title: Process factors explaining the ineffectiveness of a multidisciplinary fall prevention programme: a process evaluation.
abstract: BACKGROUND
  Falls are a major health threat to older community-living people, and initiatives to prevent falls should be a public health priority. We evaluated a Dutch version of a successful British fall prevention programme. Results of this Dutch study showed no effects on falls or daily functioning. In parallel to the effect evaluation, we carried out a detailed process evaluation to assess the feasibility of our multidisciplinary fall prevention programme. The present study reports on the results of this process evaluation.
  
  
  METHODS
  Our fall prevention programme comprised a medical and occupational-therapy assessment, resulting in recommendations and/or referrals to other services if indicated. We used self-administered questionnaires, structured telephone interviews, structured recording forms, structured face-to-face interviews and a plenary group discussion to collect data from participants allocated to the intervention group (n = 166) and from all practitioners who performed the assessments (n = 8). The following outcomes were assessed: the extent to which the multidisciplinary fall prevention programme was performed according to protocol, the nature of the recommendations and referrals provided to the participants, participants' self-reported compliance and participants' and practitioners' opinions about the programme.
  
  
  RESULTS
  Both participants and practitioners judged the programme to be feasible. The programme was largely performed according to protocol. The number of referrals and recommendations ensuing from the medical assessment was relatively small. Participants' self-reported compliance as regards contacting their GP to be informed of the recommendations and/or referrals was low to moderate. However, self-reported compliance with such referrals and recommendations was reasonable to good. A large majority of participants reported they had benefited from the programme.
  
  
  CONCLUSIONS
  The results of the present study show that the programme was feasible for both practitioners and participants. Main factors that seem to be responsible for the lack of effectiveness are the relatively low number of referrals and recommendations ensuing from the medical assessments and participants' low compliance as regards contacting their GP about the results of the medical assessment. We do not recommend implementing the programme in its present form in regular care.
  
  
  BACKGROUND
  ISRCTN64716113.
authors.affiliation: Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO box 616, 6200 MD Maastricht, The Netherlands. m.bleijlevens@socmed.unimaas.nl
authors.forename: Michel H C
authors.initials: MH
authors.lastname: Bleijlevens
authors.forename: Marike R C
authors.initials: MR
authors.lastname: Hendriks
authors.forename: Jolanda C M
authors.initials: JC
authors.lastname: van Haastregt
authors.forename: Erik
authors.initials: E
authors.lastname: van Rossum
authors.forename: Gertrudis I J M
authors.initials: GI
authors.lastname: Kempen
authors.forename: Joseph P M
authors.initials: JP
authors.lastname: Diederiks
authors.forename: Harry F J M
authors.initials: HF
authors.lastname: Crebolder
authors.forename: Jacques Th M
authors.initials: JT
authors.lastname: van Eijk
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000061:Accidents, Home / Q000517:prevention & control* / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D000368:Aged; D002985:Clinical Protocols; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005194:Family Practice; D005240:Feasibility Studies; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D016330:Frail Elderly / Q000523:psychology*; D015577:Geriatric Assessment; D005853:Geriatrics; D006801:Humans; D033183:Interdisciplinary Communication; D009426:Netherlands; D009788:Occupational Therapy / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data; D015397:Program Evaluation; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012656:Self-Help Devices / Q000706:statistics & numerical data