Research on the Translation and Implementation of Stepping On in Three Wisconsin Communities

Abstract

ObjectiveFalls are a leading cause of injury death. Stepping On is a fall prevention program developed in Australia and shown to reduce falls by up to 31%. The original program was implemented in a community setting, by an occupational therapist, and included a home visit. The purpose of this study was to examine aspects of the translation and implementation of Stepping On in three community settings in Wisconsin.MethodsThe investigative team identified four research questions to understand the spread and use of the program, as well as to determine whether critical components of the program could be modified to maximize use in community practice. The team evaluated program uptake, participant reach, program feasibility, program acceptability, and program fidelity by varying the implementation setting and components of Stepping On. Implementation setting included type of host organization, rural versus urban location, health versus non-health background of leaders, and whether a phone call could replace the home visit. A mixed methodology of surveys and interviews completed by site managers, leaders, guest experts, participants, and content expert observations for program fidelity during classes was used.ResultsThe study identified implementation challenges that varied by setting, including securing a physical therapist for the class and needing more time to recruit participants. There were no implementation differences between rural and urban locations. Potential differences emerged in program fidelity between health and non-health professional leaders, although fidelity was high overall with both. Home visits identified more home hazards than did phone calls and were perceived as of greater benefit to participants, but at 1 year no differences were apparent in uptake of strategies discussed in home versus phone visits.ConclusionAdaptations to the program to increase implementation include using a leader who is a non-health professional, and omitting the home visit. Our research demonstrated that a non-health professional leader can conduct Stepping On with adequate fidelity, however non-health professional leaders may benefit from increased training in certain aspects of Stepping On. A phone call may be substituted for the home visit, although short-term benefits are greater with the home visit.

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

“…It is important to note, our participants had low literacy levels, with 45% of participants having less than primary education, and 37.5% having difficulty reading in Spanish. This is substantially different from the experience with Stepping On participants, where participants with less than high school education are less than 20% [14, 21]. This highlights the need to perform more than translation, but the linguistic and cultural adaptation of the program.…”

“…Meanwhile, site 2 (senior housing building) had limited resources, one of the leaders was also the housing coordinator, which created logistical difficulties, and the organization had no previous experience in organizing this type of event. This correlates with the experience of Stepping On, where the implementation of the program in independent living facilities was cumbersome because the staff in charge of delivering the program were not given additional time or resources to implement the program, delivery of health promotion programs was not central to the organization’s mission [14].…”

“…Fidelity of delivery was evaluated following protocols established for Stepping On leaders [14]. For Stepping On it is expected that new leaders deliver at least 80% of elements in a satisfactory manner, however, this benchmark was established empirically from the identification of key elements [20, 21, 38].…”

“…Stepping On is a multifaceted intervention with similar characteristics to those described as desired by Hispanic communities in Wisconsin. It has been documented to decrease the risk of falls among Australian older adults by 31% [12–14], and is available in English in 22 states within the US.…”

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

“…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].…”