Tailored implementation of national recommendations on falls prevention amongst older adults in municipalities in Norway—FALLPREVENT—a hybrid type 3 cluster-randomised trial

Abstract Background Implementation of evidence-based falls prevention recommendations within community health care settings is variable and suboptimal. Objective Evaluate the effectiveness of a tailored implementation strategy on adherence to falls prevention recommendations in Norwegian municipalities. Design Hybrid type 3 cluster randomised trial. Participants Twenty-five city districts/municipalities, with 13 intervention and 12 control clusters and 487 health care professionals (HCPs). Intervention Clinical intervention: national recommendations for falls prevention for older adults. Tailored implementation strategy: leadership commitment, competence enhancement, resource teams and implementation support. Outcomes Primary: self-reported adherence to the recommendations (questionnaire). Secondary: feasibility of the recommendations (Feasibility of Intervention Measure), experience of the implementation process (Normalisation Measure Development Questionnaire), fidelity to recommendations and strategy, and fall-related injuries. Assessments were conducted at baseline (T0), post-intervention at 9 months (T1) and at follow-up 15 months after baseline (T2). Results HCPs adherence showed mean difference of 1.3 points (95% CI –0.2–2.9, P = .099) at T1 and 1.8 points (95% CI 0.2–3.5, P = .025) at T2, in favour of intervention versus control, along with higher scores on implementation experience at T2 (mean difference of 2.2 points; P = .033). No difference was found for feasibility or fall-related injuries. Fidelity to the recommendations was higher in the intervention clusters, for seminar attendance and implementation support. Conclusion A tailored strategy improved HCP reported adherence to and experience of implementing falls prevention recommendations. The limited effectiveness on clinical outcomes might be due to limited fidelity by HCPs in delivery of the falls prevention interventions or time needed to fully embed workforce wide implementation.