Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus.
College of Social Work, The Ohio State University, Columbus.
Gerontologist. 2021 Aug 13;61(6):942-953. doi: 10.1093/geront/gnaa133.
Home- and community-based service (HCBS) recipients often possess multiple fall risk factors, suggesting that the implementation of evidence-based fall prevention guidelines may be appropriate for the HCBS setting. The purpose of this exploratory study was to examine the determinants of fall prevention guideline implementation and the potential strategies that can support implementation in HCBS organizations.
Semistructured interview and focus group data were collected from 26 HCBS professionals representing the home-delivered meals, personal care, and wellness programs. Qualitative codes were mapped to the Consolidated Framework for Implementation Research by means of directed content analysis. The Consolidated Criteria for Reporting Qualitative research checklist was used to report the findings of this study.
We identified 7 major determinants of guideline implementation: recipient needs and resources, cosmopolitanism, external policy and incentives, networks and communication, compatibility, available resources, and knowledge/beliefs. Strategies to support guideline implementation included the involvement of recipient and caregiver feedback, building fall prevention networks, and conducting educational meetings for HCBS staff.
Falls and fall-related injuries will continue to plague the older adult community unless innovative approaches to fall prevention are developed and adopted. The implementation of fall prevention guidelines in the HCBS setting can help mitigate fall risk among a highly vulnerable older adult population and may be facilitated through the application of multifaceted implementation strategies.
居家和社区服务（HCBS）的接受者通常存在多种跌倒风险因素，这表明在 HCBS 环境中实施基于证据的跌倒预防指南可能是合适的。本探索性研究的目的是研究跌倒预防指南实施的决定因素，以及可以支持 HCBS 组织实施的潜在策略。
从代表送餐、个人护理和健康计划的 26 名 HCBS 专业人员中收集了半结构化访谈和焦点小组数据。通过定向内容分析，将定性代码映射到实施研究综合框架上。使用综合定性研究报告标准清单报告了本研究的结果。
我们确定了 7 个指南实施的主要决定因素：接受者的需求和资源、世界性、外部政策和激励措施、网络和沟通、兼容性、可用资源和知识/信念。支持指南实施的策略包括纳入接受者和照顾者的反馈、建立跌倒预防网络以及为 HCBS 工作人员举办教育会议。
除非开发和采用创新的跌倒预防方法，否则老年人社区的跌倒和与跌倒相关的伤害将继续困扰着老年人社区。在 HCBS 环境中实施跌倒预防指南可以帮助减轻高度脆弱的老年人群体的跌倒风险，并且可以通过应用多方面的实施策略来促进实施。
