Abstract
Introduction: Falls are a major health risk for older adults, often resulting in serious injury and long-term care (Montero-Odasso et al., 2022). Adults aged 50+ may also be vulnerable due to age-related changes in physical and cognitive function, highlighting the importance of early intervention (Karvonen-Gutierrez et al., 2020). Home modifications are an effective preventative measure (Clemson et al., 2023), yet many individuals resist making changes to their environment . Qualitative findings from our recent mixed methods systematic review identified emotional attachments and resistance to change as key barriers. This study aimed to further explore findings from the five qualitative studies included in the systematic review and identify additional barriers through Patient and Public Involvement (PPI) workshops.
Methods: A World Café approach (Lohr et al., 2020) was used to facilitate open discussions in two PPI workshops. A total of 18 participants took part, consisting of residents (n=12) aged 50 and above and key stakeholders (n=6) aged 18 and above. Discussions centred on barriers to home modifications, with participants documenting insights on notepads. Data from notes and verbal quotations were analysed using Thematic Analysis (Braun & Clarke, 2022).
Results: Emotional attachments and resistance to change were reaffirmed, consistent with the review. Three novel themes were developed: (1) Stranger danger, discomfort with unfamiliar professionals entering the home; (2) Navigating vulnerability, refusal of help was viewed as potentially signaling unmet psychological needs; and (3) Rented housing, which introduced hidden barriers stemming from landlord resistance.
Conclusion: Psychological barriers may limit the uptake of home modifications even when beneficial. Supporting individuals to recognise risk and take preparatory action is key. Future co-design workshops will develop psychological interventions using behaviour change techniques such as implementation intention strategies to improve receptivity and promote early decision making among adults aged 50 and above.
Comments
Stranger Danger
Hello. Thank you for presenting your work. How would you propose the psychological barriers to falls intervention are lowered to make it more acceptable for people to have physcial changes made to their home environment? What changes were people more resistant to having made?
Stranger Danger
Hello Alasdair,
Thanks for your comment.
If we are focusing on the theme of stranger danger, a good place to start would be making services such as Age UK’s trusted tradesperson scheme or the more recent Good Homes Hubs more widely known. These services are available to help, but are they publicised enough? From a behaviour change perspective, building awareness of trustworthy services, modelling positive experiences, and reframing modifications as future-proofing rather than decline could all help increase confidence to invite professionals into their homes.
Currently, most home modification interventions concentrate on the physical changes themselves and rarely integrate behaviour change theory. Embedding these approaches could reduce psychological resistance, build trust, and ultimately support greater uptake. Our work suggests that visible or "stigmatising" changes, such as grab rails, tend to be discussed more frequently in terms of resistance
Thank you for your poster,…
Thank you for your poster, from your work was there discussion or further work to explore self-management resources to engage individuals, families and carers to conduct their own home hazard assessment and interventions?
Self-management resources
Hello,
Thank you for the comment on our work. We are planning to run a participatory action research study with adults over the age of 50 and healthcare professionals to coproduce an intervention aimed at supporting behaviour change around home modifications for fall reduction. Self management resources aimed at helping individuals to identify hazards within their home would be a useful tool!