title: Facilitators of and barriers to hip protector acceptance and adherence in long-term care facilities: a systematic review.
abstract: BACKGROUND
  Hip protectors represent an attractive strategy for reducing hip fractures among high-risk fallers in long-term care facilities. However, clinical studies yield conflicting results regarding their clinical value. This is mainly due to poor acceptance and adherence among users in wearing these devices. As a result, there is an urgent need to identify potential barriers and facilitators to initial acceptance and continued adherence with hip protector use.
  
  
  OBJECTIVE
  The objective of this systematic review is to synthesize available research evidence to identify factors that influence acceptance and adherence among older adults living in long-term care facilities.
  
  
  METHODS
  A key word search was conducted for studies published in English between 2000 and 2013 that employed quantitative, qualitative, or mixed-methods research designs. Two independent reviewers evaluated each article for inclusion, with a third reviewer when needed to resolve discrepancies.
  
  
  RESULTS
  Twenty-eight articles met our inclusion criteria, and facilitators and barriers were clustered into 4 socio-ecological levels: system (eg, facility commitment, staff shortages), caregiver (eg, belief in the efficacy of protectors, negative perceptions), resident (eg, clinical risk factors for falls and related fractures, acute illness), and product (eg, soft shell, discomfort).
  
  
  CONCLUSIONS
  The outcomes provide decision makers, health professionals, and caregivers with a greater awareness of strategies to improve compliance with the use of hip protectors. Furthermore, researchers can use this information to design clinical trials that yield high acceptance and adherence.
authors.affiliation: Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada.
authors.forename: Alexandra M B
authors.initials: AM
authors.lastname: Korall
authors.affiliation: Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada; Older Adult Program, Fraser Health Authority, Surrey, Canada. Electronic address: Fabio.Feldman@fraserhealth.ca.
authors.forename: Fabio
authors.initials: F
authors.lastname: Feldman
authors.affiliation: British Columbia Injury Research and Prevention Unit, Vancouver, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Vicky J
authors.initials: VJ
authors.lastname: Scott
authors.affiliation: Research and Academics, Ontario Shores Centre for Mental Health Sciences, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Wasdell
authors.affiliation: Island Health, British Columbia, Canada.
authors.forename: Roslyn
authors.initials: R
authors.lastname: Gillan
authors.affiliation: Island Health, British Columbia, Canada.
authors.forename: Donna
authors.initials: D
authors.lastname: Ross
authors.affiliation: Island Health, British Columbia, Canada.
authors.forename: Tracey
authors.initials: T
authors.lastname: Thompson-Franson
authors.affiliation: Older Adult Program, Fraser Health Authority, Surrey, Canada.
authors.forename: Pet-Ming
authors.initials: PM
authors.lastname: Leung
authors.affiliation: Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Lin
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006620:Hip Fractures / Q000517:prevention & control*; D006707:Homes for the Aged; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011481:Protective Clothing / Q000706:statistics & numerical data; D011482:Protective Devices / Q000706:statistics & numerical data*; D018570:Risk Assessment
keywords: Hip protectors; adherence; compliance; falls; hip fracture; long-term care