Can a program that reduced falls among Australia’s older adults by 31 percent find widespread popularity in the U.S.? Although the Stepping On program was first introduced in North America in 2015, implementation of the evidence-based program has been limited in the U.S. A team of scientists set out to test implementation in three Wisconsin community settings with the purpose of modifying the program to make it more appealing to Americans.

The researchers share their discoveries and recommendations in an article published last month on the research-sharing website, frontiersin.org.

How Australia did it

The pilot program for Australia’s Stepping On fall prevention model was conducted with community-dwelling older adults who participated in a series of fall prevention classes led by an occupational therapist. This program included a three-month follow-up home visit to reinforce strategies taught in the class.

The program was simple and effective but it wasn’t gaining popularity in the U.S. Could a new Americanized method maintain the effectiveness of the program? The Wisconsin researchers planned to find out.

Mixing it up

The U.S. study used a mixture of methods to evaluate the Australian program’s model: rural and urban host sites; program leaders who were health professionals and those with no health background; and a combination of three-month follow-up phone calls and in-home visits. Fall prevention classes remained the hub of the program, with a mix of surveys and interviews completed by site managers, leaders, guest experts and participants.

The three community sites that hosted the U.S. classes were an independent living community, a parks and recreation center, and a rural site hosted by a parish nurse program.

Four questions were used to guide research:

1. Who can serve as a Stepping On leader? Requiring the leadership of health professionals could encumber the program’s U.S. implementation.
2. Are there differences in program implementation at different sites that would be barriers to the program’s adoption? The Australian program advocates using public venues that are easily accessible; the U.S. research team sought to challenge that approach.
3. Are there differences in the success of implementation at urban versus rural sites? U.S. researchers needed to answer that question on their own, since participants in the Australian program were at one urban location.
4. Can a phone call be substituted for a home visit in resource-strapped rural areas? The Australian program used home visits to reinforce fall prevention concepts and strategies, including exercise.

Fine-tuning the Australian model

At the conclusion of their study, the U.S. researchers were able to offer a number of evidence-based recommendations:

• Prerequisite for leaders should be expanded to include non-health care professionals, especially social workers and others who have experience working with older adults. While both health care and non-health care Step On leaders scored well in most areas of their class presentation and supervision, the non-professionals failed to emphasis the connection between exercises and falls prevention. This can be addressed by emphasis the link during training sessions for leaders.
• Both rural and urban venues attracted participants within a five-minute radius of their venue and saw more participants in their second series of classes, after news about the class spread.
• A phone call can be used in lieu of a home visit. While a one-year follow-up showed comparable positive results for both methods, the home visit had better short-term results.

The take-away

The study’s findings have been included in the U.S. edition of the Stepping On training program and guide for sites in the U.S. Although the Wisconsin study showed that public venues are the best suited to successfully adopt the program, all of us who advocate for the safety of older adults can learn from its strategies. We at Meth-Wick are currently conducting our own fall prevention research. Keep an eye on the blog over the next few months to see what our findings revealed.