A Process Evaluation of a Fall Prevention Intervention Using the RE-AIM Framework

Background: Home hazard removal programs are effective in reducing falls among older adults, but delivery in the United States is limited. Objectives: We completed a process evaluation of the Home Hazard Removal Program (HARP), an intervention delivered by occupational therapists. Methods: Using the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), we examined outcomes using descriptive statistics and frequency distribution. We examined differences between covariates using Pearson correlation coefficients and two-sample t tests. Results: 79.1% of eligible older adults participated (reach); they experienced a 38% reduction in fall rates (effectiveness). Ninety percent of recommended strategies were completed (adoption), 99% of intervention elements were delivered (implementation), and 91% of strategies were still used at 12 months (maintenance). Participants received an average of 258.6 minutes of occupational therapy. An average of US$765.83 was spent per participant to deliver the intervention. Conclusions: HARP has good reach, effectiveness, adherence, implementation, and maintenance and is a low-cost intervention. Plain Language Summary Home hazard removal programs can prevent falls for older adults but are not standard practice in the US. The Home Hazard Removal Program (HARP) is a fall prevention program for older adults delivered by an occupational therapist (OT) who works with the participant to identify hazards and find strategies to resolve them. We completed a randomized controlled trial to test HARP's effectiveness in reducing falls. This paper describes a process evaluation in which we looked at the additional outcomes of reach, adoption, implementation, maintenance, and cost. Almost 80% of eligible individuals participated (reach), and 90% of recommended strategies were carried out (adoption). Study OTs delivered 99% of the intervention elements (implementation), and 91% of strategies were still in use after 1 year (maintenance). HARP cost an average of $765.83 per participant. HARP is a low-cost fall prevention program that can be delivered among community-dwelling older adults in the US.