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Recipient and instructor perspectives of an adapted exercise-based fall prevention programme for adults aged 50+ years with vision impairment: a qualitative study nested within a randomised controlled trial.

ABSTRACT: OBJECTIVE:Older adults with vision impairment currently have no access to tailored fall prevention programmes. Therefore, the purpose of this study, nested within an ongoing randomised controlled trial (RCT), is to document the adaptation of an existing fall prevention programme and investigate the perspectives of instructors involved in delivery and the older adults with vision impairment receiving the programme (recipients). DESIGN:We documented programme adaptations and training requirements, and conducted semistructured, individual interviews with both the instructors and the recipients of the programme from 2017 to 2019. The content of each interview was analysed using behaviour change theory through deductive qualitative analysis. SETTING:New South Wales and Australian Capital Territory, Australia. PARTICIPANTS:The 11 trained instructors interviewed were employees of a vision rehabilitation organisation and had delivered at least one programme session as part of the RCT. The 154 recipients interviewed were community-dwelling adults aged ?50 years with vision impairment and no diagnosis of dementia, and had completed their participation in the programme as part of the intervention group of the RCT. RESULTS:Six key themes were identified relating to recipient (delivery aptitude, social norms, habit formation) and instructor (individualised adaptation, complimentary to scope of practice, challenges to delivery) perspectives. With initial training, instructors required minimal ongoing support to deliver the programme and made dynamic adaptations to suit the individual circumstances of each recipient, but cited challenges delivering the number of programme activities required. Recipient perspectives varied; however, most appreciated the delivery of the programme by instructors who understood the impact of vision impairment. CONCLUSIONS AND IMPLICATIONS:This novel qualitative study demonstrates that the adapted programme, delivered by instructors, who already have expertise delivering individualised programmes to older people with vision impairment, may fill the gap for a fall prevention programme in this population. TRIAL REGISTRATION NUMBER:ACTRN12616001186448.

SUBMITTER: Dillon L

PROVIDER: S-EPMC7473617 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Recipient and instructor perspectives of an adapted exercise-based fall prevention programme for adults aged 50+ years with vision impairment: a qualitative study nested within a randomised controlled trial.

Dillon Lisa L Clemson Lindy L Nguyen Helen H Jakobsen Kirsten Bonrud KB Martin Jodi J Tinsley Frances F Keay Lisa L

BMJ open 20200903 9

<h4>Objective</h4>Older adults with vision impairment currently have no access to tailored fall prevention programmes. Therefore, the purpose of this study, nested within an ongoing randomised controlled trial (RCT), is to document the adaptation of an existing fall prevention programme and investigate the perspectives of instructors involved in delivery and the older adults with vision impairment receiving the programme (recipients).<h4>Design</h4>We documented programme adaptations and trainin ...[more]

PMID: 32883736

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Project description:ObjectivesWe examined undergraduate STEM students' experiences during Spring 2020 when universities switched to remote instruction due to the COVID-19 pandemic. Specifically, we sought to understand actions by universities and instructors that students found effective or ineffective, as well as instructor behaviors that conveyed a sense of caring or not caring about their students' success.MethodsIn July 2020 we conducted 16 focus groups with STEM undergraduate students enrolled in US colleges and universities (N = 59). Focus groups were stratified by gender, race/ethnicity, and socioeconomic status. Content analyses were performed using a data-driven inductive approach.ResultsParticipants (N = 59; 51% female) were racially/ethnically diverse (76% race/ethnicity other than non-Hispanic white) and from 32 colleges and universities. The most common effective instructor strategies mentioned included hybrid instruction (35%) and use of multiple tools for learning and student engagement (27%). The most common ineffective strategies mentioned were increasing the course workload or difficulty level (18%) and use of pre-recorded lectures (15%). The most common behaviors cited as making students feel the instructor cared about their success were exhibiting leniency and/or flexibility regarding course policies or assessments (29%) and being responsive and accessible to students (25%). The most common behaviors cited as conveying the instructors did not care included poor communication skills (28%) and increasing the difficulty of the course (15%). University actions students found helpful included flexible policies (41%) and moving key services online (e.g., tutoring, counseling; 24%). Students felt universities should have created policies for faculty and departments to increase consistency (26%) and ensured communication strategies were honest, prompt, and transparent (23%).ConclusionsTo be prepared for future emergencies, universities should devise evidence-based policies for remote operations and all instructors should be trained in best practices for remote instruction. Research is needed to identify and ameliorate negative impacts of the pandemic on STEM education.

Project description:ObjectiveTo assess the effectiveness of a two year exercise programme of progressive balance retraining in reducing injurious falls among women aged 75-85 at increased risk of falls and injuries and living in the community.DesignPragmatic multicentre, two arm, parallel group, randomised controlled trial.Setting20 study sites in 16 medium to large cities throughout France.Participants706 women aged 75-85, living in their own home, and with diminished balance and gait capacities, randomly allocated to the experimental intervention group (exercise programme, n=352) or the control group (no intervention, n=354).InterventionWeekly supervised group sessions of progressive balance training offered in community based premises for two years, supplemented by individually prescribed home exercises.Outcome measuresA geriatrician blinded to group assignment classified falls into one of three categories (no consequence, moderate, severe) based on physical damage and medical care. The primary outcome was the rate of injurious falls (moderate and severe). The two groups were compared for rates of injurious falls with a "shared frailty" model. Other outcomes included the rates of all falls, physical functional capacities (balance and motor function test results), fear of falling (FES-I), physical activity level, and perceived health related quality of life (SF-36). Analysis was by intention to treat.ResultsThere were 305 injurious falls in the intervention group and 397 in the control group (hazard ratio 0.81, 95% confidence interval 0.67 to 0.99). The difference in severe injuries (68 in intervention group v 87 in control group) was of the same order of magnitude (0.83, 0.60 to 1.16). At two years, women in the intervention group performed significantly better on all physical tests and had significantly better perception of their overall physical function than women in the control group. Among women who started the intervention (n=294), the median number of group sessions attended was 53 (interquartile range 16-71). Five injurious falls related to the intervention were recorded.ConclusionA two year progressive balance retraining programme combining weekly group and individual sessions was effective in reducing injurious falls and in improving measured and perceived physical function in women aged 75-85 at risk of falling.Trial registration ClinicalTrials.gov (NCT00545350).

Project description:IntroductionPhysical inactivity among adults aged 50 years and over is a worldwide health concern. The objectives of the study were to investigate the perspectives of those involved with existing physical activity programmes on optimising recruitment, sustainability and scalability of physical activity programmes for adults aged 50 years and over.MethodsThe study was conducted in Ireland's Midwest region, where community-based physical activity programmes are delivered to groups by state-funded Local Sports Partnerships. Programme attendees, physical activity professionals and community advocates were recruited. One-to-one interviews and focus groups were conducted in 2018, recorded, transcribed and analysed by an interdisciplinary team experienced in qualitative research. Over a series of meetings, a thematic approach was used to code and analyse the transcripts, categorising data into higher order codes, themes and overarching themes with the purpose of making meaning of the data. Twenty-nine people participated in four focus groups and 18 participated in one-to-one interviews.FindingsData analysis produced three overarching themes. "Age appropriate" explains how communication and the environment should be adapted to the needs of adults aged 50 years and older. "Culture and connection" refer to the interplay of individual and social factors that influence participation, including individual fears and insecurities, group cohesion and added value beyond the physical gains in these programmes. "Roles and partnerships" outlines how key collaborations may be identified and managed and how local ownership is key to success and scalability.ConclusionSuccessful recruitment, sustainability and scalability require an understanding that the target population has unique needs that must be catered for when planning interventions, communicating messages and choosing personnel. The findings of this study can inform the development of community-based programmes to increase physical activity in adults aged 50 years and older.

Dataset Information

Recipient and instructor perspectives of an adapted exercise-based fall prevention programme for adults aged 50+ years with vision impairment: a qualitative study nested within a randomised controlled trial.

Publications

Recipient and instructor perspectives of an adapted exercise-based fall prevention programme for adults aged 50+ years with vision impairment: a qualitative study nested within a randomised controlled trial.

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