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

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.

Contaminant film thickness affects walkway friction measurements

Walkway tribometers are used to measure available friction for evaluating walkway safety and pedestrian slip risk. Numerous variables can affect tribometer measurements, including the type and distribution of contaminants on the surface. Here, we quantified the effect of application method on contaminant film thickness, and the effect of film thickness on tribometer measurements on the four reference walkway surfaces used in ASTM F2508-16e. Distilled water, 0.05% sodium lauryl sulfate (SLS) solution, and 0.04% Triton X-100 solution were poured, squirted, and sprayed onto the surfaces to quantify their naturally occurring film thicknesses. These application methods had a significant effect on the resulting film thickness (p < 0.038), with the pour method consistently generating the thickest films and the spray method generating the thinnest films. We then quantified the effect of film thickness for the three contaminants (thickness range 0.3-3.3 mm) on the friction measurements of three common tribometers (Mark IIIB, English XL, and BOT 3000E) on each reference surface. A separate ANOVA was used for each of the 3 × 4 × 3 = 36 combinations of tribometer, surface, and contaminant. Friction measured with the Mark IIIB decreased with increasing film thickness on one surface across all three contaminants and on a second surface with the SLS contaminant. Friction measured with the BOT 3000E was sensitive to film thickness on two surfaces with water and one surface with Triton. The XL was unaffected by contaminant film thickness. Overall, despite significant differences in film thickness with contaminant application method, friction measurements were either insensitive to film thickness or varied only a small amount in all cases except for the Mark IIIB on the roughest surface. Film thickness did not alter the relative slip resistance of the four ASTM F2508 reference surfaces.

Quantifying the uncertainty in tribometer measurements on walkway surfaces

Properly estimating and reporting the uncertainty of walkway surface friction is key to ensuring pedestrian safety. Here we quantified the amount and sources of uncertainty in friction measurements by having four users of four units of each of two walkway tribometer models (Slip-Test Mark IIIB, English XL) perform 12 measurements on four samples of four different surfaces that ranged from slippery to slip-resistant. We found that 51-82% of the total variance in the measurements was explained by the user, unit, sample and a user-unit interaction, which means that the variance a single user calculates from their own data does not capture most of the uncertainty in their measurements. Based on these data, the minimum uncertainty associated with the mean of a user's measurements is ±0.064 (Mark IIIB) and ±0.072 (XL) to be 95% confident that their mean captures a surface's available friction. Practitioner Summary: Walkway surface friction measurements are less accurate than they appear. Based on an experiment quantifying the amount and sources of uncertainty in surface friction measurements using two common tribometers, we quantified and report the minimum uncertainty that users can assign to their walkway surface friction measurements. Abbreviations: ANOVA: analysis of variance; ANSI: American National Standards Institute; CI: confidence interval; E: east; ILS: interlaboratory study; ISO: International Standards Organization; JCGM: joint committee for guides in metrology; N: north; S: south; SBR: styrene-butadiene rubber; SD: standard deviation; TR: test result; W: west.

Slip and Fall Incidents at Work: A Visual Analytics Analysis of the Research Domain

Slip and fall incidents at work remain an important class of injury and fatality causing mechanisms. An extensive body of safety research has accumulated on this topic. This article presents an analysis of this research domain. Two bibliometric visualization tools are applied: VOSviewer and HistCite. Samples of 618 slip and fall related articles are obtained from the Web of Science database. Networks of institutions, authors, terms, and chronological citation relationships are established. Collaboration and research activities of the slip and fall research community show that most contributors are from the United States, with the (now closed) Liberty Mutual Research Institute for Safety the most influential research organization. The results of a term clustering analysis show that the slip and fall research can be grouped into three sub-domains: epidemiology, gait/biomechanics, and tribology. Of these, early research focused mainly on tribology, whereas research on gait/biomechanics and epidemiological studies are relatively more recent. Psychological aspects of slip and fall incident occurrence represent a relatively under-investigated research topic, in which future contributions may provide new insights and safety improvements. Better linking of this research domain with other principles and methods in safety science, such as safety management and resilience, may also present valuable future development paths.

Development of a high slip-resistant footwear outsole using a hybrid rubber surface pattern

The present study examined whether a new footwear outsole with tread blocks and a hybrid rubber surface pattern, composed of rough and smooth surfaces, could increase slip resistance and reduce the risk of fall while walking on a wet floor surface. A drag test was performed to measure static and dynamic coefficient of friction (SCOF and DCOF, respectively) values for the footwear with the hybrid rubber surface pattern outsole and two types of commercially available boots that are conventionally used in food factories and restaurant kitchens with respect to a stainless steel floor covered with glycerol solution. Gait trials were conducted with 14 participants who wore the footwear on the wet stainless steel floor. The drag test results indicated that the hybrid rubber surface pattern sole exhibited higher SCOF (≥0.44) and DCOF (≥0.39) values than the soles of the comparative footwear (p<0.001). Because of such high SCOF and DCOF values, the slip frequency (p<0.01), slip distance (p<0.001), and slip velocity (p<0.001) for the footwear with the hybrid rubber surface pattern outsole were significantly lower than those for the comparative footwear, which resulted in no falls during trials.