Abstract
BackgroundWe previously developed Pisando Fuerte (PF), a linguistically and culturally appropriate version of “Stepping On”, an evidence-based fall prevention program building on self-efficacy and adult learning principles. The purpose of this study is to describe the implementation of PF at two community organizations in Wisconsin.MethodsPF consisted of 2 h sessions delivered in Spanish over the course of 8 weeks by two trained leaders, at two community sites in Wisconsin. Participants identified strategies for falls prevention and practiced progressive balance and strength exercises. The RE-AIM framework guided the mixed-methods evaluation. Falls Behavioral Risk Scale (FaB) (Outcomes), and uptake of protective behaviors (Individual Maintenance) were evaluated 6 months after completion. Fidelity of delivery (Implementation) was evaluated by an independent assessor for three sessions at each site using a-priori criteria based on key elements of Stepping On.ResultsTwenty-four Hispanic/Latino individuals, whose primary language is Spanish, were enrolled in two workshops. The mean age was 70.5 years; 71% were female, and five reported a fall in the year prior. Outcomes: There was a non-statically significant decrease in the number of falls per person [RR: 0.33 (95%CI: 0.096–1.13)] at 6 months. There was a statistically significant improvement of the mean Falls Behavioral Risk Scale (FaB) (baseline = 2.69 vs. 6-months post-intervention = 3.16, p < 0.001). Adoption: Barriers to adoption included leader training in English, time to identify Spanish-speaking guest experts, and time to prepare for each session. Implementation: Satisfactory fidelity of delivery was achieved in 69% of the elements; fidelity lapses were more common in the use of adult learning strategies and programmatic aspects. Eighty eight percent of participants completed the program, and 95% of them adequately demonstrated the exercises. Maintenance: At 6 months, 57.9% of participants continued doing exercises, 94% adopted safer walking strategies, and 67% executed at least one home safety recommendation. These results are similar to those seen in the original Stepping On program.ConclusionsOur study shows good fidelity of delivery with implementation of “Pisando Fuerte”. Pre-post data demonstrate a significant reduction in falls behavioral risk among Hispanic/Latino participants, similar to results with “Stepping On”.Trial registrationClinicalTrials.gov, NCT03895021. Registered March 29, 2019.
Highlights
In the United States (US), every hour, three older adults die as a result of a fall, and by 2030 this number is expected to increase to seven older adults [1]
This is concerning because the older adult Hispanic/Latinos population in the US is growing exponentially [4], and there is a dearth of evidence-based fall prevention programs designed for Hispanic/Latino seniors
The primary objective of this paper is to describe the implementation of Pisando Fuerte at two community organizations in Wisconsin using the RE-AIM framework [15], which includes a characterization of the reach, adoption, pre-post outcomes, implementation fidelity and costs, and maintenance of behavior change by individuals
Summary
In the United States (US), every hour, three older adults die as a result of a fall, and by 2030 this number is expected to increase to seven older adults [1]. Some evidence-based fall prevention programs that target risk factors for falls or fear of falling are available in Spanish, and they have been shown to reduce fear of falling or risk factors for falls, resulting in improve physical activity, balance, and/or lower extremity strength. They have not shown a decrease in falls among Hispanic individuals [7,8,9,10].
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