Modified Delphi Consensus to Suggest Key Elements of Stepping On Falls Prevention Program

Abstract

Falls among older adults result in substantial morbidity and mortality. Community-based programs have been shown to decrease the rate of falls. In 2007, the Centers for Disease Control and Prevention funded a research study to determine how to successfully disseminate the evidence-based fall prevention program (Stepping On) in the community setting. As the first step for this study, a panel of subject matter experts was convened to suggest which parts of the Stepping On fall prevention program were considered key elements, which could not be modified by implementers.MethodsOlder adult fall prevention experts from the US, Canada, and Australia participated in a modified Delphi technique process to suggest key program elements of Stepping On. Forty-four experts were invited to ensure that the panel of experts would consist of equal numbers of physical therapists, occupational therapists, geriatricians, exercise scientists, and public health researchers. Consensus was determined by percent of agreement among panelists. A Rasch analysis of item fit was conducted to explore the degree of diversity and/or homogeneity of responses across our panelists.ResultsThe Rasch analysis of the 19 panelists using fit statistics shows there was a reasonable and sufficient range of diverse perspectives (Infit MnSQ 1.01, Z score −0.1, Outfit MnSQ 0.96, Z score −0.2 with a separation of 4.89). Consensus was achieved that these elements were key: 17 of 18 adult learning elements, 11 of 22 programming, 12 of 15 exercise, 7 of 8 upgrading exercises, 2 of 4 peer co-leader’s role, and all of the home visits, booster sessions, group leader’s role, and background and training of group leader elements. The top five key elements were: (1) use plain language, (2) develop trust, (3) engage people in what is meaningful and contextual for them, (4) train participants for cues in self-monitoring quality of exercises, and (5) group leader learns about exercises and understands how to progress them.DiscussionThe Delphi consensus process suggested key elements related to Stepping On program delivery. These elements were considered essential to program effectiveness. Findings from this study laid the foundation for translation of Stepping On for broad US dissemination.

“Pisando Fuerte”: an evidence-based falls prevention program for Hispanic/Latinos older adults: results of an implementation trial

“…processes specific to the delivery of the program: snacks and beverages available at sessions, use of the medication record card, handouts, group size), and adult learning techniques (e.g. elements used to promote engagement and class participation: plain language, invite feedback, use of the prevention framework) [20]. Additionally, at site 2, one of the sessions was cancelled, and the booster session was not performed due to organizational factors.…”

“…The resulting program ( Pisando Fuerte ) maintains all but two of the key elements of Stepping On [20]: 1) Use of weights for leg exercises was changed to optional rather than required, in response to the community advisors’ consensus that most of the older Hispanic/Latinos participants would not comply with using weights, due to monetary and cultural barriers. 2) Background of the leaders.…”

“…Fidelity of delivery was assessed at sessions 1, 3 and 7, using pre-established checklists that were created based on the key elements of Stepping On [20]. Additional items incorporating cultural values were developed based on previously published literature [28–30], and reported under the category: cultural adaptation elements (Table 3).…”

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

“…The marked increase in effectiveness that we found in phase 2 may be due to the steps we took to ensure fidelity with dissemination. First, we identified key elements of Stepping On and developed a fidelity tool to track the delivery of key elements across all workshop sessions [11]. We then trained a new leader and monitored every session of the leaders' first workshop for fidelity.…”

“…We developed an implementation guide to coach organizations on how to prepare for and implement the workshop. The result was a comprehensive program package to support high fidelity implementation [11][12][13].…”