1
|
Ong MF, Soh KL, Saimon R, Saidi HI, Tiong IK, Myint WW, Mortell M, Japar S. Predictors of fall protection motivation among older adults in rural communities in a middle-income country: A cross-sectional study using the Protection Motivation Theory. J Adv Nurs 2024. [PMID: 38606809 DOI: 10.1111/jan.16190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 03/14/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Abstract
AIMS To evaluate factors associated with fall protection motivation to engage in fall preventive behaviour among rural community-dwelling older adults aged 55 and above using the protection motivation theory scale. DESIGN A cross-sectional study. METHODS The study was conducted in a healthcare clinic in Malaysia, using multistage random sampling from November 2021 to January 2022. Three hundred seventy-five older adults aged 55 and older were included in the final analysis. There were 31 items in the final PMT scale. The analysis was performed within the whole population and grouped into 'faller' and 'non-faller', employing IBM SPSS version 26.0 for descriptive, independent t-test, chi-square, bivariate correlation and linear regressions. RESULTS A total of 375 older participants were included in the study. Fallers (n = 82) and non-fallers (n = 293) show statistically significant differences in the characteristics of ethnicity, assistive device users, self-rating of intention and participation in previous fall prevention programmes. The multiple linear regression model revealed fear, coping appraisal and an interaction effect of fear with coping appraisal predicting fall protection motivation among older adults in rural communities. CONCLUSION Findings from this study demonstrated that coping appraisal and fear predict the protection motivation of older adults in rural communities. Older adults without a history of falls and attaining higher education had better responses in coping appraisal, contributing to a reduction in perceived rewards and improving protection motivation. Conversely, older adults from lower education backgrounds tend to have higher non-preventive behaviours, leading to a decline in fall protection motivation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE These results contribute important information to nurses working with older adults with inadequate health literacy in rural communities, especially when planning and designing fall prevention interventions. The findings would benefit all nurses, healthcare providers, researchers and academicians who provide care for older adults. PATIENT OR PUBLIC CONTRIBUTION Participants were briefed about the study, and their consent was obtained. They were only required to answer the questionnaire through interviews. Older individuals aged fifty-five and above in rural communities at the healthcare clinic who could read, write or understand Malay or English were included. Those who were suffering from mental health problems and refused to participate in the study were excluded from the study. Their personal information remained classified and not recorded in the database during the data entry or analysis.
Collapse
Affiliation(s)
- Mei Fong Ong
- Department of Nursing, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Nursing, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Kim Lam Soh
- Department of Nursing, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rosalia Saimon
- Community Medicine and Public Health, Universiti Malaysia Sarawak, Kuching, Sarawak, Malaysia
| | - Hasni Idayu Saidi
- Department of Biomedical Science, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Ing Khieng Tiong
- Department of Geriatric Medicine, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
| | - Wai Wai Myint
- Medicine and Rehabilitation, Universiti Malaysia Sarawak, Kuching, Sarawak, Malaysia
| | | | - Salimah Japar
- Department of Nursing, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| |
Collapse
|
2
|
Ong MF, Soh KL, Saimon R, Tiong IK, Saidi HI, Mortell M. Psychometric evaluation of the Protection Motivation Theory scale in assessing fall protection motivation among older adults to reduce fall risk. BMC Geriatr 2023; 23:703. [PMID: 37904086 PMCID: PMC10617071 DOI: 10.1186/s12877-023-04372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Protection Motivation Theory could be another potential and good framework that addresses essential elements in a behavioural change leading to positive fall protective behaviours. The positive behavioural change could reduce the risk of falls and improve the quality of life of the older community. The study aims to evaluate the reliability and validity of the culturally adapted Protection Motivation Theory scale for older adults' fall protection motivation or protective behaviours to reduce fall risk. METHODS A cross-sectional study was conducted to establish a psychometric instrument validation. A total of 389 participants aged 55 years and above were included. The study was conducted in Sarawak, Malaysia, from November 2021 to January 2022 in two phases, translation of the PMT Scale, cross-cultural adaptation, face validation and pre-testing of the PMT Scale. The participants were selected using multistage random sampling in a primary healthcare clinic. Data entry and statistical analysis were performed using IBM SPSS version 26 for exploratory factor analysis and SmartPLS version 3.3.7 for confirmatory factor analysis using partial least square structural equation modelling. RESULTS The Kaiser-Meyer-Olkin value was 0.760, Bartlett's sphericity test was significant and the total variance explained was 61%. It identified 31 items within eight dimensions of the Protection Motivation Theory scale. The Higher Order Constructs' measurement model indicates that the convergent and discriminant validity were established (Cronbach's alpha and composite reliability: ≥ 0.740; average variance extracted: 0.619 to 0.935 and Henseler's Heterotrait-Monotrait criterion for all constructs' discriminant validity: < 0.9). Test-retest for the intraclass correlation coefficient was 0.745. The model's coefficient of determination demonstrated R2 = 0.375. CONCLUSION Overall, the Protection Motivation Theory Scale has established its reliability and validity for assisting older adults in the community. The Protection Motivation Theory Scale could be used in fall prevention interventions by promoting fall protective behaviours to reduce fall risk among community-dwelling older adults. The scale could assist healthcare providers in assessing the intention of older adults to use fall protective behaviours to reduce fall risk and serve as an alternative reference in developing fall prevention education in a fall prevention strategy.
Collapse
Affiliation(s)
- Mei Fong Ong
- Department of Nursing, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia.
- Department of Nursing, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, 94300, Malaysia.
| | - Kim Lam Soh
- Department of Nursing, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, 94300, Malaysia.
| | - Rosalia Saimon
- Community Medicine and Public Health, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, 94300, Malaysia
| | - Ing Khieng Tiong
- Department of Geriatric Medicine, Institute of Sarawak Heart Centre/Sarawak General Hospital (Ministry of Health Malaysia), Kota Samarahan, Sarawak, 94300, Malaysia
| | - Hasni Idayu Saidi
- Department of Biomedical Science, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | | |
Collapse
|
3
|
Chen Y, Du H, Song M, Liu T, Ge P, Xu Y, Pi H. Relationship between fear of falling and fall risk among older patients with stroke: a structural equation modeling. BMC Geriatr 2023; 23:647. [PMID: 37821821 PMCID: PMC10568824 DOI: 10.1186/s12877-023-04298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 09/08/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND With reduced balance and mobility, older patients with stroke are more susceptible to fear of falling (FOF). A maladaptive form of FOF can cause excessive activity restriction, poor balance, and recurrent falls, forming a self-reinforcing vicious cycle. This study applied and adapted the FOF model to investigate the interaction between FOF and fall risk in older stroke patients. METHODS A cross-sectional study was conducted among 302 older stroke patients aged 60 and over. All participants were invited to complete the FOF, fall risk, physical activity, and balance tests, which were measured by the Falls Efficacy Scale International (FES-I), Self-Rated Fall Risk Questionnaire (FRQ), the long-form International Physical Activity Questionnaire (IPAQ-LF) and the Four-Stage Balance Test (FSBT) respectively. Data were analyzed using structural equation modeling. RESULTS The mean age of the respondents was 68.62 ± 7.62 years; 8.94% reported a high level of FOF, and 18.21% reported a moderate level of FOF. The structural equation model showed that FOF was directly associated with fall risk (β=-0.38, p < 0.001), and was indirectly associated with fall risk via physical activity (β=-0.075, p < 0.05) and balance ability (β=-0.123, p < 0.05). Depression (β=-0.47, p < 0.001), fall history (β=-0.13, p < 0.05), and female sex (β=-0.16, p < 0.05) affected FOF, while anxiety was not associated with FOF. CONCLUSIONS The increased risk of falling in older stroke patients results from a maladaptive FOF affected by depression, fall history, poor balance ability, and limited physical activity. Our results suggest that greater attention should be paid to FOF during stroke recovery and fall prevention. A multifaced intervention program encompassing physiological and psychological factors should be designed to address FOF and prevent falls.
Collapse
Affiliation(s)
- Yuanyuan Chen
- Medical School of Chinese PLA, Beijing, People's Republic of China
- Department of Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hui Du
- Department of Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Mi Song
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Ting Liu
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Pei Ge
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Yue Xu
- Department of Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hongying Pi
- Medical Service Training Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, People's Republic of China.
| |
Collapse
|
4
|
Kaushal N, Nemati D, Mann-Krzisnik D, de la Colina AN. Comparing exercise determinants between Black and White older adults with heart failure. BMC Geriatr 2023; 23:614. [PMID: 37777727 PMCID: PMC10543325 DOI: 10.1186/s12877-023-04305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 09/10/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Heart Failure is a leading cause of mortality among older adults. Engaging in regular exercise at moderate-to-vigorous intensity has been shown to improve survival rates. Theory-informed methodologies have been recommended to promote exercise, but limited application of theoretical framework has been conducted for understanding racial disparities among older adults with heart failure. This study aimed to use the Health Belief Model to compare exercise behavior determinants between Black and White older adults diagnosed with heart failure. METHODS The HF-ACTION Trial is a multi-site study designed to promote exercise among individuals with heart failure that randomized participants to an experimental (three months of group exercise sessions followed by home-based training) or control arm. The present study used structural equation modeling to test the change in Health Belief Model constructs and exercise behavior across 12 months among older adults. RESULTS Participants (n = 671) were older adults, 72.28 (SD = 5.41) years old, (Black: n = 230; White, n = 441) diagnosed with heart failure and reduced ejection fraction. The model found perceived benefits, self-efficacy, perceived threats, and perceived barriers to predict exercise behavior among Black and White older adults. However, among these constructs, only perceived benefits and self-efficacy were facilitated via intervention for both races. Additionally, the intervention was effective for addressing perceived barriers to exercise only among White participants. Finally, the intervention did not result in a change of perceived threats for both races. CONCLUSIONS Among health belief model constructs, perceived threats and barriers were not facilitated for both races in the experimental arm, and the intervention did not resolve barriers among Black older adults. Racial differences need to be considered when designing interventions for clinical populations as future studies are warranted to address barriers to exercise among Black older adults with heart failure.
Collapse
Affiliation(s)
- Navin Kaushal
- Department of Health Sciences, School of Health & Human Sciences, Indiana University, 901 W New York St., Indianapolis, IN, 46202, USA.
| | - Donya Nemati
- College of Nursing, Ohio State University, Columbus, OH, USA
| | | | - Adrián Noriega de la Colina
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- The Montreal Neurological Institute-Hospital, McGill University, Montreal, QC, Canada
| |
Collapse
|
5
|
Kwon HJ, Oh J. Comparing Older Parents' and Adult Children's Fear of Falling and Perceptions of Age-Friendly Home Modification: An Integration of the Theories of Planned Behavior and Protection Motivation. Behav Sci (Basel) 2023; 13:bs13050403. [PMID: 37232640 DOI: 10.3390/bs13050403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
This study investigated how a fear of falling affects perceptions and behavioral intentions toward age-friendly home modification (AFHM) in older parents and adult children by integrating the theory of planned behavior (TPB) to explain AFHM decision-making processes and the protection motivation theory to explain the impact of a fear of falling on AFHM intention. The target population comprised older parents (≥75 years old) and adult children (45-64 years old) in Busan, South Korea (N = 600). The participants completed a self-administered questionnaire in March 2022. Independent t-test and path model analyses were conducted to compare primary constructs between older parents and adult children and analyze the relationships among a fear of falling, TPB components, and AFHM intention. Results showed that both groups had positive attitudes toward AFHM. However, adult children showed significantly higher rates of having a fear of falling, lower perceived behavioral control, and higher AFHM intention than older parents. The proposed research models were partially supported in the older-parent group and fully supported in the adult-children group. Adult children play a critical role in AFHM, along with older adults who are directly involved in an aging society. AFHM-supporting programs, including monetary and human-force assistance, education, related public advertisements, and an active AFHM market, should be expanded.
Collapse
Affiliation(s)
- Hyun Joo Kwon
- Department of Interior & Environmental Design, Pusan National University, Busan 46241, Republic of Korea
| | - Jiyoung Oh
- Research Institute of Ecology, Pusan National University, Busan 46241, Republic of Korea
| |
Collapse
|
6
|
The mediator role of frailty in the effect of fear of falling avoidance behavior on quality of life in older adults admitted to hospital. Geriatr Nurs 2022; 48:132-138. [PMID: 36219931 DOI: 10.1016/j.gerinurse.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
The aim of this research was to determine the mediator role of frailty in the effect of fear of falling avoidance behavior on quality of life in the older adults. This descriptive and cross-sectional study was conducted with 312 individuals in Istanbul between June-October 2021. The Edmonton Frail Scale (EFS) score was 7.06±3.69, Fear of Falling Avoidance Behavior Questionnaire (FFABQ) score was 17.84±15.3. Quality of Life Scale (SF-12) physical component score was 34.21±25.12 and mental component score was 41.81±17.87. EFS plays a mediating role in the effect of FFABQ on SF-12 and strengthens its negative effect on SF-12. The frailty severity of the participants was moderate, activity limitation and participation restriction due to fear of falling were low, and their quality of life in physical and mental components was low. Avoidance behavior has a direct effect on quality of life and an indirect effect with the role of frailty.
Collapse
|