新冠肺炎不成比例地影响了老年人的健康和福祉-其中许多人患有慢性病-因为他们死亡和住院的风险更高。它还造成了几次二次大流行,包括跌倒风险增加,久坐的行为,社会孤立,以及由于封锁政策限制了流动性而缺乏身体活动。跌倒是可预防的死亡和住院的主要原因,当面循证跌倒预防计划(EBFPP)转向远程分娩变得至关重要.在2020年春季,许多EBFPP管理员开始重新设计远程交付程序,以适应大流行所需的物理距离指南。向远程分娩过渡对于老年人和残疾人保持健康至关重要,跌倒和受伤,从医院出来,也让他们参与社会。我们与社区生活管理局(ACL)合作,国家老龄委员会(NCOA),和国家瀑布预防资源中心(NFPRC),用于对远程交付的EBFPP进行深入的实施评估。我们检查了适应和实施四个EBFPP以进行远程交付的过程,在RE-AIM评估框架内远程实施计划的最佳实践。这增强了NFPRC正在进行的支持传播的工作,实施,和EBFPPs的可持续性。我们有目的地对组织进行抽样,以获得组织和提供商类型的最大差异,地理位置,以及服务不足的老年人群(布莱克,土著,或其他有色人种(BIPOC),农村,残疾人)。此定性评估包括与计划管理员进行的半结构化访谈(N=22)的提供商级别数据,工作人员,和领导者。采访指南包括什么,为什么,以及如何使用Wiltsey-Stirman(2019)适应框架(FRAME)对EBFPP干预措施和实施策略进行适应,reach,和实施成果(可接受性,可行性,保真度,和成本;Proctor等人。,2011),专注于公平,以了解这些计划为谁工作,以及解决不平等问题的机会。研究结果表明,远程EBFPP与研究人员和社区组织合作,对远程交付进行了计划和保真度一致的调整。在节目内容和交付方面关注参与者的安全。交付地点和领导者需要使用和访问技术的支持,以促进参与,并随着时间的推移而改善。虽然从程序管理员的角度来看,远程EBFPP交付增加了某些人群对EBFPP的访问,领导人,和工作人员(例如,看护者,农村居民,身体残疾人),数字鸿沟仍然是获取和舒适使用技术的障碍。远程交付的EBFPP对于交付组织和领导者来说是可以接受和可行的,能够使用程序开发人员的改编来保真度地交付,但与面对面相比,资源更密集,实施成本更高。这项工作在大流行之外具有重要意义。远程交付扩大了对传统上由面对面编程服务不足的团体的访问,特别是残疾社区。这项工作将有助于回答有关到达的重要问题,可访问性,可行性,以及为老年人和有跌倒风险的残疾人提供计划的成本,那些患有慢性病的人,以及在获得医疗保健方面最容易受到差距影响的社区,健康促进计划,和健康结果。它还将向资助者提供关键信息,说明适应EBFPP所需的要素,这些要素在面对面的环境中被证明是有效的,可以实现保真度的远程交付,以实现可比的结果。
COVID-19 disproportionally impacted the health and well-being of older adults-many of whom live with chronic conditions-due to their higher risk of dying and being hospitalized. It also created several secondary pandemics, including increased falls risk, sedentary behavior, social isolation, and physical inactivity due to limitations in mobility from lock-down policies. With falls as the leading cause of preventable death and hospitalizations, it became vital for in-person evidence-based falls prevention programs (EBFPPs) to pivot to remote delivery. In Spring 2020, many EBFPP administrators began re-designing programs for remote delivery to accommodate physical distancing guidelines necessitated by the pandemic. Transition to remote delivery was essential for older adults and persons with disabilities to access EBFPPs for staying healthy, falls and injury free, out of hospitals, and also keeping them socially engaged. We collaborated with the Administration on Community Living (ACL), the National Council on Aging (NCOA), and the National Falls Prevention Resource Center (NFPRC), for an in-depth implementation evaluation of remotely delivered EBFPPs. We examined the process of adapting and implementing four EBFPPs for remote delivery, best practices for implementing the programs remotely within the RE-AIM evaluation framework. This enhances NFPRC\'s ongoing work supporting dissemination, implementation, and sustainability of EBFPPs. We purposively sampled organizations for maximum variation in organization and provider type, geographic location, and reach of underserved older populations (Black, Indigenous, or other People of Color (BIPOC), rural, disabilities). This qualitative evaluation includes provider-level data from semi-structured interviews (N = 22) with program administrators, staff, and leaders. The interview guide included what, why, and how adaptations were made to EBFPP interventions and implementation strategies using Wiltsey-Stirman (2019) adaptations framework (FRAME), reach, and implementation outcomes (acceptability, feasibility, fidelity, and costs; Proctor et al., 2011), focusing on equity to learn for whom these programs were working and opportunities to address inequities. Findings demonstrate remote EBFPPs made planned and fidelity-consistent adaptations to remote delivery in partnership with researchers and community organizations, focusing on participant safety both in program content and delivery. Supports using and accessing technology were needed for delivery sites and leaders to facilitate engagement, and improved over time. While remote EBFPP delivery has increased access to EBFPPs for some populations from the perspective of program administrator, leaders, and staff (e.g., caregivers, rural-dwellers, persons with physical disabilities), the digital divide remains a barrier in access to and comfort using technology. Remote-delivered EBFPPs were acceptable and feasible to delivery organizations and leaders, were able to be delivered with fidelity using adaptations from program developers, but were more resource intensive and costly to implement compared to in-person. This work has important implications beyond the pandemic. Remote delivery has expanded access to groups traditionally underserved by in-person programming, particularly disability communities. This work will help answer important questions about reach, accessibility, feasibility, and cost of program delivery for older adults and people with disabilities at risk for falls, those living with chronic conditions, and communities most vulnerable to disparities in access to health care, health promotion programming, and health outcomes. It will also provide critical information to funders about elements required to adapt EBFPPs proven effective in in-person settings for remote delivery with fidelity to achieve comparable outcomes.