Mechanisms of change in a community-based multifactorial fall prevention intervention

Background

Falls among older adults are a major public health concern, leading to injuries, functional decline, and reduced quality of life. Multifactorial interventions addressing physical, medical, and environmental risk factors are recommended, yet evidence on how these interventions lead to behavioural and functional change remains limited. In Aarhus Municipality, Denmark, a community-based fall prevention programme has been implemented for adults at increased risk of falling. This study explores participant interactions and potential mechanisms of change.

Methods

A qualitative process evaluation was conducted following the Medical Research Council framework, focusing on participant responses and potential mechanisms of change. The intervention includes a multifactorial assessment, tailored exercise, and patient education delivered in a community-based setting. Qualitative data were collected through 13 semi-structured interviews and analysed using qualitative content analysis, with findings reported as preliminary.

Results

Emerging qualitative findings suggest that participants’ motivation may be shaped by prior experiences and concerns about future risk. The programme is experienced as challenging and sometimes anxiety-provoking, particularly when confronting previously avoided situations, yet appears to support gradual increases in confidence and behavioural change. Training outdoors is perceived as enhancing transferability to everyday life. Group-based training may promote motivation and peer identification, while also challenging individual tailoring.

Conclusions

Preliminary findings suggest participation is driven by perceived risk and shaped through challenging activities. The intervention may support confidence and behavioural change, with outdoor and group-based elements enhancing transferability and motivation, while requiring attention to individual tailoring.

Key messages

• Behavioural change may be influenced by perceived risk and engagement with challenging activities within the intervention.

• Outdoor and group-based elements may support motivation and transfer of gains to everyday life, while also requiring attention to individual tailoring.