"Are your clients having fun?" The implications of respondents' preferences for the delivery of group exercise programs for falls prevention
- Authors: McPhate, Lucy , Simek, Emily , Haines, Terry , Hill, Keith , Finch, Caroline , Day, Lesley
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Aging and Physical Activity Vol. 24, no. 1 (2016), p. 129-138
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- Description: Background: Group exercise has been shown to be effective in preventing falls; however, adherence to these interventions is often poor. Older adults' preferences for how these programs can be delivered are unknown. Objective: To identify older people's preferences for how group exercise programs for falls prevention can be delivered. Design: A two-wave, cross-sectional, state-wide telephone survey was undertaken. Respondents were community-dwelling men and women aged 70+ in Victoria, Australia. Methods: Open-ended questions were asked to elicit information regarding respondent preferences of the program, which were analyzed using a framework approach. Results: Ninetyseven respondents completed the follow-up survey. The results indicate that older adults most frequently report the short-term advantages and disadvantages when describing their preferences for group exercise, such as enjoyment, social interaction, and leader qualities. Longer-term advantages such as falls prevention were described less frequently. Conclusions: This study indicates the importance of interpersonal skills, and that the opportunity for social interaction should not be overlooked as a positive feature of a group exercise program. © 2016 Human Kinetics, Inc.
A Novel exercise initiative for seniors to improve balance and physical function
- Authors: Sales, Myrla , Polman, Remco , Hill, Keith , Levinger, Pazit
- Date: 2017
- Type: Text , Journal article
- Relation: Journal of Aging and Health Vol. 29, no. 8 (2017), p. 1424-1443
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- Description: Objective: To investigate the feasibility, effectiveness, and short-term effects of an exercise intervention using a novel exercise park in improving seniors’ balance, physical function, and quality of life. Method: Randomized controlled trial with pre- and post-intervention design (baseline and 18-week intervention) was used. Outcome measures included measures of balance, strength, and function, as well as quality of life and fear of falling. MANCOVA was used to assess differences between groups (control and exercise intervention) over time. Results: Intervention group showed significant improvement on single leg stance (p = .02, 95% confidence interval [CI] = [−8.35, −0.549]), knee strength (p < .01, 95% CI = [−29.14, −5.86]), 2-min walk (p = 0.02, 95% CI = [−19.13, −0.859]), and timed sit to stand (p = .03, 95% CI = [−2.26, −0.143]) tests. Discussion: The exercise park program improved physical function and had high adherence and participation rate. Such intervention has been shown to be safe and therefore might enhance participation in exercise programs for older adults.
A protocol for evidence-based targeting and evaluation of statewide strategies for preventing falls among community-dwelling older people in Victoria, Australia
- Authors: Day, Lesley , Finch, Caroline , Hill, Keith , Haines, Terry , Clemson, Lindy , Thomas, Margaret , Thompson, Catherine
- Date: 2011
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 17, no. 2 (2011), p. 1-8
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Relation: http://purl.org/au-research/grants/nhmrc/546282
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- Description: Background: Falls are a significant threat to the safety, health and independence of older citizens. Despite the now substantial evidence about effective falls prevention interventions, translation into falls reductions has not yet been fully realised. While the hip fracture rate is decreasing, the number and rate of fall-related hospital admissions among older people is increasing. The challenge now is to deliver the most effective interventions efficiently at a population level, and for these interventions to be taken up by older people. Objective: To support the development, and evaluation of, effective falls prevention policy and practice in the state of Victoria, Australia. Methods: The RE-AIM model (Reach, Efficacy, Adoption, Implementation, Maintenance) was used to identify strategies for an effective programme. Research objectives were developed to support the strategies. These include: (1) identification of subgroups of older people most frequently admitted to hospital for falls; (2) examining the acceptability of established falls interventions; (3) identification of factors that encourage and support relevant lifestyle changes; (4) identifying opportunities to incorporate confirmed interventions in existing programmes and services; (5) developing guidelines for sustainability. The research results will subsequently guide strategy details for the falls prevention plan. RE-AIM will provide the framework for the evaluation structure. Outcome measures: Measures to monitor the implementation of the selected interventions will be determined for each intervention, based on the five key factors of the RE-AIM model. The overall effect of the falls prevention plan will be monitored by time series analysis of fall-related hospital admission rates for community-dwelling older people.
Comparison of two fall risk assessment tools (FRATs) targeting falls prevention in sub-acute care
- Authors: Wong Shee, Anna , Phillips, Bev , Hill, Keith
- Date: 2012
- Type: Text , Journal article
- Relation: Archives of Gerontology and Geriatrics Vol. 55, no. 3 (November 2012 2012), p. 653-659
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- Description: FRATs are designed to identify both persons at high risk of falls and to allow for cost-effective targeting of fall prevention strategies. This study compares two FRATs (BHS FRAT and TNH-STRATIFY) for accuracy of predicting falls and targeting of fall prevention strategies in a sub-acute hospital. Comparisons of retrospective audit data over two periods (use of the BHS-FRAT; post TNH-STRATIFY implementation) were used in the evaluation (n=362). Inter-rater reliability of the TNH-STRATIFY was evaluated from independent assessment by two nurses for 30 sub-acute patients and using intraclass correlation coefficient (ICC2,1). Event rate (ER) and standard measures of predictive accuracy were calculated for both FRATs. The proportions of patients with documented fall prevention strategies addressing identified fall risk factors were compared between audit phases. The TNH-STRATIFY had high inter-rater reliability (ICC2,1=0.96). The BHS-FRAT and TNH-STRATIFY demonstrated poor predictive accuracy using recommended high risk cut-off scores, with low specificityER (0.07 and 0.13 respectively) and very low Youden IndexER (0.04 and 0.07 respectively), although these measures improved using modified cut-off scores. Positive and negative predictive values were moderate for the BHS-FRAT (0.51, 0.64) and TNH-STRATIFY (0.52, 0.61). The falls rate and proportion of recurrent fallers did not change between audit phases. Implementation rates for prevention strategies for key risk factors were higher following implementation of the TNH-STRATIFY. The results indicated that the TNH-STRATIFY, combined with associated nursing care plan falls documentation, improved the targeting of prevention strategies for key risk factors such as cognitive impairment, incontinence and mobility impairment.
- Description: C1
Does action follow intention with participation in home and group-based falls prevention exercise programs? An exploratory, prospective, observational study
- Authors: Haines, Terry , Hill, Keith , Vu, Trang , Clemson, Lindy , Finch, Caroline , Day, Lesley
- Date: 2016
- Type: Text , Journal article
- Relation: Archives of Gerontology and Geriatrics Vol. 64, no. (2016), p. 151-161
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: Background: Exercise for falls prevention is effective but of limited uptake in real life. The link between intention and behavior is central to many health-behavior models, but has not been examined in the falls prevention exercise context. Objective: This study examines this relationship and prospectively identifies factors associated with participation in group and home-based falls prevention exercise. Design: This was an observational study of community-dwelling adults in Australia >70 years of age with a 12 month follow-up (n = 394 commenced baseline assessment, n = 247 commenced follow-up). Methods: Intention, and other potential predictive factors examined, were measured at baseline while participation was measured using self-report at 12 month follow-up. Results: Between 65% and 72% of our sample at baseline agreed or strongly agreed they would participate in the falls prevention exercise programs. n = 27 respondents participated in home-based exercise during follow-up and had intention to do so while n = 29 who participated did not have intention. In contrast, n = 43 respondents participated in group exercise and had intention to do so compared to 11 who participated but did not intend to at baseline. Perception of personal effectiveness and previous exposure to the exercise intervention were most strongly predictive of future participation. Conclusion: More people who do not want to participate in home exercise actually participate in home exercise than people who do not want to participate in group exercise that actually do. It may be easier to convince people who do not want to participate in falls prevention exercise to participate in a home program. © 2016 Elsevier Ireland Ltd.
Fall Prevention in Australia: Policies and activities
- Authors: Clemson, Lindy , Finch, Caroline , Hill, Keith , Lewin, Gill
- Date: 2010
- Type: Text , Journal article
- Relation: Clinics in geriatric medicine Vol. 26, no. 4 (2010), p. 733-749
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- Description: Fall prevention recommendations and plans have been prolific in Australia since 1986 but Commonwealth recommendations have rarely been acted on from a national perspective and the funds for prevention at a national level have been limited At a state level, although increasing annually funds for fall prevention have also remained as only a low proportion of total health spending Several Australian states have developed their own strategic plans and their activities have developed separately and uniquely although referring to national guidelines This article presents a perspective of Australian fall prevention policy over time provides insights into the current focus, and draws on some specific examples of activities from the 2 most populous Australian states (New South Wales and Victoria) and from our largest geographic state Western Australia
Feasibility and acceptability of a volunteer-mediated diversional therapy program for older patients with cognitive impairment
- Authors: Shee, Anna Wong , Phillips, Bev , Hill, Keith , Dodd, Karen
- Date: 2014
- Type: Text , Journal article
- Relation: Geriatric Nursing Vol. 35, no. 4 (2014), p. 300-305
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- Description: Understanding the perceptions of stakeholders is critical for determining acceptability and feasibility of volunteer-mediated programs. This study evaluated the feasibility and acceptability for staff, volunteers, patients and their carers, of a volunteer diversional therapy program for patients with cognitive impairment undergoing inpatient rehabilitation. Post-program structured interviews were conducted with the volunteers (n = 10), patients (n = 30) and their carers (n = 3); and nursing staff (n = 6) participated in a focus group. Thematic analysis identified five themes (values, attitudes, knowledge, purpose, support) in two dimensions (personal, team culture). Overall, patients, carers, staff and volunteers were satisfied with the volunteer program and perceived benefits for quality of care. Recommendations for improvements to the program related to staff engagement with the program and the volunteers' education and training. The volunteer diversional therapy pilot program for patients with cognitive impairment on a sub-acute ward was acceptable and feasible for patients, carers, staff and volunteers. (C) 2014 Mosby, Inc. All rights reserved.
Identifying clusters of falls-related hospital admissions to inform population targets for prioritising falls prevention programmes
- Authors: Finch, Caroline , Stephan, Karen , Shee, Anna Wong , Hill, Keith , Haines, Terry , Clemson, Lindy , Day, Lesley
- Date: 2015
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 21, no. 4 (2015), p. 254-259
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Relation: http://purl.org/au-research/grants/nhmrc/1058737
- Relation: http://purl.org/au-research/grants/nhmrc/546282
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- Description: Background: There has been limited research investigating the relationship between injurious falls and hospital resource use. The aims of this study were to identify clusters of community-dwelling older people in the general population who are at increased risk of being admitted to hospital following a fall and how those clusters differed in their use of hospital resources. Methods: Analysis of routinely collected hospital admissions data relating to 45 374 fall-related admissions in Victorian community-dwelling older adults aged ≥65 years that occurred during 2008/2009 to 2010/2011. Fall-related admission episodes were identified based on being admitted from a private residence to hospital with a principal diagnosis of injury (International Classification of Diseases (ICD)-10-AM codes S00 to T75) and having a first external cause of a fall (ICD-10-AM codes W00 to W19). A cluster analysis was performed to identify homogeneous groups using demographic details of patients and information on the presence of comorbidities. Hospital length of stay (LOS) was compared across clusters using competing risks regression. Results: Clusters based on area of residence, demographic factors (age, gender, marital status, country of birth) and the presence of comorbidities were identified. Clusters representing hospitalised fallers with comorbidities were associated with longer LOS compared with other cluster groups. Clusters delineated by demographic factors were also associated with increased LOS. Conclusions: All patients with comorbidity, and older women without comorbidities, stay in hospital longer following a fall and hence consume a disproportionate share of hospital resources. These findings have important implications for the targeting of falls prevention interventions for community-dwelling older people. © 2015, BMJ Publishing Group. All right reserved.
Implementing person-environment approaches to prevent falls: A qualitative inquiry in applying the Westmead approach to occupational therapy home visits
- Authors: Clemson, Lindy , Donaldson, Alex , Hill, Keith , Day, Lesley
- Date: 2014
- Type: Text , Journal article
- Relation: Australian Occupational Therapy Journal Vol. 61, no. 5 (2014), p. 325-334
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- Description: Background/aims: Despite evidence of the effectiveness of home safety interventions for preventing falls, there is limited uptake of such interventions within community services. Therefore, as part of a broader translational project, we explored issues underlying the implementation of an evidence-based home safety fall prevention intervention. Method: We conducted in-depth interviews with eight occupational therapists and two programme coordinators engaged to deliver a home safety fall prevention intervention. Six community health centres within two metropolitan regions of Melbourne, Australia participated. The RE-AIM framework and Diffusion of Innovations theory underpinned the interviews which examine the enablers and barriers to implementing a home safety fall prevention intervention and integrating it into routine community preventive practice. Analysis involved thematic and content analysis. Results: Investment in the home safety for fall prevention intervention was supported and valued by coordinators and therapists alike, and a number of themes emerged which influenced implementation of this intervention. These included issues of: compatibility with organisational processes, individual practitioner practices and skills, a prevention approach, and client expectations; relative advantage in terms of flexibility of the process, client engagement and regional capacity building; complexity of implementing the intervention; and observability related to the invisible nature of fall prevention outcomes. Conclusion: Implementation of this home safety fall prevention intervention was influenced by a range of interrelated organisational, practitioner and client related factors. The findings from this project provide insights into, and opportunities to increase the sustainable implementation of the home safety fall prevention intervention into practice.
Investigation of older adults’ participation in exercises following completion of a state-wide survey targeting evidence-based falls prevention strategies
- Authors: Lee, Den-Ching , Day, Lesley , Finch, Caroline , Hill, Keith , Clemson, Lindy , McDermott, Fiona , Haines, Terry
- Date: 2014
- Type: Text , Journal article
- Relation: Journal of Aging and Physical Activity Vol.23, no.2 (2014), p.256-263
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: This paper examines whether involvement in an observational study may prompt participants to change their exercise behaviors. Data was collected from 394 older community dwellers in Victoria, Australia using a baseline survey, and 245 of these participated in a follow-up survey one year later. Survey domains were drawn from constructs of relevant health behavior models. Results showed that the proportion of respondents who were currently participating in exercises to prevent falls at follow-up was 12% higher than at baseline (Wilcoxon p value<0.001). Twenty-nine percent reported they had changed their perceptions about falls and their risk of falls, with comments focused on threat appraisal. Forty-four percent reported having taken strategies to reduce their risk of falling, with comments based on implementation of different preventive strategies. Respondents who held favorable views towards exercises for the prevention of falls appear to change their behaviors that might address falls when participating in observational studies.
Key factors influencing implementation of falls prevention exercise programs in the community
- Authors: Day, Lesley , Trotter, Margaret , Donaldson, Alex , Hill, Keith , Finch, Caroline
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Aging and Physical Activity Vol. 24, no. 1 (2016), p. 45-52
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- Description: The study aim was to evaluate the implementation of group-and home-based exercise falls prevention programs delivered through community health agencies to community-dwelling older people. Interviews with program staff were guided by the Diffusion of Innovations theory. Highly consistent themes emerged for the two types of programs. Both had high overall compatibility, high relative advantage, good observability and high inherent trialability-all factors known to strengthen implementation. The level of complexity and low financial compatibility emerged as the strongest potential inhibitors to program implementation in the context examined. The two main factors contributing to complexity were the need to challenge balance safely across a broad range of capability, and practical considerations associated with program delivery. A range of strategies to provide more technical support for exercise program leaders to tailor balance challenge for exercise program leaders may enhance implementation of falls prevention exercise programs. © 2016 Human Kinetics, Inc.
Mental fatigue does not affect static balance under both single and dual task conditions in young adults
- Authors: Salihu, Abubakar , Usman, Jibrin , Hill, Keith , Zoghi, Maryam , Jaberzadeh, Shapour
- Date: 2023
- Type: Text , Journal article
- Relation: Experimental Brain Research Vol. 241, no. 7 (2023), p. 1769-1784
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- Description: The ability to control balance and prevent falls while carrying out daily life activities may require a predominantly controlled (cognitive) or automatic processing depending on the balance challenge, age, or other factors. Consequently, this process may be affected by mental fatigue which has been shown to impair cognitive abilities. Controlling static balance in young adults is a relatively easy task that may proceed automatically with minimal cognitive input making it insusceptible to mental fatigue. To investigate this hypothesis, static single and dual task (while concurrently counting backward by seven) balance was assessed in 60 young adults (25.2 ± 2.4 years) before and after 45 min of Stroop task (mental fatigue condition) and watching documentary (control), presented in a randomized counterbalanced order on separate days. Moreover, because mental fatigue can occur due to task underload or overload, participants carried out two different Stroop tasks (i.e., all congruent, and mainly incongruent trials) on separate days in the mental fatigue condition. Results of the study revealed a significantly higher feeling of mental fatigue after the mental fatigue conditions compared to control (p < 0.001). Similarly, the performance on congruent Stroop trials decreases with time indicating objective mental fatigue (p < 0.01). However, there was no difference in balance or concurrent task performance under both single and dual task assessments between the three conditions (p > 0.05) indicating lack of effect of mental fatigue on static balance in this population. Therefore, future studies investigating this phenomenon in occupational or sport settings in similar population should consider using more challenging balance tasks. © 2023, The Author(s).
Older adults’ perceptions of a novel outdoor exercise initiative: A qualitative analysis
- Authors: Sales, Myrla , Polman, Remco , Hill, Keith , Levinger, Pazit
- Date: 2018
- Type: Text , Journal article
- Relation: The journal of aging and social change Vol. 8, no. 1 (2018), p. 61-78
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- Description: This study aimed to investigate the acceptability, barriers, enablers, perceived benefits, and outcomes in undertaking an exercise intervention using a novel outdoor exercise park designed for senior citizens. This study was a parallel randomised controlled trial with pre- and post-intervention design (outcome assessments at baseline and at eighteen weeks after participation commencement). Twenty-seven independent community-dwelling adults (75.1 ± 7.9 years seventeen females ten males) underwent an interview after completing the eighteen-week exercise intervention. A thematic analysis approach was used to evaluate the content of the interviews. Participants reported that the exercise intervention proposed was very enjoyable and had varied perceived benefits. The exercise intervention has been positively rated by the participants. The main outcomes perceived from their participation were physical (e.g., improvements in muscle strength, balance, flexibility, and gait), psychological (e.g., improved confidence and well-being and reduced depression symptoms) and psychosocial (e.g., improved social interaction). Participants also perceived an improvement on their ability to perform activities of daily living (e.g. climbing stairs, tying shoelaces, and catching public transport). The exercise-park program has been shown to be a well-accepted, novel option for older adults to exercise outdoors and therefore might enhance exercise uptake and attendance and sustain participation in exercise programs for older adults in the community.
The association between physical activity and social isolation in community-dwelling older adults
- Authors: Robins, Lauren , Hill, Keith , Finch, Caroline , Clemson, Lindy , Haines, Terry
- Date: 2018
- Type: Text , Journal article
- Relation: Aging and Mental Health Vol. 22, no. 2 (2018), p. 175-182
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: Objectives: Social isolation is an increasing concern in older community-dwelling adults. There is growing need to determine effective interventions addressing social isolation. This study aimed to determine whether a relationship exists between physical activity (recreational and/or household-based) and social isolation. An examination was conducted for whether group- or home-based falls prevention exercise was associated with social isolation. Methods: Cross-sectional analysis of telephone survey data was used to investigate relationships between physical activity, health, age, gender, living arrangements, ethnicity and participation in group- or home-based falls prevention exercise on social isolation. Univariable and multivariable ordered logistic regression analyses were conducted. Results: Factors found to be significantly associated with reduced social isolation in multivariable analysis included living with a partner/spouse, reporting better general health, higher levels of household-based physical activity (OR = 1.03, CI = 1.01–1.05) and feeling less downhearted/depressed. Being more socially isolated was associated with symptoms of depression and a diagnosis of congestive heart failure (pseudo R2 = 0.104). Discussion: Findings suggest that household-based physical activity is related to social isolation in community-dwelling older adults. Further research is required to determine the nature of this relationship and to investigate the impact of group physical activity interventions on social isolation.
What are the characteristics of home exercise programs that older adults prefer? A cross-sectional study
- Authors: Simek, Emily , McPhate, Lucy , Hill, Keith , Finch, Caroline , Day, Lesley , Haines, Terry
- Date: 2015
- Type: Text , Journal article
- Relation: American Journal of Physical Medicine & Rehabilitation Vol. 94, no. 7 (2015), p. 508-521
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
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- Description: Objective The aim of this study was to examine the preferences of older adults toward the structure and delivery of home exercise programs for the prevention of falls as well as the perceived benefits of and barriers to program adherence. Methods A two-wave cross-sectional telephone survey of community-dwelling older adults was conducted in Victoria, Australia. Respondents were categorized as current, previous, or nonparticipants of a home exercise program in the last 6 yrs. Thematic analysis of open-response questions examining the preferences of current and previous participants toward participation in, and delivery of, home exercise programs for falls preventions was performed. Results A total of 245 respondents completed the follow-up survey. The respondents were classified as current (n = 54), previous (n = 22), or nonparticipants (n = 169) of a home exercise program in the last 6 yrs. Program adherence was influenced by the perceived effect of programs on physical and mental health, participant autonomy, and how well the program structure complemented individual exercise and lifestyle preferences. Conclusions Adherence to home exercise programs for falls prevention is influenced by personal preferences toward program structure and delivery as well as perceived benefits of and barriers to program participation. To optimize participant adherence, service providers need to consider personal preferences and some flexibility in the program being delivered.
‘‘Better for others than for me’’: A belief that should shape our efforts to promote participation in falls prevention strategies
- Authors: Haines, Terry , Day, Lesley , Hill, Keith , Clemson, Lindy , Finch, Caroline
- Date: 2014
- Type: Text , Journal article
- Relation: Archives of Gerontology and Geriatrics Vol. 59, no. (2014), p. 136-144
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
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- Description: Falls are a common occurrence amongst older adults yet participation in prevention strategies is often poor. Although older adults may perceive a strategy works in general, they may not participate because they feel it will not benefit them personally. We aimed to describe how frequently and why older adults identify falls prevention strategies as being ‘‘better for others than for me’’. A cross-sectional survey with n = 394 community-dwelling older adults in Victoria, Australia was undertaken. Participants were provided with detailed descriptions of four evidence-based falls prevention strategies and for each were asked whether they felt that the strategy would be effective in preventing falls for people like them, and then whether they felt that the strategy would be effective for preventing falls for them personally. Follow-up questions asked why they thought the strategy would be more effective for people like them than for them personally where this was the case. We found the ‘‘better for others than for me’’ perception was present for between 25% and 34% of the strategies investigated. Participants commonly said they felt this way because they did not think they were at risk of falls, and because they were doing other activities they thought would provide equivalent benefit. Strategies to promote participation in evidence-based falls prevention strategies may need to convince older adults that they are at risk of falls and that what activities they are already doing may not provide adequate protection against falls in order to have greater effect.