Implementation of evidence based fall-prevention programmes in the health care services: Quality, competency and effectiveness (FALLPREVENT)

This year of FALLPREVENT has had its main focus on the implementation study, where the spring semester consisted of feasibility testing, planning, and recruitment of municipalities/districts. The autumn semester involved the commencement of data collection, randomization, and the start of the intervention period of the cluster-randomized study where 25 municipalities/districts in Norway are participating. The PhD projects associated with FALLPREVENT are now in their final year, focusing on completion and submission of articles. In 2023, the PhD project "Implementation of evidence-based fall prevention in primary care with clinical decision support" collected data for both a journal review and conducted an implementation study in a district where three questions to identify older adults at increased risk of falls were tested among healthcare professionals. The systematic literature review on the effect of decision support used in fall prevention on healthcare provider and patient outcomes is also in its final stages, with the candidate finalizing a manuscript for potential publication by the end of this year. Furthermore, the aim is to complete the other two articles for submission in the first quarter of 2024, culminating the doctoral period with completion around summer. The PhD project titled "Reducing the gap between evidence-based knowledge and practice in the field of fall prevention: development of user-centered implementation interventions" has during this phase, completed an article based on the co-creation study, which now is accepted for publication. This work has laid the foundation for the development of an implementation intervention, tested in a feasibility study in two districts in spring 2023. During this work, the candidate has collaborated with the post-doctoral candidate, and the wider research group, to providing important insights into how an implementation intervention can be carried out in practice. An article based on this work is in its final stages and will be submitted before the end of the year. Concurrently, the candidate is working on a systematic literature review, conducting updated searches. The role of leaders in implementation has been highlighted in this PhD, leading to a qualitative study involving interviews with 8 new leaders during the autumn of 2023. The study explores leaders' experiences with implementation in home-based services and their perspectives on how national clinical guidelines for fall prevention can be implemented. In spring 2023, WP3 saw significant activity, particulary in connection with the developments in WP2. The work in WP2 was expanded upon and integrated into the planning phase of the cluster-randomized implementation study. This phase involved multiple engagements with national and international partners aimed at finalizing the study design. Additionally, a national resource group, comprising seven representatives from various organizations such as the Pensioners’ Association, Norwegian Directorate of Health, Center for Quality in General Practice, Norwegian Physiotherapy Association, Norwegian Nurses Association, Norwegian Association for Public Health, and the Development Center for Nursing Homes and Home Care services, was established. This group contributed to a meeting where study specifics were presented, followed by insightful feedback from the representatives. The study has been registered and submitted for approval to the REK and Sikt. Regarding the recruitment of districts and municipalities, invitations were disseminated via the Development Center for Nursing Homes and Home Care Services. Subsequently, telephone conversations were conducted to confirm or deny interest, followed by digital meetings involving approximately 30 municipalities expressing interest in participation. Before summer, the target of including 25 municipalities/city districts was achieved. An assistant started in the project, with primary task to follow up the municipalities during conduction of the study. Data collection commenced in August, followed by randomization and the initiation of interventions. Leader gatherings and regional sessions were conducted across four regions, complemented by digital local meetings with each of the intervention municipalities. The study protocol has been finalized and submitted for possible publication.

The path from research to service innovation and implementation in practice may be long.Health professionals, patients, policymakers, and the public aspire to making healthcare decisions based on the best available research evidence.FALLPREVENT seeks interaction within and between the services and service innovation for ensuring sound and efficient patient and user pathways.The focus of the FALLPREVENT,is to develop an innovative model for implementation of evidence-based fall prevention programmes based on the knowledge,competence and experience of users and other stakeholders.We have designed four work packages of the project to address the challenges we expect to meet in implementing fall-prevention programmes.FALLPREVENT aims to explore the'know-do gap'in fall prevention in Norway and eterminants of practice in fall prevention.We will tailor implementation interventions to address the identified determinants,and assess the effectiveness of the implementation interventions in a cluster randomized trial,where 20 Norwegian municipalities/city districts will be randomized to the intervention and 20 Norwegian municipalities/city districts or the control group in Norway including the 15 city districts of Oslo.We will use a combination of data sources,and a combination of qualitative and quantitative method for the empirical analyses.Users will contribute to the project by involvement in developing the project,in the data collection and sampling of informants,and they will provide feedback on the milestones of the project through a user reference group.The project and its consortium will strengthen implementation research and promote better health by strengthening the foundation for knowledge-based education,knowledge-based health service,professional practice and policymaking.FALLPREVENT fits in with the highest priority areas under HELSEVEL,by developing research and innovation that enhances quality,competency and efficiency in the health care and welfare services.