A qualitative study of primary healthcare professional’s views of falls prevention

This study examines the views of primary healthcare professionals in the UK on falls prevention and the challenges they encounter in treating older people who fall. The research aims to improve patient care and outcomes by identifying barriers and opportunities for falls prevention.

Evidence based practice

Table of Contents
INTRODUCTION...........................................................................................................................2
BODY..............................................................................................................................................2
BELIEVABILITY...........................................................................................................................3
Author’s credential......................................................................................................................3
Abstract........................................................................................................................................4
ROBUSTNESS................................................................................................................................4
Research problem/purpose...........................................................................................................4
Literature review..........................................................................................................................4
Study design.................................................................................................................................5
Sampling......................................................................................................................................6
Ethical consideration...................................................................................................................6
Data Collection............................................................................................................................6
Data Analysis...............................................................................................................................7
Findings.......................................................................................................................................7
CONCLUSION................................................................................................................................9
REFERENCES..............................................................................................................................10

Topic: “A qualitative study of primary healthcare professional’s views of falls prevention”
INTRODUCTION
Falls are recognized as an important ill-health syndrome and this majorly find out in older
people, and also has a substantial effect on daily life and independence. Such that study also
shows that people whose age is in between 65 fall at least once in a year. That is why, WHO
define a primary care and they should be contact with the primary health care professionals in
order to manage the fall. The current study is based upon the qualitative paper and uses Ryan et
al critiquing framework. Also this research helps to improve the care, lives and outcomes of
patients and groups of people. The aim of this study is to provide a knowledge to the reader and
also to identify the views of primary healthcare professionals in UK, with regards to preventing
falls. This study is also essential in nursing because it will help to know the perspective of the
healthcare professionals regarding the specific topic.
BODY
According to Tarafdar et al (2018) Fall is the major health issue that is cause in 1 to 3
age people as well as 65 and over than that. Thus, it is clearly reflected that the major cause of
the injury is age and when an aged people fall, it leads to serious injury such that hip fracture. On
the other side, Mulvey (2018) stated that there is an important association between frailty and
falls and also determine the five ill health syndromes as well. Moreover, the General Medical
Service also contracts with UK general practitioners to take care of the older people with regards
to fall. Also, much research is also focused on the barriers as well as help for the fall intervention
which their patients perceived. Though it is also analyzed that routinely applying effective fall
prevention intervention in the practice is more challenging for the people. Further Allied health
professionals also have an important role to determine and manage the fall risk such that they
provide physical and exercise therapy.
Gettel and et.al., (2020) critically evaluated that there are many therapy provided by the
doctors in order to generate the best outcome but there is a need to have proper skills which also
assist people in order to manage the treatment in better manner. For that Norrmalization Process
Theory is also proposed which introduce four key concepts i.e. Coherence that means new way

of working makes sense of people, next is Cognitive participation where people cognitively
engage with new work, next is collective action where people enact new work of practice and
last is reflexive monitoring where people find ways to live a life which has been worthwhile.
The limitation of the study is to provide an initial understanding to determine the barriers
and if there was a little data collected related to professionals and if the quantitative study will be
taken then it will help to generate the best results. Further, researcher also chooses the
recruitment method which may not have offered the full representation of the primary healthcare
professionals, then they may choose top professionals as well. Another limitation is such that the
study was led by the general practitioners that also have influenced the response of the
participants and did not include the actual results. on the other side, the strength of the study is
the top professionals provide their actual views but it is not easy to determine the actual results
that helps to meet the define aim and objectives. Moreover, it is also analyzed that the current
study provide in-depth results and context and condition with semi- structured interviews in
order to get proper response that helps to meet the define aim and answer the research questions
as well.
BELIEVABILITY
Author’s credential
 The current study is written by Suhial Amin Tarafdar who is a general practitioner in
West Midland, England.
 Another author who contributes in this study is Nichola Pugh who is a senior officer,
school of Public Health in University of Birmingham, England.
 Alison Dayle another author who was also contributes their efforts to make the research
successful and he is a service delivery lead in Public Health in University of
Birmingham, England.
 Further, Debbie Bowen who is an officer of Population Health and Care in Birmingham
Public Health in England.
 Next is a Kathy Lee and Julie Law who is a senior officer of Birmingham Public Health
in England.

 Last one is Hashmum Mahmood who is a Public helath manager in Birmingham City
Council public helath and Staffordshire University in England.
Abstract
Fall among older people is consider one of the major cause of hospital admission and
many primary health care professionals are also plays their important role in preventing falls
even though they are facing barriers in order to provide better treatment. Through this study,
researcher wants to determine the view of professionals of UK and what are the barriers did they
face in order to provide better treatment to their patients. Therefore, the results are also identified
through major themes basically in two key aspect i.e. challenges and opportunities. Such that
challenges involve lack of association between primary as well as secondary care as well as
awareness of all the services. On the other side, opportunities refer to the recognition of falls and
that is consider as a priority and risk satisfaction of the older people. Hence, the main aim of this
study is to analyze the main barriers or risk which the top professionals face in order to provide
proper treatment for their patients.
ROBUSTNESS
Research problem/purpose
The research problem of this study is to determine the problems which professionals face
in order to provide better treatment to the older age people when they fall. So, the purpose of the
study is to develop knowledge among the professionals so that they get proper knowledge and
determine the issues as well. As the aim also identifies that by study on this topic, researcher also
develop skills regarding nursing which will help them in their future as well. So, significance of
the study is to enhance the knowledge with regards to the study that will help in the future
options.
Literature review
According to the Racine and et.al., (2020) most of the general practitioner are completely
agree that they face range of challenge in order to treat the people when they fall and among all
time constraint is consider one of the biggest challenge that affect the overall profession.
Because most of them state that they face issue from the secondary services which they get from

the hospitals and doctors take enough time in order to make discharge sheet and as a result,
primary health care professionals take time to provide proper treatment because they provide
physiotherapy that helps to provide proper treatment. In the same time, the Royal College of
General Practitioners also state the issue and highlight that there must be a ten minute
consultation should be doctors in order to increase inadequate for the complex older adults.
While on the other side, other study shows that lack of time is consider one of the another
barrier which affect the overall treatment in negative manner.
Olij and et.al., (2019) stated that government also make different policy in order to
creates awareness among the practitioners so that they provide proper treatment to the older
people who fall and among all, primary health care professionals are plays an important role so
that they will also generate some opportunity i.e. risk stratification, improve public health etc.
Robins and et.al., (2016) also argued that the workshops are also included the latest research
evidence for the fall prevention and keep discussing on how to implement the evidence into the
practice as well as generate the opportunity which helps many GP. Further, poor communication
between the general practice and adult social care is also consider one the major issue that affect
the overall professionals that is why, through primary health care professionals, most of the
older age people provide proper treatment in order to cure the patients.
In addition to this, awareness of localized fall services was consider one of the essential
for effective falls prevention and some of the primary health care professionals are also state that
importance of care home staff in identifying patients at risk of falling in nursing as well as
residential homes.
Study design
The current study uses a qualitative approach in which top professionals are selected in
order to get their views of different aspects which are as mention below:
 Is the prevention of falls as well as fractures among older people is a priority?
 Do all the primary health care practitioners routinely assess all the older people who fall?
 What are the main challenges which health care professionals face when they provide
treatment to the older age people.

Sampling
In order to conduct the research in better manner researcher had chosen purposive
sampling technique and researcher also provide invitation to all the selected sample through
newspaper in Birmingham. On the other side, email is invitation is also sent to all the GP who
were work in clinics and educational supervisors for Birmingham. On the other side, research
article also shows that researcher had choose snowball sampling in order to take advantage of the
professionals network of all the primary health care professionals. So, top professionals are
selected in order to get the results.
Ethical consideration
In order to conduct primary research, scholar has to make sure that they take full consent
from the sample. On the other side, proper confidentiality should be maintain which means all
the personal detail should not be shared to third party and make sure that all the selected sample
sign to the ethical foo ensure that they know the terms and condition of the research (Khong and
et.al., 2017). Moreover, researcher has to make that there must be proper flow of communication
between the respondents so that it will not cause any negative impact upon the results. In
addition to this, researcher has to comply with the data protection act and proper respect and
integrity should be maintain that helps to generate the best results and answer the research
questions as well.
Data Collection
It is the method which is used to gather the information related to the research and for
this current study, researcher chooses both primary and secondary data collection method which
helps to meet the define aim and objectives. Such that under primary data collection method,
researcher chooses semi- structured I.e. face to face interview method with participants. Such
that questions were asked from the selected sample and then these were recorded and later
transcribed. While on the other side, questionnaire is also sent to primary health care
professionals through email or post. Further, semi- structure interview questions also contain
both open and close ended questions that helps to determine the view of all the professionals
with regards to the fall and also analyze the challenges and barriers which they face in order to
treat the older people. Under this, total 17 primary professionals are selected from Birmingham

and Solihull were recruited and thus, eight questions were asked in the form of face to face
interviews while, nine questionnaire are perform through email.
Further, under the secondary research, researcher selects some articles and Journals
which help to support the views from the selected sample in order to get the best results. Also,
through secondary research, scholar gain the knowledge and analyze whether the selected sample
also help to meet the define aim or not. Using this type of data collection method, researcher also
select newspaper and some clinical files which assist to get accurate results and make a list of all
the older people who ill due to fall and this will support researcher in order to answer the
research questions as well.
Data Analysis
Data analysis is the simple process of inspecting, cleansing and modeling the information
and its main goal is to discover some useful information and then inform the conclusion for
better decision making. There are two main types of data analysis method such that qualitative
and quantitative. Among all, researcher chooses thematic data analysis in order to inductively
generate codes and themes which is based upon two key aspect i.e. Challenges and opportunity.
Further the data from the interviews and the questionnaire were actually analyzed from the
different phases such that collecting as well as recording the interviews and the questionnaire.
Transcription of recoding, coding and categorizing descriptors and then determine the themes.
So, with proper data analysis, researcher determines the views of the selected sample and
also determines the barriers which they face when they treat the patients.
Findings
While conducting the interview, there are different challenges were identified and among
all, lack of integration is consider one of the major challenge that most of the professionals face.
Under this, professionals are facing issue in order to manage and prevent the health problems
which is caused by falls and this lack of integration is develop between primary care, secondary
care and community oriented intervention. On the other side, most of the health care
professionals also state that when they come to treat at primary basis and then reviewed from the
discharge letter that hospitals spent lot of time and amount to referring the patients to
appropriate doctors (Cuesta-Benjumea and et.al., 2017). On the other side, some of them state

that they face a challenge that is to inability off primary healthcare professionals who directly
refer to the patients in order to obtain the personal aid but this services are only to provide
intermediary response i.e. Physiotherapist.
On the other side, from the interview it is also analyzed that Awareness of service is
another challenge because most of the patients did not know about these services and as a result,
the patients prefer to top hospitals rather than getting treatment from the primary health care
professionals. The third challenge which most of the professionals face is Lengthy referral
pathways because it is one of the major issue to the efficient management of falls as well as
fractures (de Jong and et.al., 2019). It is so because of the long time taken in order to refer
patients to healthcare services. Such that most of them are referred through fax, post and this
cause delay in the treatment.
Beside this, under opportunity, most of the health care professional state that one of the
biggest benefit of fall prevent is to raise the independence and confidence of older adults. In
addition to this, most of the participants also highlight the devasting consequence of fractures
and injury is such that there is a huge priority due to significant mortality and cost associated.
Further, there is an important for the prevention off the fractures and injuries in elderly because
they require extra care and much healthcare facilities which help them to meet or provide better
cure without affecting much time.
On the other side, risk stratification is another opportunity which healthcare professionals
stated in which they agree that most of them did not use any formal screening tools for falls. But
many of them are also in favored that risk stratification for falls wanted a tool which would be
easy to execute and also be reliable and specific, also it did not consume enough time. Also,
some of them are against with the statement (Finnegan, Bruce and Seers, 2019). So the possible
incorporation of fall and factures in the quality as well as results framework i.e. QOF also state
that it would be valuable as it allow all the primary health care professionals to think more about
the falls and its prevention rather than commenting on the others.
Last opportunity which the professionals state i.e. Improve public health because they
think that local health services has an important role in falls prevention at the population local
which actually includes addressing the wider determinants of health and also influence localized

clinical commissioning through the define pathways. Also most of the respondents do not use
screening tool, however, those who did provides a locally enhanced service and a direct
enhanced services in order to avoid unplanned admission of all the elder people. While on the
other side, some of them uses medication reviews in order to ask about the hypothesis symptoms
for falls and their prevention. From the sampling, around half of them are linked with the care
home, so at that time, assessment by the nurses and healthcare assistant were shared by nurses
that provide further opportunities for fall prevention (Olij and et.al., 2019). Not only this, most of
the health care professionals also visit care homes in order to check whether they did not have
any problem or any issue related to their fall and fractures. Therefore, it is clearly reflected that
respondents face more challenges as compare to opportunity which cause negative impact upon
the overall business and they even do no provide proper care to the older age people as well.
CONCLUSION
By summing up above, it has been concluded that the perspective of health care
professionals is achieved through the current study. Also, through the primary research it has
been concluded that professionals faces both challenge as well as opportunity within a treatment
such that they face three main challenge i.e. low integration between primary and secondary
care, late referrals and last is not aware of all the services. Further, on the other side, it is also
concluded that they also find out different opportunity such that improve public health and they
provide confidence to the old age people when they get ill. Thus, it is actually reflected from the
research that if the researcher chooses interview question under survey method then it will be
better to determine the answer and also by reducing the risk of falls, primary health care
practitioners are perfectly placed in order to improve the quality of life off older adults and this
in turn assist to prevent morbidity and mortality.

REFERENCES
Books and Journals
Cuesta-Benjumea, C.D.L. and et.al., 2017. Falls prevention among older people and care
providers: protocol for an integrative review.
de Jong, L. D. and et.al., 2019. Views and experiences of visually impaired older people and
exercise instructors about the Falls Management Exercise programme: a qualitative
study. Disability and Rehabilitation, pp.1-7.
Finnegan, S., Bruce, J. and Seers, K., 2019. What enables older people to continue with their
falls prevention exercises? A qualitative systematic review. BMJ open. 9(4).
Gettel, C.J. and et.al., 2020. Care transition decisions after a fall‐related ED visit: a qualitative
study of patients’ and caregivers’ experiences. Academic emergency medicine.
Khong, L.A. and et.al., 2017. Can peer education improve beliefs, knowledge, motivation and
intention to engage in falls prevention amongst community-dwelling older
adults?. European journal of ageing. 14(3). pp.243-255.
Mulvey, M. S., Social marketing interventions to promote physical activity among 60 years and
older: a systematic review of the literature.
Olij, B.F. and et.al., 2019. Evaluation of implementing a home-based fall prevention program
among community-dwelling older adults. International journal of environmental
research and public health. 16(6). p.1079.
Racine, E., and et.al., 2020. ‘I’ve always done what I was told by the medical people’: a
qualitative study of the reasons why older adults attend multifactorial falls risk
assessments mapped to the Theoretical Domains Framework. BMJ open. 10(2).
Robins, L.M., and et.al., 2016. Older adult perceptions of participation in group-and home-based
falls prevention exercise. Journal of aging and physical activity. 24(3). pp.350-362.
Tarafdar S, Pugh N, Doyle A et al (2018) A qualitative study of primary healthcare
professionals’ views of falls prevention. Primary Health Care. doi:
10.7748/phc.2018.1429