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Table 1 Details of included qualitative studies of barriers and facilitators to fall-prevention interventions

From: Factors influencing the implementation of fall-prevention programmes: a systematic review and synthesis of qualitative studies

Study location Study aim and type of fall-prevention intervention addressed Stated methodology Method of investigation. Analysis method. Setting, sample size, and strategy (where specified in the study) and characteristics
Aminzadeh and Edwards 1998 (Canada)[25] To explore views of older people on the use of assistive devices. Focus groups Four focus group interviews. Thematic analysis based on methods by Krueger. Convenience sample of community-dwelling older people.
n = 30 (Italian and British-Canadian)
n = 21 women; n = 9 men. Mean age 72.2 (range = 61–86); 16 lived alone.
Baker et al., 2005 (USA)[13] To report on barriers and facilitators to incorporate evidence-based fall risk assessment into clinical practice in a defined geographical area. Multiple professional behaviour-change interventions were used to encourage providers to incorporate evidence-based fall assessment into practice. Discourse analysis Semistructured interviews. Healthcare providers who agreed to receive outreach visits as part of the Connecticut Collaboration for Fall Prevention (CCFP) programme. n = 119 rehabilitation facilities; n = 125 primary care offices; n = 7 hospitals; n = 26 home care agencies.
Discourse analysis of interviews.
Bell and Stirling 2006 (Australia)[23] To explore the development of ‘whole-of-patient’ approaches fall intervention by the implementation of a quick screen fall risk assessment tool in general practice by registered nurses. Semistructured interviews 10 semistructured interviews. Registered practice nurses implementing a Clinical Falls Assessment Tool in 10 general practices (n = 10) in Tasmania.
Textual hermeneutic analysis (interpretation of principal themes).
Chou et al., 2005 (USA)[22] To identify barriers and facilitators to the implementation of fall risk management in primary care through academic (education) outreach visits with primary care providers. Semistructured interviews 18 semistructured interviews. Primary care physicians who had attended an educational outreach visit as part of CCFP programmes within last three months; n = 18.
Constant comparative method based on Glaser and Strauss.
De Groot and Fagerstrom 2011 (Norway)[32] To describe the motivating factors and barriers for older adults to adhere to group exercises in the local community that aim to prevent falls and thereby gain further knowledge about how health professionals can stimulate adherence. Semistructured interviews 10 semistructured interviews. 10 adults; 5 men and 5 women who had previously been part of an exercise intervention project. Mean age 83. Equal representation of those afraid of falling and those who were not.
Descriptive content analysis.
Dickinson et al., 2011 (UK)[34] To explore older people’s perceptions of the facilitators and barriers to participation in fall-prevention exercise interventions in the United Kingdom. The study included participants who had taken part or declined to take part in postural stability, Tai Chi, and general exercise classes. Focus groups and semistructured interviews 17 focus groups and 65 semistructured interviews. 187 older people who had previously attended fall-prevention interventions in four geographical areas in the South of England. Caucasian (n = 125; men = 35, women = 90; mean age 77.6). Asian (n = 32; men = 6, women = 26; mean age 69.7). Chinese (n = 30; men = 9, women = 21; mean age 75).
17 focus groups (n = 122 attending). Interviews (n = 65).
Constant comparative method drawn from grounded theory.
Evron et al., 2009a (Denmark)[37] To describe the social processes affecting the implementation of new strategies in fall management through health education. Interviews, participant observation, and document analysis 28 semistructured interviews and participant observation. Convenience sample of staff working in a falls assessment clinic. Interviews with key informants in hospitals, n = 6; key informants from rehabilitation clinic, n = 4; key informants from municipality, n = 2; ad hoc informants (healthcare professionals, patients encountered during participant observation), n = 16.
Thematic analysis.
Evron et al., 2009b (Denmark)[28] To gain new knowledge about barriers to participation in hospital-based fall assessment and interventions, including exercise. Semistructured interviews 20 semistructured interviews. Convenience sample of community-dwelling older people attending a falls assessment clinic. n = 10 refusers: n = 8 women, n = 2 men, mean age 81 years (range = 70–87); n = 10 acceptors: n = 8 women, n = 2 men, mean age 86 years (range = 78–94).
Thematic analysis.
Fortinsky et al., 2004 (USA)[14] To establish how far an educational intervention helps healthcare providers address evidence-based fall risk factors and determine barriers to implementation. Structured interviews 33 structured interviews. Healthcare professionals participating in the CCFP programme. n = 22 women; n = 11 men; mean age 46 (range = 28–63).
Thematic analysis.
n = 5 emergency dept physicians; n = 10 hospital discharge planners; n = 10 home health agency nurses; n = 8 office-based primary care physicians.
Hanson and Salmoni, 2011 (Canada)[24] To identify stakeholders’ perceptions of sustainability after the completion of a community-based fall-prevention education project in three communities in Ontario. Holistic, multiple case study method 45 semistructured interviews following a focussed interview format and using open-ended questions. Key stakeholders involved in components of fall-prevention programmes in three Ontario communities. n = 18 community one; n = 15 community two; n = 12 community three.
Interview analysis using pattern matching and explanation building aided by NVivo software.
Hawley 2009 (UK)[31] To explore what might encourage older people to exercise at home after falls rehabilitation. Grounded theory Nine unstructured interviews. Community-dwelling older people who had participated in a fall-prevention programme; >60 years of age.
Grounded theory.
Horne et al., 2009 (UK)[29] To identify salient beliefs that influence uptake and adherence to exercise for fall prevention among different ethnic communities. Ethnographic 15 focus groups, 40 semistructured interviews. Purposive sample of community-dwelling older people with different experiences of participation or nonparticipation in exercise. Recruited through fieldwork.
Framework analysis.
Focus groups n = 87 (n = 58 Caucasian; n = 44 women; n = 14 men; mean age 65.4).(n = 29 South Asian; n = 13 women; n = 16 men; mean age 66.1 years).
Interviews n = 40 (n = 14 Caucasian women; n = 9 Caucasian men; mean age 64.8; n = 10 South Asian women; n = 7 South Asian men; mean age 65.2).
Horton and Dickinson, 2011 (UK)[35] To explore the perceptions about the use of physical activity in older Chinese people, living in England, and identify barriers and facilitators to exercise uptake. Grounded theory Two focus groups, 10 in-depth interviews. Purposive sample of 30 Chinese community-dwelling older people who attended Tai Chi classes (male = 9, female = 21, mean age 70.2). Focus groups n = 20 (10 in each group). Interviews n = 10.
Constant comparative analysis.
Hutton et al., 2009 (New Zealand)[30] To identify factors that older adults feel help or hinder their involvement in exercise classes. Focus groups Five focus groups. Community-dwelling older people identified at risk of falling who had participated in a randomised controlled trial of Tai Chi intervention classes. Focus groups = 20 participants aged 68–81 years.
Thematic analysis.
Mackenzie 2009 (Australia, UK, Canada)[21] To identify how educating health professionals about home hazard reduction improves the implementation of home modification fall-prevention programmes in the community. Focus groups and semistructured interviews 10 focus groups (n = 2 Australia, n = 4 in Canada, n = 4 in UK). Healthcare professionals using HOME FAST falls and accident screening tool. Occupational therapists n = 30; occupational therapy assistants n = 2; nurses n = 10; physiotherapists n = 3; paramedics n = 2; geriatricians n = 1; social worker n = 1; consumer organisation representative n = 1.
50 semistructured interviews.
Constant comparative analysis.
Nahm et al., 2009 (USA)[33] To ascertain the impact of the social cognitive theory-based structured hip fracture prevention website (TSW) on health behaviours through peer education. Online, randomised controlled study—part of an exploratory, qualitative study Content analysis of discussion board postings. Convenience sample of 116 participants from 245 people (77.6%) who had posted thoughts about falling on online discussion boards. All participants were >55 years, community-dwelling, English speaking who had access to, and working knowledge of, the internet and email access either at home or in the community.
Stewart and McVittie, 2011 (UK)[36] To examine the psychological experiences of involvement in a multidisciplinary educational falls-prevention programme. Semistructured interviews Eight semistructured interviews. Purposive sample of eight housebound, community-dwelling older people who had participated in a multidisciplinary fall-prevention programme (n = 1 male, n = 7 female). Mean age 84 years. All participants were of Scottish (European) background.
Interpretative phenomenological approach (IPA).
Vernon and Ross, 2008 (UK)[27] To explore the barriers to access and acceptability to participation in community-based exercise classes for fall prevention. Mixed qualitative 22 open interviews. Community-dwelling older people who had attended a community balance class. n = 20 women; n = 2 men; age range 65–94. Black British Caribbean n = 4; White Irish n = 2; White British n = 16.
Questionnaires (only interview analysis reported in the paper).
Three focus groups.
Yardley et al., 2006 (Denmark, Germany, Greece, Switzerland, The Netherlands, UK)[26] To identify barriers and facilitators to the uptake of various fall-prevention interventions, including exercise and home modifications. 69 semistructured interviews Interviews. Community-dwelling older people who had declined or participated in fall-prevention interventions. n = 19 men; n = 50 women. Age ranges 68–97 across six European countries (50% of the participants had previously fallen).
    Framework and content analysis.