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BMC Health Services Research
Published in: BMC Health Services Research 1/2014

Open Access 01-12-2014 | Research article

Making sense of a cognitive behavioural therapy intervention for fear of falling: qualitative study of intervention development

Authors: Tracy L Finch, Claire Bamford, Vincent Deary, Neil Sabin, Steve W Parry

Published in: BMC Health Services Research | Issue 1/2014

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Abstract

Background

Fear of Falling (FoF) is commonly reported among older adults (up to 50%) and can impact negatively on physical and social activities, mood and quality of life. This paper explores the development, acceptability and feasibility of a cognitive behavioural therapy intervention (CBTi) for FoF.

Methods

The process evaluation of the CBTi development phase of an RCT (conducted in the UK) reported here, used ethnographic methods. Data included: interviews with patients and carers (n = 16), clinic staff (n = 6) and the psychologists developing the CBTi (n = 3); observational field notes and transcripts of intervention development meetings (n = 9) and stakeholder engagement meetings (n = 2); and informal discussions with staff developing the CBTi (n = 8). Data collection and thematic analysis were guided by Normalisation Process Theory (NPT).

Results

The process evaluation showed two domains of work necessary to develop a CBTi that made sense to stakeholders, and that could be delivered as part of an RCT. For the psychologists developing the content of the CBTi, a growing understanding of the complexity of FoF highlighted the need for an individualised rather than a manualised intervention. For the research team, the work involved adapting the structures and processes of the RCT to address preliminary concerns over the acceptability and feasibility of the proposed CBTi.

Conclusions

Theory-based approaches to process evaluation can sensitise researchers to contested understandings about proposed interventions that could undermine implementation. Drawing on the coherence construct of NPT, this study emphasises the nature and extent of work required to ensure an intervention makes sufficient sense to key stakeholders in order to maximise chances of successful implementation.
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Literature
1.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: the new medical research council guidance. BMJ. 2008, 337: a1655-10.1136/bmj.a1655.CrossRefPubMedPubMedCentral
2.
Oakley A, Strange V, Bonell C, Allen E, Stephenson J: Process evaluation in randomised controlled trials of complex interventions. BMJ. 2006, 332 (7538): 413-416. 10.1136/bmj.332.7538.413.CrossRefPubMedPubMedCentral
3.
Zijlstra GAR, Van Haastregt JCM, Van Rossum E, Van Eijk JTM, Yardley L, Kempen GIJM: Interventions to reduce fear of falling in community-living older people: a systematic review. J Am Geriatr Soc. 2007, 55 (4): 603-615. 10.1111/j.1532-5415.2007.01148.x.CrossRefPubMed
4.
Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE: Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing. 2008, 37 (1): 19-24.CrossRefPubMed
5.
Logghe IHJ, Verhagen AP, Rademaker ACHJ, Bierma-Zeinstra SMA, van Rossum E, Faber MJ, Koes BW: The effects of Tai Chi on fall prevention, fear of falling and balance in older people: a meta-analysis. Prev Med. 2010, 51 (3–4): 222-227.CrossRefPubMed
6.
Parry SW, Finch T, Deary V: How should we manage fear of falling in older adults living in the community?. BMJ. 2013, 346: f2933-10.1136/bmj.f2933.CrossRefPubMed
7.
Freiberger E, Häberle L, Spirduso WW, Rixt Zijlstra GA: Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial. J Am Geriatr Soc. 2012, 60 (3): 437-446. 10.1111/j.1532-5415.2011.03859.x.CrossRefPubMed
8.
Vind AB, Andersen HE, Pedersen KD, Joergensen T, Schwarz P: Effect of a program of multifactorial fall prevention on health-related quality of life, functional ability, fear of falling and psychological well-being. A randomized controlled trial. Aging Clin Exp Res. 2010, 22 (3): 249-254. 10.1007/BF03324804.CrossRefPubMed
9.
Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A: A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. J Gerontol B Psychol Sci Soc Sci. 1998, 53 (6): 384-392.CrossRef
10.
Zijlstra GAR, van Haastregt JCM, Ambergen T, van Rossum E, van Eijk JTM, Tennstedt SL, Kempen GIJM: Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: results of a randomized controlled trial. J Am Geriatr Soc. 2009, 57 (11): 2020-2028. 10.1111/j.1532-5415.2009.02489.x.CrossRefPubMed
11.
Huang T-T, Yang L-H, Liu C-Y: Reducing the fear of falling among community-dwelling elderly adults through cognitive-behavioural strategies and intense Tai Chi exercise: a randomized controlled trial. J Adv Nurs. 2011, 67 (5): 961-971. 10.1111/j.1365-2648.2010.05553.x.CrossRefPubMed
12.
Hadjistavropoulos T, Carleton RN, Delbaere K, Barden J, Zwakhalen S, Fitzgerald B, Ghandehari OO, Hadjistavropoulos H: The relationship of fear of falling and balance confidence with balance and dual tasking performance. Psychol Aging. 2012, 27 (1): 1-13.CrossRefPubMed
13.
Hadjistavropoulos T, Delbaere K, Fitzgerald TD: Reconceptualizing the role of fear of falling and balance confidence in fall risk. J Aging Health. 2011, 23 (1): 3-23. 10.1177/0898264310378039.CrossRefPubMed
14.
James IA: Cognitive behavioural therapy with older people. 2010, London: Jessica Kingsley Publishers
15.
Evans C: Cognitive–behavioural therapy with older people. Adv Psychiatr Treat. 2007, 13 (2): 111-118. 10.1192/apt.bp.106.003020.CrossRef
16.
Williams C, Garland A: A cognitive–behavioural therapy assessment model for use in everyday clinical practice. Adv Psychiatr Treat. 2002, 8 (3): 172-179. 10.1192/apt.8.3.172.CrossRef
17.
Tom K, Roger J, Simon D, Paul S, Simon W, Trudie C: Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial. BMJ. 2005, 331 (7514): 435-10.1136/bmj.38545.505764.06.CrossRef
18.
Daniilidou P, Carding P, Wilson J, Drinnan M, Deary V: Cognitive behavioral therapy for functional dysphonia: a pilot study. Ann Otol Rhinol Laryngol. 2007, 116 (10): 717-722. 10.1177/000348940711601002.CrossRefPubMed
19.
van Haastregt JCM, Zijlstra GAR, van Rossum E, van Eijk JTM, de Witte LP, Kempen GIJM: Feasibility of a cognitive behavioural group intervention to reduce fear of falling and associated avoidance of activity in community-living older people: a process evaluation. BMC Health Serv Res. 2007, 7: 156-10.1186/1472-6963-7-156.CrossRefPubMedPubMedCentral
20.
Ullmann G, Williams H, Plass C: Dissemination of an evidence-based program to reduce fear of falling, South Carolina, 2006–2009. Prev Chronic Dis. 2012, 9: 110093.
21.
May C, Finch T: Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology. 2009, 43 (3): 535-554. 10.1177/0038038509103208.CrossRef
22.
Murray E, Treweek S, Pope C, MacFarlane A, Ballini L, Dowrick C, Finch T, Kennedy A, Mair F, O'Donnell C, Ong BN, Rapley T, Rogers A, May C: Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Medicine. 2010, 8 (1): 63-10.1186/1741-7015-8-63.CrossRefPubMedPubMedCentral
23.
Parry S, Deary V, Finch T, Bamford C, Sabin N, McMeekin P, O'Brien J, Caldwell A, Steen N, Whitney S, Macdonald C, McColl E: The STRIDE (Strategies to Increase confidence, InDependence and Energy) study: cognitive behavioural therapy-based intervention to reduce fear of falling in older fallers living in the community - study protocol for a randomised controlled trial. Trials. 2014, 15 (1): 210-10.1186/1745-6215-15-210.CrossRefPubMedPubMedCentral
24.
Clark JP: How to peer review a qualitative manuscript. Peer Review in Health Sciences. Edited by: Godlee F, Jefferson T. 2003, London: BMJ Books, 219-235. Second
25.
Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, Lamb SE, Dixon-Woods M, McCulloch P, Wyatt JC, Chan A-W, Michie S: Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014, 348: g1687-10.1136/bmj.g1687.CrossRefPubMed
26.
Yardley L, Beyer N, Hauer K, Kempen GIJM, Piot-Ziegler C, Todd C: Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing. 2005, 34 (6): 614-619. 10.1093/ageing/afi196.CrossRefPubMed
27.
Delbaere K, Close JCT, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR: The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study. Age Ageing. 2010, 39 (2): 210-216. 10.1093/ageing/afp225.CrossRefPubMed
28.
Folstein M, Folstein S, McHugh P: Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatry Res. 1975, 12: 189-198. 10.1016/0022-3956(75)90026-6.CrossRef
29.
Glaser BG, Strauss AL: The discovery of grounded theory: strategies for qualitative research. 1967, Chicago: Aldine Publishing Company
30.
Bailey C, Cogan L, Roberts S, Cunningham C: “I fell out of my standing” Falls narratives, ageism and socio-medical understanding of falls in older persons. Acculturating age: approaches to cultural gerontology. Edited by: Worsfold BJ. 2011, Lleida, Spain: Edicions and Publicacions de la Universitat de Lleida, 59-77.
31.
Delbaere K, Crombez G, van Haastregt JCM, Vlaeyen JWS: Falls and catastrophic thoughts about falls predict mobility restriction in community-dwelling older people: a structural equation modelling approach. Aging Ment Health. 2009, 13 (4): 587-592. 10.1080/13607860902774444.CrossRefPubMed
32.
O'Cathain A, Thomas KJ, Drabble SJ, Rudolph A, Hewison J: What can qualitative research do for randomised controlled trials? A systematic mapping review. BMJ Open. 2013, 3 (6): e002889.CrossRefPubMedPubMedCentral
Metadata
Title
Making sense of a cognitive behavioural therapy intervention for fear of falling: qualitative study of intervention development
Authors
Tracy L Finch
Claire Bamford
Vincent Deary
Neil Sabin
Steve W Parry
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2014
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-14-436

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