Factors influencing the implementation of fallprevention programmes: a systematic review and synthesis of qualitative studies

Background:
More than a third of people over the age of 65 years fall each year. Falling can lead to areduction in quality of life, mortality, and a risk of prolonged hospitalisation. Reducing andpreventing falls has become an international health priority. To help understand why researchevidence has often not been translated into changes in clinical practice, we undertook asystematic review and synthesis of qualitative research in order to identify what factors serveas barriers and facilitators to the successful implementation of fall-prevention programmes.
Methods:
We conducted a review of literature published between 1980 and January 2012 for qualitativeresearch studies that examined barriers and facilitators to the effective implementation of fallpreventioninterventions among community-dwelling older people and healthcareprofessionals. Two reviewers independently screened studies for inclusion, extracted data,and assessed methodological quality according to predefined criteria. Findings weresynthesised using meta-ethnography.
Results:
Of the 5010 articles identified through database searching, 19 were included in the review.Analysis of the 19 studies revealed limited information about the mechanisms by whichbarriers to implementation of fall-prevention interventions had been overcome. Datasynthesis produced three overarching concepts: (1) practical considerations, (2) adapting forcommunity, and (3) psychosocial. A line of argument synthesis describes the barriers andfacilitators to the successful implementation of fall-prevention programmes. These conceptsshow that the implementation of fall-prevention programmes is complex and multifactorial.This is the first systematic review and synthesis of qualitative studies to examine factorsinfluencing the implementation of fall-prevention programmes from the perspectives of boththe healthcare professional and the community-dwelling older person.
Conclusions:
The current literature on barriers and facilitators to the implementation of fall-preventionprogrammes examines a variety of interventions. However, the ways in which theinterventions are reported suggests there are substantial methodological challenges that ofteninhibit implementation into practice. We recommend that successful implementation requiresindividuals, professionals, and organisations to modify established behaviours, thoughts, andpractice. The issues identified through this synthesis need to be fully considered andaddressed if fall-prevention programmes are to be successfully implemented into clinicalpractice.

Source: http://www.implementationscience.com/content/7/1/91

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