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"Managing pieces of a personal puzzle': Older people's experiences of self-management falls prevention exercise guided by a digital program or a booklet
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.ORCID iD: 0000-0002-5147-9715
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Umeå University, Faculty of Science and Technology, Department of Computing Science.
Umeå University, Faculty of Science and Technology, Department of Computing Science.
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2019 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, article id 43Article in journal (Refereed) Published
Abstract [en]

Background: Exercise is effective in order to prevent falls in community-dwelling older people. Self-management programs have the potential to increase access and reduce costs related to exercise-based fall prevention. However, information regarding older people's views of participating in such programs is needed to support implementation. The aim of this study was to explore older people's experiences of a self-management fall prevention exercise routine guided either by a digital program (web-based or mobile) or a paper booklet.

Methods: This qualitative study was part of a feasibility study exploring two completely self-managed exercise interventions in which the participants tailored their own program, guided either by a digital program or a paper booklet. Individual face-to-face semi-structured interviews were conducted with a purposeful sample of 28 participants (18 women), mean age 76yrs. Qualitative content analysis was used to analyse the data.

Results: Self-managing and self-tailoring these exercise programs was experienced as Managing pieces of a personal puzzle'. To independently being able to create a program and manage exercise was described in the categories Finding my own level' and Programming it into my life'. The participants experienced the flexibility and independence provided by completely self-managed exercise as positive and constructive although it required discipline. Furthermore, different needs and preferences when managing their exercise were described, as well as varying sources of motivation for doing the exercise, as highlighted in the category Defining my source of motivation'. The category Evolving my acquired knowledge' captures the participants' views of building their competence and strategies for maintenance of the exercise. It describes a combined process of learning the program and developing reflection, which was more clearly articulated by participants using the digital program.

Conclusions: This study provides new knowledge regarding experiences, preferences and motivations of older people to engage in home-based self-managed fall prevention exercise. They expressed both a capability and willingness to independently manage their exercise. A digital program seems to have strengthened the feeling of support while creating their own exercise program and tailoring it to their preferences and circumstances, which might therefore create better opportunities for adoption and adherence in the long term.

Place, publisher, year, edition, pages
BioMed Central, 2019. Vol. 19, article id 43
Keywords [en]
Accidental falls, Aged, Exercise, Qualitative research, eHealth, Digital health, Self-management, Falls prevention, Intervention, Behaviour change
National Category
Geriatrics Nursing
Identifiers
URN: urn:nbn:se:umu:diva-157209DOI: 10.1186/s12877-019-1063-9ISI: 000459122200003PubMedID: 30777026Scopus ID: 2-s2.0-85061861155OAI: oai:DiVA.org:umu-157209DiVA, id: diva2:1299331
Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2023-03-24Bibliographically approved
In thesis
1. Fall prevention exercise for older adults: self-management with support of digital technology
Open this publication in new window or tab >>Fall prevention exercise for older adults: self-management with support of digital technology
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Digital fallprevention – egenträning för äldre personer
Abstract [en]

Background: Falls are a major public health issue, which can cause physical and psychological suffering for the individual as well as large costs for the society. To increase access and adherence to evidence-based fall prevention exercise, utilisation of older adults’ own capabilities and digital health offers promising solutions. The aim of this thesis was to explore a digital programme as support for self-management of fall preventive exercises in community-dwelling older adults with a focus on participant experiences, behaviour change, and intervention reach.

Methods: This thesis comprises four papers, of which Papers I and II report from a feasibility study comparing two self-managed fall prevention exercise programmes, a paper booklet and the digital Safe Step programme. Papers III and IV describes a randomised controlled trial, which evaluates the effectiveness of the Safe Step programme in combination with educational videos, to reduce falls in comparison with educational videos alone. In Paper I, individual interviews were analysed with inductive qualitative content analysis to explore older adults’ experiences of self-managing their fall prevention exercise. In Paper II, a deductive and inductive approach was utilised for the analysis of comments in questionnaires, individual, and focus group interviews to explore experiences of self-determination when using the Safe Step programme. The classification system of motivational and behaviour change strategies based on Self-determination theory was utilised as a categorisation matrix. An additional analysis of behavioural regulation for exercise according to the Self-determination theory was performed in this thesis. Paper III is a protocol for a randomised controlled trial, and Paper IV describes the recruitment strategies, and reach of this trial through comparison with another representative sample of adults 70 years or older by descriptive statistics.

Results: Results from Papers I and II show that the older adults appreciated the autonomy of a self-managed exercise programme. They expressed a capability to independently select exercises and manage their progression with support from the programme. However, some wanted the support of others in their training. The behaviour change support in the Safe Step programme was voiced as motivating and supportive, and the diversity of behaviour change strategies was emphasized as important to suit many older adults’ preferences. In Paper II, the behaviour change support were found supportive for the basic human psychological needs according to the Self-determination theory, although, support for autonomy and competence were more clearly stated than for relatedness. An additional category was formed and proposed as an amendment to the classification system used as an analytical matrix. In the thesis, expressions of intrinsic and extrinsic motivations for doing the exercise from participants in Paper I were triangulated with results from the Behavioural Regulations in Exercise Questionnaire-2. The results confirmed the trend found in the qualitative analysis of more intrinsically motivated expressions in the group using the Safe Step programme. A study protocol was written that described the design of the Safe Step randomised controlled trial, including the aims, methodology and overall organisation of the research (Paper III). In Paper IV, the most successful recruitment strategy to the randomised controlled trial was identified as advertisement in social media. The recruited participants were predominantly women, highly educated, and frequently used applications or internet on mobile devices.

Conclusion: Finding of this thesis support implementation of fall prevention strategies through increased utilisation of older adults' self-management capabilities. Older adults’ experiences of exercising with a self-managed digital exercise program can be understood as managing pieces of a personal puzzle and was shaped more by the sum of the features and behaviour change support in the programme than by parts of the programme. The Safe step programme seems to provide support for more self-determined exercise motivation, than a paper booklet, which can support maintenance of the new exercise routines. The older adults’ experiences, as well as the characteristics of the participants reached, highlight the necessity for a variety of fall prevention strategies that reflect the diversified needs and preferences of older adults.

Abstract [sv]

Fallolyckor bland äldre personer är ett av vår tids största folkhälsoproblem. Fallen orsakar psykiskt och fysiskt lidande för individen och ger upphov till stora kostnader för samhället. Ungefär en tredjedel av alla personer som är minst 65 år och bor i sitt ordinarie boende faller varje år. Den äldre befolkningen växer och det är därför av stor vikt att arbeta fallförebyggande. Det finns stort vetenskapligt underlag för träningens effekter för att förhindra fallolyckor, därtill finns också kunskap om vilken typ av övningar som bör genomföras. Dock har det visat sig att hälften av alla som påbörjar fallpreventiv träning slutar inom ett år.

En möjlig lösning för att det ska vara lättare att träna under längre tid är att äldre personer är mer delaktiga i beslut om sin egen träning. Allt fler digitala lösningar utvecklas och utvärderas för att ge stöd för träning till fler äldre personer och ge möjlighet att vara delaktiga i att förebygga fall. Digital teknik kan stödja träningen i det egna hemmet och ger möjligheten att inkludera stöd för beteendeförändring, också över tid. Dock behövs mer forskning om vilket stöd som behövs för att äldre personer, med olika förutsättningar och förmågor, ska kunna vara mer självständiga i utformandet och utförandet av fallpreventionsträning. Syftet med denna avhandling var att utforska självständig fallförebyggande träning med stöd av digital teknologi.

Avhandlingen innehåller fyra delstudier. De två första delstudierna baseras på en genomförbarhetsstudie där deltagarna själva valt om de vill träna med ett digitalt program (Säkra steg) eller med ett pappersbaserat program under fyra månader. Den första delstudien utforskar deltagarnas upplevelser och erfarenheter av självständig träning genom individuella intervjuer med äldre personer i båda träningsgrupperna. Den andra delstudien utforskar deltagarnas erfarenheter av stöd för beteendeförändring i det digitala Säkra steg-programmet. Intervjuer genomfördes både individuellt och i fokusgrupper. Vid analysen inkluderades även kommentarer från enkäter. Båda delstudierna analyserades med kvalitativ innehållsanalys. I den andra delstudien relaterades deltagarnas upplevelser också till ett klassifikationssystem av motivations- och beteendeförändringstekniker baserat på självbestämmandeteorin. En tilläggsanalys i kappan beskriver deltagarnas motivation enligt denna teori före och efter studiens genomförande. De sista två delstudierna beskriver utformning av en nationell randomiserad kontrollerad studie och undersöker rekryteringen till denna samt vilka äldre personer som visat intresse för att delta. I den sista delstudien beskrivs och jämförs bakgrundsdata från de deltagare som inkluderats med data från personer 70 år och äldre som besvarat Folkhälsoenkäten utgiven av Folkhälsomyndigheten.

Resultaten från denna avhandling ger insikter om äldre personers erfarenheter och förmågor att självständigt genomföra fallförebyggande träning i hemmet. Deltagarnas erfarenheter byggde på ett dynamiskt samspel mellan personens egna drivkrafter och motivation, stödet från programmet samt hur man utformar sina träningsrutiner. Det digitala Säkra steg-programmet verkar ha bidragit med ett större stöd för deltagarna att bibehålla sin träning. Detta stöds både av intervjuerna men också av tilläggsanalyser i avhandlingen baserat på enkäten gällande motivation enligt självbestämmandeteorin. Rekryteringen till den nationella randomiserade kontrollerade studien var mer framgångsrik via annonser i sociala medier än via andra rekryteringsstrategier. Äldre personer intresserade av att delta studien var till största delen kvinnor, de hade hög utbildning och använde ofta internet eller applikationer på sin mobiltelefon eller surfplatta dagligen. Andelen kvinnor och utbildningsnivå var också högre i studien än i jämförelse med äldre personer som besvarat Folkhälsoenkäten.

En mängd olika insatser för fallprevention behövs, både när ett fall har skett men också innan. Äldre personer bildar inte en homogen grupp när det gäller förutsättningar, preferenser och motivation och därför kan inte ett enskilt fallpreventivt program passa alla. Resultatet från denna avhandling visar att ett digitalt träningsprogram med stöd för beteendeförändring är en sådan möjlighet. Deltagarnas uttryckta förmåga till att vara aktiva deltagare i sin fallpreventionsträning kan bidra till vägledning i fortsatt utformning av fallpreventionsinsatser för äldre personer.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2021. p. 78
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2122
Keywords
eHealth, digital health, fall prevention, self-management, smartphone, digital technology, behavioural change support, Self-determination theory, Fallprevention, eHälsa, egenvård, digital teknik, beteendeförändring, självbestämmandeteorin
National Category
Physiotherapy
Research subject
physiotherapy; Public health
Identifiers
urn:nbn:se:umu:diva-183077 (URN)978-91-7855-537-6 (ISBN)978-91-7855-536-9 (ISBN)
Public defence
2021-06-10, Aula Biologica, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2021-05-20 Created: 2021-05-17 Last updated: 2022-04-29Bibliographically approved

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Pettersson, BeatriceWiklund, MariaJanols, RebeckaLindgren, HelenaLundin-Olsson, LillemorSandlund, Marlene

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