. All included reports described the evaluation of risk factors (assessment), but only seven reports
(seven studies) clearly described screening for fall risk
[29, 30, 38, 39, 42, 44, 46]. All included reports had exercise, medication review/education, and environmental
hazards identification/education as part of their intervention. Important fall risk factors such as incontinence,
pain, cognitive decline, and fear of falling were often not
considered.
Description of implementation strategies
The majority of the studies described implementation
strategies on multiple levels of the context (i.e., older person, healthcare professional, organization, community,
policy/society) (n = 15) [17, 27–31, 33–37, 39, 41–48].
Renehan et al. (2019), Milisen et al. (2006), and Gholamzadeh et al. (2021) only focused on implementation
strategies at the level of the older person [32, 38, 40].
Six studies (seven reports) reported on “Stepping On,” a
multifaceted community-based program using a small
group learning environment [27, 28, 31, 40, 41, 45, 48].
One study explored the use of iSOLVE (Integrated SOLutions for sustainable falls preVEntion), which consisted
of a decision tool for GPs with referrals to other healthcare professionals, a stay independent fall checklist, GP
Mackenzie, 2021
[29]
Study 2
Medical practices
Australia
Clemson, 2004 [27] Community group
Ballinger, 2006 [28] Home of older
person
Australia
Study 1
Setting
Report
Study
Table 3 Description of included studies
QUAL
Clemson
• RCT
Ballinger
• QUAL
Design
Screening: Yes
Assessment: Yes
• Exercise
• Medication review
• Orthostatic hypotension
• Environment:
home hazards
• Incontinence
• Vision
• Podiatry/footwear
• Cognitive decline
• Falls prevention in
general
Screening: No
Assessment: Yes
• Group exercise:
strength and balance
• Medication
• Environment:
community safety,
home hazards
• Risk behavior
• Vision
• Footwear and
clothing hazards
• Vitamin D and
calcium
• Hip protectors
Control group:
• Two social visits
from OT students
• Not discussing
falls or falls prevention
Multifactorial
falls prevention
Interventions
Integrated solutions for sustainable falls prevention (iSOLVE)
• Decision tool for
GPs
• Stay independent
fall checklist for the
older person
• Fall-risk assessment
• List of recommended individualized and tailored
interventions
• Training of GPs
Stepping On
Multifaceted
community-based
program using a
small-group learning environment
to improve fall selfefficacy, encourage
behavioral change,
and reduce falls
Older person:
• 2h weekly session
for 7 weeks + 1
follow-up home
visit by an OT (6
weeks after final
session) + booster
session (after 3
months)
Healthcare professional:
• Training
Implementation
strategy
Older person:
• GP
Healthcare professional:
• Project coordinator
Older person:
• OT
Healthcare professional:
• Researcher
Actor
Older person
(65+)
GPs
Older person
(70+)
Healthcare
professionals
Action target
Normalization process
theory
• Feasibility
• Penetration
• Adoption
• Satisfaction
• Experiences/perspective
• Beliefs
Clemson
• Effectiveness
• Adherence/compliance
Ballinger
• Satisfaction
• Experiences/perception
• Attitude
Outcomes
Knowledge-toaction framework
(KAT) [59]
Behaviour change
wheel [60]
Normalization process theory [61]
Adult education
principles [56]
Enhancement
of self-efficacy
(Bandura) [57]
Decision-making
process (Janis and
Mann) [58]
Justification
Vandervelde et al. Implementation Science
(2023) 18:4
Page 7 of 24
Mora-Pinzon, 2019
[31]
Study 4
Community
organizations
• Multipurpose
facility that organizes community
activities year
round
• Apartment
complex
USA
Middlebrook, 2012 Home of older
[30]
person
Australia
Study 3
Setting
Report
Study
Table 3 (continued)
Mixed Method
QUAL
Design
Screening: No
Assessment: Yes
• Group exercise
(strength and balance)
• Medication
• Environment
• Risk behavior
• Vision
• Shoes
• Bone health
• How to talk to
your doctor
Screening: Yes
Assessment: Yes
• Exercise
• Medication
• Orthostatic hypotension
• Environment
• Vitamin D
• Vision
Multifactorial
falls prevention
Interventions
Stepping On =
Pisando fuerte
Cultural linguistically — tailored
multifaceted
falls prevention
program (Hispanic
seniors)
Multifaceted
community-based
program using a
small-group learning environment
to improve fall selfefficacy, encourage
behavioral change,
and reduce falls
8 sessions of 2,5h
+ booster session
3 months
Chronic disease
management plan
To offer preventive
and coordinated
care for older
persons with
chronic conditions
and complex care
needs
5 sessions
Implementation
strategy
Older person:
• Leader (allied
health professional,
fitness expert,
community health
worker, health educator, promotor,
peer leader
Healthcare professionals: Researchers
Organization:
Researchers
Older person:
• Australian government trough
Medicare
• GP, PT, OT
Healthcare professional:
• Government
Actor
Older persons
(65+)
Healthcare
professional
Organization
Older person
Healthcare
professional
Action target
RE-AIM model
• Effectiveness
• Fidelity
• Cost
• Reach
• Knowledge
• Adherence/compliance
• Maintenance
• Acceptability
• Sustainability
• Challenges/recommendations
Outcomes
Adult education
principles [56]
Enhancement of
self-efficacy
(Bandura) [57]
Decision-making
process (Janis and
Mann) [58]
No information
Justification
Vandervelde et al. Implementation Science
(2023) 18:4
Page 8 of 24
Garner, 1996 [33]
Hahn, 1996 [34]
Kempton, 2000
[35]
Barnett, 2003 [36]
Barnett, 2004 [37]
Study 6
Mixed method
Design
Community setting Garner, 1996
Australia
Descriptive
Hahn, 1996
Non-RCT
Kempton, 2000
Non-RCT
Barnett, 2003
Descriptive
Barnett, 2004
Mixed method
Renehan, 2019 [32] Home of older
person
Australia
Study 5
Setting
Report
Study
Table 3 (continued)
Screening: No
Assessment: Yes
• Group exercise
class: insufficient
physical activity,
poor balance and
gait
• Medication
• Environment:
domestic and public environment
• Vision
• Shoes
• Chronic Illness
Screening: No
Assessment: Yes
• Exercise (based on
Otago)
• Medication
• Environment
• Vision
• Footwear
• Education, recommendations
Multifactorial
falls prevention
Interventions
Actor
Stay On Your Feet
(SOYF)
• Awareness raising
and information
dissemination
• Community
education
• Policy development
• Home safety
• Support for GP
and health workers
Research group,
older persons, local
community health
teams, community
health education
groups, community organizations,
councils, access
committees
PT, RN, pharmacist
Posthospital falls
prevention intervention
Tailored exercise program,
medication review,
education
20- to 30-min
exercise program
three to five times
per week for 6
months
Exercise physiologist visited at 1, 2,
4, and 8 weeks
Monthly phone
calls
Implementation
strategy
Older person(60+)
Healthcare
professional
Organization
Community
Policy/society
Older person
(65+)
Action target
Justification
Garner
• Penetration
• Reach
• Challenges and recommendations
Hahn
• Reach
• Effectiveness
• Knowledge
• Awareness
• Attitude
Kempton
• Reach
• Beliefs
• Adherence/compliance
• Effectiveness
• Knowledge
• Attitude
• Awareness
Barnett, 2003
• Penetration
• Sustainability
• Reach
Barnett, 2004
• Sustainability
Goals of the
Ottawa Charter for
Health promotion
(WHO) provided
the framework for
strategy development [62]
• Adoption
No information
• Challenges and recommendations
• Dose
• Experiences/perspective
• Adherence/compliance
• Effectiveness
Outcomes
Vandervelde et al. Implementation Science
(2023) 18:4
Page 9 of 24
Report
Milisen, 2006 [38]
Mackenzie, 2020
[39]
Study
Study 7
Study 8
Table 3 (continued)
Home of older
person
Australia
Home of older
person
Belgium
Setting
Mixed method
Mixed method
Design
Screening: yes
Assessment: Yes
• Exercise (Otago)
• Medication
• Environment (also
community)
Screening: Yes
Assessment: Yes
• Exercise (gait,
mobility, balance)
• Medication
• Orthostatic hypotension
• Environment
• Risk behavior
• Incontinence
• Vitamin D
• Vision
• Podiatry/shoes
• Cognitive decline
Recommendations
and referrals
Perso
