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

Abstract

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.