Outcomes Associated with the Scale-up of the Stepping On Falls Prevention Program: A Case Study in Redesigning for Intervention


Introduction. Translating complex behavior change interventions into practice can be accompanied by a loss of fidelity and effectiveness. We present the evaluation of two sequential phases of implementation of a complex evidence-based community workshop to reduce falls, using the Replicating Effective Programs Framework.. Between the two phases, the workshop training and delivery were revised to improve fidelity with key elements. . Methods. Stepping On program participants completed a questionnaire at baseline (Phase 1: n=361, Phase 2: n=2219) and 6 months post workshop (Phase 1: n=232, Phase 2: n=1281). Phase 2 participants had an additional follow up at 12 months (n=883). Outcomes were the number of falls in the prior 6 months and the falls behavioral risk (FaB) score. Results. Workshop participation in Phase 1 was associated with a 6% reduction in falls (RR=0.94, 95% CI 0.74, 1.20) and a 0.14 improvement in FaB score (95% CI, 0.11- 0.18) at 6 months. Workshop participation in Phase 2 was associated with a 38% reduction in falls (RR=0.62, 95% CI 0.57 to 0.68), and a 0.16 improvement in FaB score (95% CI, 0.14-0.18) at 6 months, and a 28% reduction in falls (RR=0.72, 95% CI 0.65 to 0.80) and a 0.19 score improvement in FaB score (95% CI, 0.17-0.21) at 12 months follow-up. Conclusions: Effectiveness can be maintained with widespread dissemination of a complex behavior change intervention if attention is paid to fidelity of key elements. An essential role for implementation science is to ensure effectiveness as programs transition from research to practice.

Journal of Clinical and Translational Research