title: Barriers to participation in a hospital-based falls assessment clinic programme: an interview study with older people.
abstract: OBJECTIVE
  To gain new knowledge about barriers to participation in hospital-based falls assessment.
  
  
  METHODS
  Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Those who refused referral were recruited in relation to a systematic falls screening programme performed by preventive home visitors. Accepters were selected among 72 participants successively completing the falls assessment clinic programme. The time between the interviews was 12 months; different levels of knowledge were expected, owing to accepters' participation in the programme. Interview transcriptions were thematically analysed. The analysis was directed towards identification of barriers to falls assessment.
  
  
  RESULTS
  Barriers to participation were categorized as being either within or outside the falls clinic, and included administration, time, communication, attitudes to fall prevention, and expected future costs. Accepters completing the programme expressed a feeling of being ''met'' in the system and maintaining authority over their own life, while the refusers expressed concern about the healthcare system taking over their life.
  
  
  CONCLUSIONS
  This study indicates that older at-risk patients acknowledge their falls problem, but refuse to participate in hospital-based assessment programmes because they expect to lose their authority and to be caught up in the healthcare system. In order to transform the findings of this study to a public health message, we have to consider moving the focus of falls prevention strategies from disease control to the domain of health promotion in order to engage older adults in preventive healthcare.
authors.affiliation: Centre for Elder Research, Copenhagen University Hospital, Bispebjerg, Denmark. lotte.evron@gmail.com
authors.forename: Lotte
authors.initials: L
authors.lastname: Evron
authors.forename: Kirsten
authors.initials: K
authors.lastname: Schultz-Larsen
authors.forename: Tine
authors.initials: T
authors.lastname: Fristrup
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D010358:Patient Participation; D015397:Program Evaluation; D012017:Referral and Consultation; D012307:Risk Factors; D011795:Surveys and Questionnaires