Date Presented 04/06/19
The "My Safe and Sound Plan" workbook contributes to the available methods of fall prevention assessment and education, providing a self-assessment, home safety checklist, and education on fall risks. This instrument demonstrated content validity of all items, as rated by five experts, covering content necessary for fall prevention. Experts indicated that education alone was not sufficient to reduce falls; readiness to change was a vital factor in reducing fall risks.
Primary Author and Speaker: Brenda Howard
Additional Authors and Speakers: Kathryn Boomershine, Rachel Gramman, Clare Schirmer, Jerica Schomber
PURPOSE: The purpose of this study was to determine the content validity of the My “Safe and Sound” Plan for Staying Falls-Free workbook, a self-assessment and educational tool for communicating evidence-based fall risk factors to clients. Most falls prevention interventions have been community based. However, occupational therapists have provided falls prevention education and intervention in the clinical setting. Current clinical falls prevention interventions vary in methodology and effectiveness, and there is a need for a clear, consistent, efficient, evidence-based tool to use in the clinical setting.
DESIGN: Investigators utilized a panel of five experts to establish content validity of the My “Safe and Sound” Plan for Staying Falls-Free workbook. Investigators recruited participants from outpatient rehabilitation departments at two large health systems. Inclusion criteria required that participants were physical or occupational therapy practitioners with experience in falls prevention education.
METHOD: Three occupational therapists and two physical therapists working in outpatient settings completed surveys rating the representativeness and clarity of 29 items on a 4-point rating scale. The survey included the option for open-ended qualitative comments for elaboration. Data were analyzed for inter-rater agreement (IRA) by counting how many experts rated each item as a 1 or 2, and how many experts rated each item as a 3 or 4, to determine how many experts deemed the item as “clear” or “representative”. Investigators calculated inter-rater agreement for the entire measure for each of clarity and representativeness items by dividing the number of items considered 100% reliable by the total number of items in the tool. An acceptable level of IRA was considered to be .80 for each item. To determine the content validity index (CVI) of the representativeness of each item, researchers transformed variables to combine items 1 and 2 as not representative and items 3 and 4 as representative. The number of items that experts rated as 3 or 4 was then divided by the total number of experts. To calculate the CVI for the tool as a whole, investigators calculated the average CVI across all representativeness items by adding up all items with a CVI of at least .80 and dividing by the total number of items in the representativeness category. An acceptable level of CVI was considered to be .80.
RESULTS: Results demonstrated IRA for all representativeness items (1.00), and IRA for clarity items was .862. CVI was 1.00, indicating that items were representative of what is known about fall risks. Results established content validity of the tool. Investigators used member checking and qualitative responses to revise the workbook. Experts recommended more options to individualize exercises and a list of resources for home modifications. Experts also stated that, while education items were clear, some clients using the workbook were not ready to make changes.
CONCLUSION: Investigators met the purpose of this study by determining that the My “Safe and Sound” Plan for Staying Falls-Free workbook demonstrated inter-rater agreement and content validity. Implications for practice included respecting the agency and individuality of clients while addressing fall risk factors. Utilizing a client-centered self-assessment may result in clients being more likely to follow through with recommendations.
IMPACT STATEMENT: Practitioners must establish effective therapist-client communication for effective falls prevention interventions. An evidence-based tool with content validity increases the likelihood of clear evidence translation and successful occupational therapy intervention outcomes.
References
Rubio, D., Berg-Weger, M., Tebb, S., Lee, E. S., & Rauch, S. (2003). Objectifying content validity: Conducting a content validity study in social work research. Social Work Research, 27(2), 94-104.
Child, S., Goodwin, V., Garside, R., Jones-Hughes, T., Boddy, K., & Stein, K. (2012). Factors influencing the implementation of fall-prevention programmes: A systematic review and synthesis of qualitative studies. Implementation Science, 7(91), 1-14.
Peterson, E. W., Finlayson, M., Elliot, S. J., Painter, J. A., & Clemson, L. (2012). Unprecedented opportunities in fall prevention for occupational therapy practitioners. American Journal of Occupational Therapy, 66(2), 127-130. doi: 10.5014/ajot.2012.003814
Centers for Disease Control and Prevention. (2015). Preventing falls: A guide to implementing effective community-based fall prevention programs (2nd Ed.). Atlanta, GA: National Center for Injury Prevention and Control.
