Table 3

 Recommendations for promoting uptake and adherence to falls-related interventions

Recommendation (clarification)Rating*General theory/evidenceFalls-related theory/evidence
*Median agreement rating (with interquartile range in brackets) on the 9-point scale used in the internet consultation.
3. Utilise a variety of forms of social encouragement to engage older people in interventions. (Uptake may be encouraged by the use of personal invitations to participate (preferably from a health professional) and positive media images and peer role models to illustrate the social acceptability, safety and multiple benefits of taking part. Uptake and adherence may be encouraged by ongoing support from family, peers, and professionals.) 4. Ensure that the intervention is designed to meet the needs, preferences and capabilities of the individual. (There is a need to consider the individual’s lifestyle, values, and ethnicity, and environmental factors such as place of residence and access to services.) 5. Encourage confidence in self-management rather than dependence on professionals, by giving older people an active role. (Although some supervision is necessary for safety, the older person should be able to select from different interventions, different formats of the same intervention, or from among a range of intervention goals.) 6. Draw on validated methods for promoting and assessing the processes that maintain adherence, especially in the longer term. (These could include encouraging realistic positive beliefs, assisting with planning and implementation of new behaviours, building self-confidence, and providing practical support.)1 (1–3) 2 (1–3) 1 (1–2) 1 (1–3)Known social influences on health-related behaviour are encouragement, approval and social support from health professionals and other sources1 and role models who provide an example of successful accomplishment of health-related goals.21 Psychological research suggests that adherence to interventions can be promoted by addressing the specific beliefs, goals and difficulties of the individual relevant to participation.25,26 Giving the individual an active role in selecting activities and setting goals increases motivation and self-efficacy (ie, confidence in the ability to carry out a behaviour), which in turn promotes adherence.21,27 A review of research on adherence to prolonged therapeutic programmes concluded that it is most effective to combine a variety of approaches that have been shown to increase adherence.1Research in older people indicates that concern about social disapproval poses a barrier to undertaking physical activity, although social support, positive media images and real-life examples of ordinary people doing physical activity could promote greater physical activity.22–24 Qualitative research on attitudes to falls prevention programmes is consistent with this, and also suggests that an invitation from a health professional to participate is important, and that likes and dislikes of social contacts in group interventions may strongly influence participation.6,11 A systematic review of views of falls-prevention programmes found that views about what lifestyle changes are acceptable vary widely, and that people have different needs and desires in relation to prevention programmes.11 A qualitative study of the views of 66 older people on falls-prevention advice found that participants rejected advice that they felt did not suit their circumstances.9 Self-efficacy exerts a consistently powerful influence on the exercise behaviour of older adults, particularly its initiation, whereas self-regulatory skills are important in sustaining exercise behaviour.28 Carrying out tai chi, which has been used as a form of falls prevention,29 has been shown to increase self-efficacy levels, which in turn improves adherence.30 Findings from research (mainly qualitative) on attitudes to falls prevention interventions suggest that uptake and adherence are indeed influenced by factors identified as important to adherence to other therapies,1 such as practical support, encouragement from therapists, the belief that the intervention is necessary and effective, and confidence in being able to carry it out.6,11