Feasibility of a Contextually Adapted Fall Prevention Exercise Programme with Behaviour Change Support in Indonesia

Introduction: Falls are a leading cause of injury and loss of independence among older adults, with a particularly high prevalence in low- and middle-income countries (LMICs) such as Indonesia. Although exercise-based fall prevention programmes are effective globally, few have been contextually adapted or tested in LMIC settings. This study assessed the feasibility, acceptability, and safety of a contextually adapted fall prevention exercise programme incorporating behaviour change support for community-dwelling older adults in Indonesia.

Method: A two-arm feasibility randomised controlled trial with an embedded qualitative evaluation was conducted across three primary care facilities in Indonesia. Thirty-two older adults (16 per group) were randomly assigned to receive either (1) fall prevention education materials or (2) a contextually adapted Otago exercise programme incorporating behaviour change techniques. Feasibility outcomes included recruitment, retention, intervention fidelity, adherence, safety, and acceptability. Secondary outcomes included preliminary changes in physical performance (Short Physical Performance Battery [SPPB]) and fear of falling. Quantitative data were analysed descriptively, and qualitative data thematically.

Results: The programme was feasible, safe, and well-received by older adult participants. Recruitment and retention were high, with all 32 participants completing the 12-week programme. Most participants attended at least six of seven physiotherapy sessions. Adherence to home exercise sessions reached 89%. No serious adverse events occurred, with only mild, transient muscle soreness reported. Preliminary improvements were observed in the intervention group compared with controls across measures of balance, gait speed, and physical performance. Qualitative findings indicated that behaviour change support increased participants’ confidence and engagement. 

Conclusion: A contextually adapted fall prevention exercise programme with behaviour change support appears feasible, acceptable, and safe for community-dwelling older adults in Indonesia. The findings suggest that behaviour change techniques may enhance exercise adherence and engagement, supporting progression to a definitive effectiveness trial.