Samenvatting

Background: Successful implementation of multifactorial fall prevention
interventions (FPIs) is essential to reduce increasing fall rates in communitydwelling
older adults. However, implementation often fails due to the complex
context of the community involving multiple stakeholders within and across
settings, sectors, and organizations. As there is a need for a better
understanding of the occurring context-related challenges, the current scoping
review purposes to identify what contextual determinants (i.e., barriers and
facilitators) influence the implementation of FPIs in the community.
Methods: A scoping reviewwas performed using the Arksey andO’Malley framework.
First, electronic databases (Pubmed, CINAHL, SPORTDiscus, PsycINFO) were
searched. Studies that identified contextual determinants that influence the
implementation of FPIs in the community were included. Second, to both validate
the findings from the literature and identify complementary determinants, health
and social care professionals were consulted during consensus meetings (CMs) in
four districts in the region of Utrecht, the Netherlands. Data were analyzed following
a directed qualitative content analysis approach, according to the 39 constructs of
the Consolidated Framework for Implementation Research.
Results: Fourteen relevant studies were included and 35 health and social care
professionals (such as general practitioners, practice nurses, and physical therapists)
were consulted during four CMs. Directed qualitative content analysis of the
included studies yielded determinants within 35 unique constructs operating as
barriers and/or facilitators. The majority of the constructs (n = 21) were identified in
both the studies and CMs, such as “networks and communications”, “formally
appointed internal implementation leaders”, “available resources” and “patient needs
and resources”. The other constructs (n = 14) were identified only in the .
Discussion: Findings in this review show that awide array of contextual determinants
are essential in achieving successful implementation of FPIs in the community.
However, some determinants are considered important to address, regardless of
the context where the implementation occurs. Such as accounting for time
constraints and financial limitations, and considering the needs of older adults. Also,
broad cross-sector collaboration and coordination are required in multifactorial
FPIs. Additional context analysis is always an essential part of implementation efforts,
as contexts may differ greatly, requiring a locally tailored approach.