Fall prevention behaviour after participation in the Stepping On program: a pre–post study

OBJECTIVE The Stepping On program has been shown to prevent falls among community-dwelling people in a research setting and was implemented statewide by the New South Wales (NSW) Ministry of Health in 2008. This study measured ongoing fall prevention strategies and behaviours undertaken by Stepping On participants during the 6 months after program completion. Secondary objectives were to document participant satisfaction with the program, and to identify motivators for, and barriers to, fall prevention behaviour and uptake of the strategy. METHODS We conducted a pre-post prospective study among Stepping On program participants, with 6-month follow-up. Participants commenced Stepping On in 2015 and 2016 in 15 Local Health Districts across NSW. A study-specific survey was completed at baseline and 6 months after completion of Stepping On. Measures were current self-reported fall prevention strategies and behaviours; the Falls Behavioural (FaB) Scale; the Incidental and Planned Exercise Questionnaire (IPEQ); and motivators for, and barriers to, uptake of fall prevention strategies and behaviours. RESULTS Baseline questionnaires were completed by 458 participants (mean age 77; standard deviation [SD] 6.7; 76% female). Both baseline and follow-up surveys were completed by 291 participants (64%; mean age 78; SD 6.9; 76% female). Program satisfaction was high - 251 participants (86%); completed the whole program, 284 (98%) said it increased their awareness of falls, and 284 (98%) would recommend Stepping On to others. There were statistically significant increases in the proportion of participants who reported doing regular balance and strength exercise (74% vs 24%; p < 0.0001), and using safe walking strategies (78% vs 51%; p < 0.0001) at follow-up compared with baseline. There was also a significant improvement in the FaB Scale, indicating less risk-taking behaviour (mean increase 0.15 out of 4; 95% confidence interval [CI] 0.12, 0.19; p < 0.0001), and an increase in IPEQ-reported structured exercise (mean increase 2.0 hours per week; 95% CI 1.6, 2.5; p < 0.0001). The main motivators for, and barriers to, uptake of structured exercise included participants' health, availability and access to local programs, and the amount of time available to take part. CONCLUSION This study demonstrates the appeal of the Stepping On program, and its positive impact on fall prevention behaviours among adults in the community aged 65 years and older. It is important to note the study limitations - namely, the self-reported nature of the measures used and the large amount of missing data.