Abstract
Translating complex behavior change interventions into practice can be accompanied by a loss of fidelity and effectiveness. We present the evaluation of two sequential phases of implementation of a complex evidence-based community workshop to reduce falls, using the Replicating Effective Programs Framework. Between the two phases, workshop training and delivery were revised to improve fidelity with key elements. Stepping On program participants completed a questionnaire at baseline (phase 1: n = 361; phase 2: n = 2219) and 6 months post-workshop (phase 1: n = 232; phase 2: n = 1281). Phase 2 participants had an additional follow-up at 12 months (n = 883). Outcomes were the number of falls in the prior 6 months and the Falls Behavioral Scale (FaB) score. Workshop participation in phase 1 was associated with a 6% reduction in falls (RR = 0.94, 95% CI 0.74-1.20) and a 0.14 improvement in FaB score (95% CI, 0.11- 0.18) at 6 months. Workshop participation in phase 2 was associated with a 38% reduction in falls (RR = 0.62, 95% CI 0.57-0.68) and a 0.16 improvement in FaB score (95% CI 0.14-0.18) at 6 months, and a 28% reduction in falls (RR = 0.72, 95% CI 0.65-0.80) and a 0.19 score improvement in FaB score (95% CI 0.17-0.21) at 12-month follow-up. Effectiveness can be maintained with widespread dissemination of a complex behavior change intervention if attention is paid to fidelity of key elements. An essential role for implementation science is to ensure effectiveness as programs transition from research to practice.
Highlights
Translating complex behavior change interventions into practice can be accompanied by a loss of fidelity and effectiveness
There was an improvement of 0.14 points in Falls Behavioral Scale (FaB) at 6 months associated with Stepping On participation, from a baseline score of 2.91
The percentage of patients completing the workshop was significantly less for participants in small rural locations (69.8%) or attending small rural workshop sites (68.2%), compared to participants in urban locations (80.6%) or attending urban workshop sites (80.8%) (p = 0.0005 for all participant location comparisons versus urban location; p < 0.0001 for all workshop site comparisons versus urban workshop site). This natural experiment afforded us the opportunity to see if an evidence-based program that was not effective when first implemented in a few counties in Wisconsin could become effective when disseminated statewide with attention to fidelity
Summary
Translating complex behavior change interventions into practice can be accompanied by a loss of fidelity and effectiveness. We present the evaluation of two sequential phases of implementation of a complex evidence-based community workshop to reduce falls, using the Replicating Effective Programs Framework. Workshop training and delivery were revised to improve fidelity with key elements. Results: Workshop participation in phase 1 was associated with a 6% reduction in falls (RR = 0.94, 95% CI 0.74–1.20) and a 0.14 improvement in FaB score (95% CI, 0.11– 0.18) at 6 months. Conclusions: Effectiveness can be maintained with widespread dissemination of a complex behavior change intervention if attention is paid to fidelity of key elements. In the United States, there is little data about the effectiveness of evidence-based falls prevention programs when implemented in community settings. The phase of implementation should be concerned with strategies for improving program fidelity in the field [1]. Evaluation of outcomes suggested fidelity may have been compromised; there was no reduction in falls in association with the program
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
