Indicators for evaluating the implementation process and outcomes of integrated approaches to fall prevention: a qualitative co-creation study

Abstract Background In the past two decades, we have seen a rapid increase in the global incidence of falls among older adults. In the Netherlands, integrated multidisciplinary approaches to fall prevention are increasingly being implemented for community-dwelling older adults. While previous studies have mainly focused on outcome-based indicators to assess effectiveness, indicators measuring implementation processes have been underexplored, leaving a gap in our understanding of how these approaches are operationalized. Moreover, few of these studies capture the broader perspectives of both implementers and the target group such as professionals and older adults. The aim of our study was to, together with professionals and older adults, co-create a comprehensive set of indicators measuring both the implementation and outcomes of integrated multidisciplinary approaches to fall prevention. Methods Desk research and co-creation sessions were conducted with 13 stakeholders, including professionals and older adults. To identify and refine indicators for use in practice, we applied a four-round, stepwise and iterative co-creation approach involving group sessions, feedback rounds and individual consultations involving stakeholders and older adults. Results Stakeholders identified a total of 43 indicators for measuring the implementation and outcomes of integrated approaches to fall prevention. The indicators were categorized into nine overarching clusters: ‘Preconditions’, ‘Professional accountability’, ‘Older adult accountability’, ‘Intervention content’, ‘Accessibility and participation of older adults’, ‘Collaboration’, ‘Regular physical activity provision’, ‘Sustainability’ and ‘Outcomes’. Conclusion Our study provides a comprehensive set of implementation and outcome indicators that enable the evaluation of the effectiveness of integrated multidisciplinary approaches to fall prevention. By capturing these implementation indicators, we facilitate a more comprehensive understanding of the process, beyond evaluation based solely on outcome indicators. This study contributes to research by expanding the focus on outcome-based indicators to a more comprehensive perspective including indicators that capture implementation processes. This study also highlights the importance of co-creation when evaluating complex public health systems. The indicators provide a practical tool for researchers, practitioners and policymakers to evaluate and improve existing approaches to fall prevention.