Citation

Johnston YA, Reome-Nedlik C, Parker EM, Bergen G, Wentworth L, Bauer M. Gerontologist 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Oxford University Press)

DOI

10.1093/geront/gnac111

PMID

35917287

Abstract

BACKGROUND AND OBJECTIVES: Falls are a leading cause of injuries and injury deaths for older adults. The Centers for Disease Control and Prevention's Stopping Elderly Accidents Deaths and Injuries (STEADI) initiative, a multifactorial approach to fall prevention, was adapted for implementation within the primary care setting of a health system in upstate New York. The purpose of this paper is to: (a) report process evaluation results for this implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and (b) examine the utility of RE-AIM for assessing barriers and facilitators. RESEARCH DESIGN AND METHODS: This evaluation used mixed methods. Qualitative evaluation involved semi-structured interviews with key stakeholders and intercept interviews with healthcare providers and clinic staff. Quantitative methods utilized surveys with clinic staff. Process evaluation tools were developed based on the AIM dimensions of the RE-AIM framework. The study was conducted over a 2-month period approximately 18 months post-implementation and complements previously published results of the program's reach and effectiveness.

RESULTS: Primary barriers by RE-AIM construct included competing organizational priorities (Adoption); competing patient care demands (Implementation); and staff turnover (Maintenance). Primary facilitators included having a physician champion (Adoption); preparing and training staff (Implementation); and communicating about STEADI and recognizing accomplishments (Maintenance).

DISCUSSION AND IMPLICATIONS: Results revealed a high degree of concordance between qualitative and quantitative analyses. The framework supported assessments of various stakeholders, multiple organizational levels, and the sequence of practice change activities. Mixed methods yielded rich data to inform future implementations of STEADI-based fall prevention.

Language: en

Keywords

Evaluation; Barriers; Falls; Analysis – Mixed Methods; Facilitators; STEADI