A qualitative study to identify factors influencing the perceived acceptability, appropriateness and feasibility of implementing a falls risk assessment service in primary care

Problem

A new integrated falls prevention pathway for community-dwelling older adults was introduced in southwest Ireland in 2015, including new multidisciplinary falls risk assessment clinics in primary care delivered by existing staff. The aim of this study is to identify the factors that influenced the acceptability, appropriateness and feasibility of implementation among primary healthcare professionals delivering these clinics.

Approach

Methods involved one-to-one interviews with healthcare professionals (physiotherapists, occupational therapists, nurses) delivering the clinics across four sites. Interviews were conducted prior to implementation and six months after implementation had commenced, in 2016 and 2017. Data were analysed using two implementation frameworks – one focused on barriers and facilitators to implementation and the other on implementation outcomes.

Findings

A total of 15 healthcare professionals took part in the study. Availability of resources in primary care, particularly personnel, strongly influenced the perceived acceptability and feasibility of implementation. Lack of engagement with key stakeholders undermined acceptability and feasibility, particularly non-attendance by service users and lack of engagement by GPs referring to the service. Complexity of the intervention influenced all three outcomes: while the multifactorial assessment was deemed comprehensive and concise, the multi-disciplinary scope of the assessment proved challenging for some healthcare professionals.

Consequences

The study highlights the importance of greater planning of resources at the pre-implementation stage, particularly in terms of adequate staffing, appropriate physical infrastructure and ongoing training for primary healthcare professionals. Issues regarding engagement with key stakeholders highlights the need to foster greater understanding and awareness of the service among both service users and potential referrers.