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

Jane E Mahoney, Lindy Clemson, Amy Schlotthauer, Karin A Mack, Terry Shea, Vicki Gobel, Sandy Cech, Jane E Mahoney, Lindy Clemson, Amy Schlotthauer, Karin A Mack, Terry Shea, Vicki Gobel, Sandy Cech

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.

Methods: Older 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.

Results: The 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.

Discussion: The 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.

Keywords: Delphi consensus; Stepping On; fall prevention; health promotion; implementation.

References

    1. Stevens J, Burns E. A CDC Compendium of Effective Fall Interventions: What Works for Community Dwelling Older Adults. 3rd ed Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; (2015).
    1. Sudsawad P. Knowledge Translation: Introduction to Models, Strategies, and Measures. Austin, TX: Southwest Educational Development Laboratory, National Center for the Dissemination of Disability Research; (2007).
    1. Petrescu-Prahova M, Belza B, Kohn M, Miyawaki C. Implementation and maintenance of a community-based older adult physical activity program. Gerontologist (2015) 56(4):677–86.10.1093/geront/gnv024
    1. Day L, Donaldson A, Trotter MJ, Hill K, Finch CF. Key factors influencing implementation of falls prevention exercise programs in the community. J Aging Phys Act (2015) 42(1):45–52.10.1123/japa.2014-0143
    1. Kilbourne AM, Neumann MS, Pincus HA, Bauer MS, Stall R. Implementing evidence-based interventions in health care: application of the replicating effective programs framework. Implement Sci (2007) 2:42.10.1186/1748-5908-2-42
    1. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci (2009) 4:50.10.1186/1748-5908-4-50
    1. Clemson L, Cumming RG, Kendig H, Swann M, Heard R, Taylor K. The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial. J Am Geriatr Soc (2004) 52(9):1487–94.10.1111/j.1532-5415.2004.52411.x
    1. Clemson L, Swann M, Twible R, Cumming R, Kendig H, Taylor K. Stepping On: Building Confidence and Reducing Falls. A Community-Based Program for Seniors. Cedar Falls, IA: Freiberg Press; (2007).
    1. Clemson L, Swann M, Mahoney J. Stepping On: Building Confidence and Reducing Falls. A Community-Based Program for Seniors. 3rd ed Cedar Falls, IA: Freiberg Press; (2011).
    1. Boud D, Walker P. Experience and Learning Reflection at Work. Geelong, VC: Deakin University Press; (1991).
    1. Bandura A. Self-Efficacy: The Exercise of Control. New York: W.H. Freeman; (1997).
    1. Janis IL, Mann L. Decision Making: A Psychological Analysis of Conflict, Choice, and Commitment. New York: Free Press; (1977).
    1. Clemson L, Swann M, Twible R, Cumming R, Kendig H. Stepping On: Building Confidence and Reducing Falls. A Community-Based Program for Older Adults. Sydney: University of Sydney; (2003).
    1. Mahoney JE, Shea TA, Przybelski R, Jaros L, Gangnon R, Cech S, et al. Kenosha County Falls Prevention Study: a randomized, controlled trial of an intermediate-intensity, community-based multifactorial falls intervention. J Am Geriatr Soc (2007) 55:489–98.10.1111/j.1532-5415.2007.01144.x
    1. Lorig K, Sobel DS, Stewart AL, Brown BW, Bandura A, Ritter P, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care (1999) 37(1):5–14.10.1097/00005650-199901000-00003
    1. United States Department of Health and Human Services (HHS). (2016). Available from:
    1. Frank JC, Coviak CP, Healy TC, Belza B, Casado BL. Addressing fidelity in evidence-based health promotion programs for older adults. J Appl Gerontol (2008) 27(1):4–33.10.1177/0733464807308621
    1. Sandler I, Ostrom A, Bitner MJ, Ayers TS, Wolchik S, Daniels VS. Developing effective prevention services for the real world: a prevention service development model. Am J Community Psychol (2005) 35(3–4):127–42.10.1007/s10464-005-3389-z
    1. Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CF, Askham J, et al. Consensus development methods, and their use in clinical guideline development. Health Technol Assess (1998) 2(3):i–iv,1–88.
    1. Dalkey N, Helmer O. An experimental application of the Delphi method to the use of experts. Manage Sci (1963) 9:458–67.10.1287/mnsc.9.3.458
    1. Custer R, Scarcella J, Stewart B. The modified Delphi technique – a rotational modification. J Voc Tech Educ (1998) 15(2):50–8.
    1. Ward L, Stebings S, Sherman KJ, Cherkin D, Baxter GD. Establishing key components of yoga interventions for musculoskeletal conditions: a Delphi survey. BMC Complement Altern Med (2014) 14:196.10.1186/1472-6882-14-196
    1. Hiltz SR. Online Communities: A Case Study of the Office of the Future. Norwood, NJ: Ablex Press; (1984).
    1. Rasch G. Probabilistic Models for Some Intelligence and Attainment Tests. Chicago: University of Chicago Press; (1960).
    1. Bond TG, Fox CM. Applying the Rasch Model: Fundamental Measurement in the Human Sciences. 2nd ed Mahwah, NJ: Lawrence Erlbaum Associates Publishers; (2007).
    1. Wright BD, Masters GN. Rating Scale Analysis: Rasch Measurement. Chicago: MESA Press; (1982).
    1. Wisconsin Institute for Healthy Aging and Centers for Disease Control and Prevention. Stepping On Site Implementation Guide. (2012). Available from:
    1. Mahoney JE, Gobel VL, Shea T, Janczewski J, Cech S, Clemson L. Improving fidelity of translation of the stepping on falls prevention program through root cause analysis. Front Public Health (2016) 4:251.10.3389/fpubh.2016.00251
    1. Mahoney JE. “Stepping On”: stepping over the chasm from research to practice. Front Public Health (2015) 2:148.10.3389/fpubh.2014.00148
    1. Mahoney J, Clemson L, Lovarini M. Stepping On: a community based falls prevention program. In: Malone M, Capezuti E, Palmer RM, editors. Geriatrics Models of Care: Bringing ‘Best Practice’ to an Aging America. New York: Springer Publishing; (2015). p. 193–8.
    1. Jancey JM, Lee AH, Howat PA, Burke L, Leong CC, Shilton T. The effectiveness of a walking booster program for seniors. Am J Health Promot (2011) 25(6):363–7.10.4278/ajhp.090512-ARB-164
    1. Dijkstra M, Mesters I, De Vries H, van Breukelen G, Parcel GS. Effectiveness of a social influence approach and boosters to smoking prevention. Health Educ Res (1999) 14(6):791–802.10.1093/her/14.6.791
    1. Botvin GJ, Renick NL, Baker E. The effects of scheduling format and booster sessions on a broad-spectrum psychosocial approach to smoking prevention. J Behav Med (1983) 6(4):359–79.10.1007/BF00846324
    1. Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown BW, Jr, Bandura A, et al. Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care (2001) 39(11):1217–23.10.1097/00005650-200111000-00008
    1. Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A. A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. J Gerontol B Psychol Sci Soc Sci (1998) 53(6):384–92.10.1093/geronb/53B.6.P384
    1. Healy TC, Peng C, Haynes MS, McMahon EM, Botler JL, Gross L. The feasibility and effectiveness of translating a matter of balance into a volunteer lay leader model. J Appl Gerontol (2008) 27(1):34–51.10.1177/0733464807308620
    1. van der Steen JT, Radbruch L, Hertogh CM, de Boer ME, Hughes JC, Larkin P, et al. White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliat Med (2014) 28(3):197–209.10.1177/0269216313493685
    1. Campbell SM, Cantrill JA, Roberts D. Prescribing indicators for UK general practice: Delphi consultation study. BMJ (2000) 321(7258):425–8.10.1136/bmj.321.7258.425
    1. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med (2003) 163(22):2716–24.10.1001/archinte.163.22.2716
    1. Clemson L, Fitzgerald M, Heard R. Content validity of an assessment tool to identify home fall hazards: the Westmead Home Safety Assessment. Br J Occup Ther (1999) 62(4):171–9.10.1177/030802269906200407
    1. Elwyn G, O’Connor A, Stacey D, Volk R, Edwards A, Coulter A, et al. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ (2006) 333(7565):417.10.1136/

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe