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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Health Services Research 1/2018

Evaluating the impact of a falls prevention community of practice in a residential aged care setting: a realist approach

BMC Health Services Research > Ausgabe 1/2018
Jacqueline Francis-Coad, Christopher Etherton-Beer, Caroline Bulsara, Nicole Blackburn, Paola Chivers, Anne-Marie Hill
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12913-017-2790-2) contains supplementary material, which is available to authorized users.



Falls are a major socio-economic problem among residential aged care (RAC) populations resulting in high rates of injury including hip fracture. Guidelines recommend that multifactorial prevention strategies are implemented but these require translation into clinical practice. A community of practice (CoP) was selected as a suitable model to support translation of the best available evidence into practice, as it could bring together like-minded people with falls expertise and local clinical knowledge providing a social learning opportunity in the pursuit of a common goal; falls prevention. The aims of this study were to evaluate the impact of a falls prevention CoP on its membership; actions at facility level; and actions at organisation level in translating falls prevention evidence into practice.


A convergent, parallel mixed methods evaluation design based on a realist approach using surveys, audits, observations and semi-structured interviews. Participants were 20 interdisciplinary staff nominating as CoP members between Nov 2013-Nov 2015 representing 13 facilities (approximately 780 beds) of a RAC organisation. The impact of the CoP was evaluated at three levels to identify how the CoP influenced the observed outcomes in the varying contexts of its membership (level i.), the RAC facility (level ii.) and RAC organisation (level iii.).


Staff participating as CoP members gained knowledge and awareness in falls prevention (p < 0.001) through connecting and sharing. Strategies prioritised and addressed at RAC facility level culminated in an increase in the proportion of residents supplemented with vitamin D (p = 0.002) and development of falls prevention education. At organisation level a falls policy reflecting preventative evidence-based guidelines and a new falls risk assessment procedure with aligned management plans were written, modified and implemented. A key disenabling mechanism identified by CoP members was limited time to engage in translation of evidence into practice whilst enabling mechanisms included proactive behaviours by staff and management.


Interdisciplinary staff participating in a falls prevention CoP gained connectivity and knowledge and were able to facilitate the translation of falls prevention evidence into practice in the context of their RAC facility and RAC organisation. Support from RAC organisational and facility management to make the necessary investment in staff time to enable change in falls prevention practice is essential for success.
Additional file 1: CoP member confidence, motivation and opportunity to engage in intranet usage and lead falls prevention activity. (DOCX 15 kb)
Additional file 2: Matrix of knowledge flow through CoP and member connections through discussion board participation. (DOCX 21 kb)
Additional file 3: Proportion of residents supplemented with vitamin D measured in July 2014 and re-measured November 2015. (JPEG 48 kb)
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