Contextual factors influencing fall prevention exercise delivery in Canadian community group programs: A comparative case study

Introduction: Fall prevention exercise programs are available to community-dwelling Canadians aged 50+ through diverse organizational models that vary in how they meet criteria to effectively prevent falls. Context, the unique combination of characteristics and circumstances in which a program is embedded, is essential for understanding program delivery and guiding adaptation. Our objective is to describe and compare the implementation contexts of four Canadian community fall prevention group exercise programs.

Methods: Data gathered from each program included organizational documents, key informant interviews, exercise leader survey and interviews, class observation, and participant focus groups. Preliminary conventional content analysis identified program characteristics, strengths, extent to which programs meet criteria for effective fall prevention exercise, and issues affecting future adaptation. Identified constructs were then compared with summative content analysis. 

Results: Preliminary analysis identified alignment in some areas of context and points of divergence. There was substantial variation in organizational structure across programs, with two non-profit organizations (program A, C) and two within provincial health systems (program B, D). Two programs (A, B) used volunteer peer leaders to deliver exercise, and two (C, D) used exercise professional staff. Programs ranged in size from 2-299 exercise leaders and 3-123 sites. All programs offered programming at no cost to participants. Three programs (B, C, D) offered additional resources to supplement in-person group exercise. No programs fully address all criteria for effective fall prevention exercise.

Conclusion: Data will continue to be analyzed with the Consolidated Framework for Implementation Research (CFIR), Context and Implementation of Complex Interventions (CICI) framework, and Implementation in Context (ICON) framework to identify additional aspects of context for each case and generate data on the applicability of context frameworks in community fall prevention exercise. This analysis will be used to select and tailor implementation strategies that align with the unique contextual realities of each program.