PenCLAHRC, University of Exeter Medical School, University of Exeter, Exeter, UK.
Implement Sci. 2012 Sep 14;7:91. doi: 10.1186/1748-5908-7-91.
More than a third of people over the age of 65 years fall each year. Falling can lead to a reduction in quality of life, mortality, and a risk of prolonged hospitalisation. Reducing and preventing falls has become an international health priority. To help understand why research evidence has often not been translated into changes in clinical practice, we undertook a systematic review and synthesis of qualitative research in order to identify what factors serve as barriers and facilitators to the successful implementation of fall-prevention programmes.
We conducted a review of literature published between 1980 and January 2012 for qualitative research studies that examined barriers and facilitators to the effective implementation of fall-prevention interventions among community-dwelling older people and healthcare professionals. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality according to predefined criteria. Findings were synthesised using meta-ethnography.
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 which barriers to implementation of fall-prevention interventions had been overcome. Data synthesis produced three overarching concepts: (1) practical considerations, (2) adapting for community, and (3) psychosocial. A line of argument synthesis describes the barriers and facilitators to the successful implementation of fall-prevention programmes. These concepts show that the implementation of fall-prevention programmes is complex and multifactorial. This is the first systematic review and synthesis of qualitative studies to examine factors influencing the implementation of fall-prevention programmes from the perspectives of both the healthcare professional and the community-dwelling older person.
The current literature on barriers and facilitators to the implementation of fall-prevention programmes examines a variety of interventions. However, the ways in which the interventions are reported suggests there are substantial methodological challenges that often inhibit implementation into practice. We recommend that successful implementation requires individuals, professionals, and organisations to modify established behaviours, thoughts, and practice. The issues identified through this synthesis need to be fully considered and addressed if fall-prevention programmes are to be successfully implemented into clinical practice.
每年有超过三分之一的 65 岁以上的人跌倒。跌倒会导致生活质量下降、死亡和住院时间延长的风险。减少和预防跌倒已成为国际健康重点。为了帮助理解为什么研究证据往往没有转化为临床实践的改变，我们进行了系统的综述和定性研究的综合分析，以确定哪些因素是成功实施预防跌倒计划的障碍和促进因素。
我们对 1980 年至 2012 年 1 月期间发表的定性研究进行了文献综述，这些研究检查了社区居住的老年人和医疗保健专业人员中预防跌倒干预措施有效实施的障碍和促进因素。两名评审员独立筛选研究纳入情况，提取数据，并根据预先确定的标准评估方法学质量。使用元民族学综合研究结果。
通过数据库搜索确定的 5010 篇文章中，有 19 篇被纳入综述。对 19 项研究的分析表明，关于实施预防跌倒干预措施的障碍如何克服的信息有限。数据综合产生了三个总体概念：（1）实际考虑，（2）适应社区，和（3）心理社会。论证综合描述了成功实施预防跌倒计划的障碍和促进因素。这些概念表明，预防跌倒计划的实施是复杂的、多因素的。这是第一次系统综述和定性研究的综合分析，从医疗保健专业人员和社区居住的老年人的角度检查影响预防跌倒计划实施的因素。
目前关于预防跌倒计划实施的障碍和促进因素的文献检查了各种干预措施。然而，干预措施的报告方式表明，存在许多方法学挑战，这些挑战常常阻碍了将其付诸实践。我们建议，成功实施需要个人、专业人员和组织改变既定的行为、思维和实践。如果要成功地将预防跌倒计划实施到临床实践中，就需要充分考虑和解决通过这一综合分析确定的问题。
