Outcomes associated with scale-up of the Stepping On falls prevention program: A case study in redesigning for dissemination

Jane E Mahoney; Ron Gangnon; Lindy Clemson; LaVerne Jaros; Sandy Cech; Jill Renken

doi:10.1017/cts.2020.17

Outcomes associated with scale-up of the Stepping On falls prevention program: A case study in redesigning for dissemination

J Clin Transl Sci. 2020 Mar 4;4(3):250-259. doi: 10.1017/cts.2020.17.

Authors

Jane E Mahoney¹, Ron Gangnon², Lindy Clemson³, LaVerne Jaros⁴, Sandy Cech⁵, Jill Renken⁶

Affiliations

¹ Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
² Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
³ Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁴ Kenosha County Aging and Disability Resource Center, Kenosha, WI, USA.
⁵ Captain James A. Lovell Veterans Administration Hospital, North Chicago, IL, USA.
⁶ Wisconsin Institute for Healthy Aging, Madison, WI, USA.

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, 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 Scale (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 0.57-0.68) 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 0.65-0.80) and a 0.19 score improvement in FaB score (95% CI 0.17-0.21) at 12-month 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.

Keywords: Implementation; dissemination; evidence-based programs; falls prevention; fidelity.