Preferences of older Australians for fall prevention exercise program features: a discrete choice experiment

BACKGROUND: Falls are a major cause of injury, disability and health service use among older Australians. While exercise-based interventions can reduce falls, participation remains low. Understanding preferences for program features may inform design and implementation of fall prevention exercise programs to maximise uptake, adherence and impact. METHODS: An online discrete choice experiment was conducted with 383 community-dwelling Australians aged ≥ 60 years, independent in daily activities and not currently enrolled in a fall prevention program. Participants completed choice tasks with varying levels of six program attributes: cost per class, delivery mode, class size, personalisation, program duration and access to professional support. Data was analysed using mixed multinomial logit and latent class models to estimate preferences, willingness to pay and preference heterogeneity. Policy simulations estimated predicted uptake under alternative service configurations. RESULTS: Participants generally preferred lower-cost, individual programs of short duration (1-3 months) delivered in-person at home with on-demand professional support. There was no significant preference for personalisation. Latent class analysis identified three subclasses: "opt-out" (19%), "cost-sensitive" (37%) and "support-oriented" (44%). Policy simulations showed high uptake in the support-oriented class and low uptake in the opt-out class regardless of configuration and greater responsiveness to cost reductions among the cost-sensitive class. CONCLUSIONS: Preferences for fall prevention program features at point of uptake vary across identifiable older Australian subclasses. Offering flexible configurations, including low-cost options for cost-sensitive participants and enhanced features for those willing to pay, may improve program uptake and long-term sustainability. These findings provide actionable evidence to inform program design and policy decisions for scalable fall prevention initiatives.