117 Spread, adoption, implementation and maintenance of the falls management exercise (FaME) programme; learning from a mixed methods implementation study in demographically diverse regions of the UK

<h3>Background</h3> The Falls Management Exercise (FaME) Programme is a group-based, face-to-face and home-based, six-month multi-component exercise intervention for older adults. It reduces falls and fear of falling, increases physical activity and improves confidence and balance. FaME is also cost effective. Despite this evidence, it is not widely available in the UK. <h3>Objective</h3> To study the spread, implementation, adherence, ‘real world’ outcomes and quality management of FaME in 14 organisations across three demographically diverse regions of the UK. <h3>Programme Description</h3> Using the Consolidated Framework for Implementation Research to map themes, we undertook a qualitative analysis of 40 Semi-structured interviews with FaME commissioners, providers and participants, 25 class observations and content analysis of management documents. To assess participant outcomes we analysed quantitative functional and self-reported fall outcomes from 1601 participants. <h3>Outcomes and Learnings</h3> Class availability tripled in one region, whilst delivery remained consistent in others. Factors influencing spread included FaME’s evidence base, perceived fit with organisational values and the personal experiences and beliefs of decision-makers. Univariate pre/post analyses of routinely-collected outcomes showed significant improvements in confidence and balance (Confbal p&lt;0.001), falls (in the previous 3 months, p&lt;0.001) and Timed-Up-and-Go (p&lt;0.001). Participants valued social opportunities as well as improvements in their physical abilities and reported wellbeing benefits beyond fall prevention. Newer programmes or those with quality assurance systems in place showed higher fidelity and quality. Programmes varied in duration and aspects of delivery but a national community of practice forum provided improvement opportunities and mechanisms. <h3>Implications</h3> Complex and interacting factors influence FaME’s availability, delivery, uptake, participant adherence and outcomes. Findings could be extrapolated to other exercise interventions and have informed the production of an updated implementation toolkit to assist its high-quality implementation. <h3>Conclusions</h3> FaME is an evidence-based fall prevention programme but delivery is often inconsistent and there are areas without any provision in the UK. Awareness of its evidence-base is necessary but not sufficient for spread and measures to ensure continued fidelity, quality, outcomes and adherence need to be designed into contracted delivery.