Evaluating a user-centered design driven multifactorial falls risk assessment tool in primary care: a randomized effectiveness-implementation study

Purpose  Multifactorial falls risk assessment tools (FRATs) help identify and target individual falls risk factors in older adults, but barriers can limit their effectiveness. This study evaluated a User-Centered Design (UCD) developed digital multifactorial FRAT, the Fall Analysis 2.0 in Dutch primary care.
Methods  A randomized effectiveness-implementation study included 19 health care professionals (HCPs) from 15 primary care practices, randomly assigned to either the intervention or usual care group (control). The intervention involved using the Fall Analysis 2.0 and corresponding training. Participants were community-dwelling (65 +) at high risk of falling (36 intervention vs 27 control; mean age 81 years; 63.5% female). Primary outcomes included HCPs falls risk management behavior and older adults’ adherence-related motivation to falls prevention advice, analyzed using Fisher’s Exact tests and Mann Whitney U tests. Secondary outcomes of the Fall Analysis 2.0 user experience was explored through HCP interviews.
Results  Fully completed multifactorial falls risk assessments (86.1%; n = 31) were significantly higher in the intervention than control group (3.7%, n = 1), p < .001. Use of validated tools was lower in the control group (11.1%; n = 3), p < .001. HCPs rated the Fall Analysis 2.0 highly for user experience. Successful implementation is dependent on improved reimbursement and interoperability with electronic health records. No significant differences in older adults’ adherence-related motivation were found due to a ceiling effect.
Conclusion  UCD developed digital multifactorial FRATs like the Fall Analysis 2.0 show promise for improving falls prevention care quality. Future research should disentangle the effects of UCD from digitalization.