Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, São Paulo, Brazil.
Orthopedic and Traumatology Institute, Faculty of Medicine, Universidade de São Paulo - FMUSP, São Paulo, Brazil.
Arch Gerontol Geriatr. 2021 Jan-Feb;92:104287. doi: 10.1016/j.archger.2020.104287. Epub 2020 Oct 22.
To understand the reasons older people engage in a multifactorial fall prevention program and, to identify the barriers and facilitators for adherence.
Cross-sectional study, with 218 older adults from the intervention group of a 12-week multifactorial fall prevention program (Prevquedas Brazil). We interviewed participants using a semi-structured questionnaire concerning reasons to engage in, barriers, and facilitators to participating in the program. We compared participants with low (0-5 sessions) and moderate/high (6-12 sessions) adherence regarding barriers and facilitators.
Physical and mental health problems (55 %), and competing demands (45.2 %) were the most frequent barriers reported. Pleasant environment (97.7 %), a sense of receiving proper care (96.7 %), and empathy with the team (96.7 %) were the main facilitators. Seven out of the twelve facilitators distinguished participants with high adherence from those with low adherence. Only the barriers related to the program characteristics and the lack of social support were able to identify participants with low adherence. Open-ended questions revealed that self-determination, commitment, and the desire of being physically active and fit promoted participation. Anticipated health benefits and functional gains, a need to take action due to fall consequences, and encouragement from others were among the reasons to engage in the program.
Although barriers should not be neglected, facilitators are critically important for adherence. Health professionals may develop skills to facilitate uptake and optimize older adults' participation. Implementing sustainable fall prevention programs in low and middle-income countries requires overcoming the fragmentation and inflexibility of healthcare services.
了解老年人参与多因素防跌倒计划的原因，并确定其坚持治疗的障碍和促进因素。
这是一项横断面研究，共纳入了来自巴西 Prevquedas 为期 12 周的多因素防跌倒计划干预组的 218 名老年人。我们使用半结构式问卷对参与者进行访谈，内容涉及参与该计划的原因、障碍和促进因素。我们比较了低（0-5 次）和中/高（6-12 次）依从性的参与者在障碍和促进因素方面的差异。
身体和心理健康问题（55%）和竞争需求（45.2%）是报告最多的障碍。愉快的环境（97.7%）、感觉得到适当的照顾（96.7%）和对团队的同理心（96.7%）是主要的促进因素。在 12 个促进因素中有 7 个可以将高依从性的参与者与低依从性的参与者区分开来。只有与计划特征相关的障碍和缺乏社会支持才能识别出低依从性的参与者。开放性问题的回答显示，自我决定、承诺、保持身体活跃和健康的愿望、对健康获益和功能改善的期望、对跌倒后果的重视以及他人的鼓励是参与该计划的原因。
尽管不应忽视障碍，但促进因素对于坚持治疗至关重要。卫生专业人员可以培养促进参与的技能，以优化老年人的参与度。在中低收入国家实施可持续的防跌倒计划需要克服医疗服务的碎片化和缺乏灵活性。
