Objective:

Falls are a significant problem for many older patients after hospital discharge. The purpose of this study was to evaluate the fidelity and impact of a tailored patient fall prevention education programme from the perspective of the educators who delivered the programme.

Design:

Qualitative sequential design.

Setting:

Three rehabilitation hospitals in Western Australia.

Method:

Three experienced physiotherapists trained as ‘educators’ to deliver a tailored fall prevention education programme to 195 older patients prior to hospital discharge, together with monthly telephone follow-up for 3 months after discharge. Educator–patient interactions were recorded in a standardised educator diary. Post-intervention, educators participated in a mini-focus group, providing their perspectives regarding education delivery and its impact on patient abilities to engage in fall prevention strategies. Data were analysed using deductive content analysis.

Results:

Educators followed up 184 (94%) patients, identifying multiple barriers and enablers affecting patient engagement in planned fall prevention strategies. Key barriers included unresolved medical conditions, reluctance to accept assistance on discharge, delays in assistive service provision, patient beliefs and perceptions about falls and, in some cases, patients’ absolving responsibility for recovery. Enablers were related to programme design, the completion of hospital discharge processes and support networks following discharge.

Conclusion:

Educators identified several barriers and enablers to programme delivery, receipt and enactment by older patients that contributed to the fidelity of the education programme. The consistent need for more patient support to enable improved enactment of plans and assist with safe recovery long after discharge warrants further attention at policy and health system levels.

中文翻译：

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出院老年人跌倒预防教育：教育者的观点

客观的：

对于许多出院后的老年患者来说，跌倒是一个重大问题。本研究的目的是从提供该计划的教育者的角度评估量身定制的患者跌倒预防教育计划的保真度和影响。

设计：

定性顺序设计。

环境：

西澳大利亚的三个康复医院。

方法：

三名经验丰富的物理治疗师接受过“教育者”培训，在出院前为 195 名老年患者提供量身定制的预防跌倒教育计划，并在出院后每月进行 3 个月的电话随访。教育者与患者的互动记录在标准化的教育者日记中。干预后，教育工作者参加了一个小型焦点小组，提供他们对教育实施及其对患者参与预防跌倒策略能力的影响的看法。使用演绎内容分析法分析数据。

结果：

教育工作者对 184 (94%) 名患者进行了随访，确定了影响患者参与计划的跌倒预防策略的多个障碍和促成因素。主要障碍包括未解决的医疗状况、不愿接受出院协助、提供协助服务的延迟、患者对跌倒的信念和看法，以及在某些情况下，患者免除康复责任。促成因素与项目设计、出院流程的完成和出院后的支持网络有关。

结论：

教育工作者确定了老年患者实施、接受和制定计划的几个障碍和推动因素，这些障碍和推动因素有助于提高教育计划的保真度。始终需要更多的患者支持以改进计划的制定并在出院后很长时间内协助安全康复，这需要在政策和卫生系统层面进一步关注。