European Journal of Ageing

, Volume 14, Issue 3, pp 243–255 | Cite as

Can peer education improve beliefs, knowledge, motivation and intention to engage in falls prevention amongst community-dwelling older adults?

  • Linda A. M. Khong
  • Richard G. Berlach
  • Keith D. Hill
  • Anne-Marie Hill
Original Investigation


The aim of the study was to evaluate the effectiveness of delivering a contemporary peer-led falls prevention education presentation on community-dwelling older adults’ beliefs, knowledge, motivation and intention to engage in falls prevention strategies. A two-group quasi-experimental pre-test–post-test study using a convenience sample was conducted. A new falls prevention training package for peer educators was developed, drawing on contemporary adult learning and behaviour change principles. A 1-h presentation was delivered to community-dwelling older adults by peer educators trained with the new package (intervention group). Control group participants received an existing, 1-h falls prevention presentation by trained peer educators who had not received the adult learning and behaviour change training. Participants in both groups completed a purpose-developed questionnaire at pre-presentation, immediately post-presentation and at one-month follow-up. Participants’ levels of beliefs, knowledge, motivation and intention were compared across these three points of time. Generalised estimating equations models examined associations in the quantitative data, while deductive content analysis was used for qualitative data. Participants (control n = 99; intervention n = 133) in both groups showed significantly increased levels of beliefs and knowledge about falls prevention, and intention to engage in falls prevention strategies over time compared to baseline. The intervention group was significantly more likely to report a clear action plan to undertake falls prevention strategies compared to the control group. Peer-led falls prevention education is an effective approach for raising older adults’ beliefs, knowledge and intention to engage in falls prevention strategies.


Accidental falls Peer group Health education Health promotion 



The authors are grateful and thank the older adults who willingly gave their time to participate in the pre-tests, pilot trial, control group and intervention group trials. We would also like to thank Council on the Ageing Australia’s Mall Walkers at Karrinyup and Belmont, and particularly B. Joss and N. Gillman (Hollywood Functional Rehabilitation Clinic) for their help with the trials. We would especially like to thank Injury Control Council of Western Australia’s Falls Prevention Program’s staff especially Alexandra White and Juliana Summers and their volunteer peer educators for facilitating the conduct of this study. Finally, we are grateful to P. Chivers and M. Bulsara for their statistical expertise, advice and support.


This work was supported by the Australian Government’s Collaborative Research Networks (CRN) programme. The peer education programme is run as part of the Stay On Your Feet WA® programme. This falls prevention health promotion programme is coordinated by the Injury Control Council of Western Australia and supported by the Government of Western Australia.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Abraham C, Michie S (2008) A taxonomy of behavior change techniques used in interventions. Health Psychol 27(3):379–387. doi: 10.1037/0278-6133.27.3.379 CrossRefGoogle Scholar
  2. AIHW: Bradley C (2012). Hospitalisations due to falls by older people, Australia 2007–08. AIHW, Canberra. Vol. Injury research and statistics series no. 61. Cat. no. INJCAT 137. Retrieved from
  3. Allen T (2004) Preventing falls in older people: evaluating a peer education approach. Br J Community Nurs 9(5):195–200CrossRefGoogle Scholar
  4. Anderson LW, Krathwohl DR, Bloom BS (2001) A taxonomy for learning, teaching, and assessing: a revision of Bloom’s taxonomy of educational objectives. Longman, New YorkGoogle Scholar
  5. Australian Bureau of Statistics (2013) Socio-economic indexes for areas-postal areas (ABS catalogue 2033.0.55.001). ACT, Belconnen. Retrieved from
  6. Australian Commission on Safety and Quality in Healthcare (2009) Guidebook for preventing falls and harm from falls in older people: Australian community care. ACSQHC, NSWGoogle Scholar
  7. Bellg AJ, Borrelli B, Resnick B, Hecht J, Minicucci DS, Ory M, Ogedegbe G, Orwig D, Ernst D, Czajkowski S, Workgroup Treatment Fidelity (2004) Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH behavior change consortium. Health Psychol 23(5):443–451. doi: 10.1037/0278-6133.23.5.443 CrossRefGoogle Scholar
  8. Cane J, O’Connor D, Michie S (2012) Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci 7(1):1–17. doi: 10.1186/1748-5908-7-37 CrossRefGoogle Scholar
  9. Cohen S (2004) Social relationships and health. Am Psychol 59(8):676–684CrossRefGoogle Scholar
  10. Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E (2010) Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology 21(5):658–668. doi: 10.1097/EDE.0b013e3181e89905 CrossRefGoogle Scholar
  11. Deery H, Day L, Fildes B (2000) An impact evaluation of a falls prevention program among older people. Accid Anal Prev 32(3):427–433. doi: 10.1016/S0001-4575(99)00043-3 CrossRefGoogle Scholar
  12. Dickinson A, Machen I, Horton K, Jain D, Maddex T, Cove J (2011) Fall prevention in the community: what older people say they need. Br J Community Nurs 16(4):174–180. doi: 10.12968/bjcn.2011.16.4.174 CrossRefGoogle Scholar
  13. Elo S, Kyngas H (2008) The qualitative content analysis process. J Adv Nurs 62(1):107–115. doi: 10.1111/j.1365-2648.2007.04569.x CrossRefGoogle Scholar
  14. Fleming ND (2008) The VARK questionnaire (Version 7.8). Retrieved from
  15. Foster G, Taylor SJ, Eldridge SE, Ramsay J, Griffiths CJ (2007) Self-management education programmes by lay leaders for people with chronic conditions. Cochrane Database Syst Rev 4(4):CD005108. doi: 10.1002/14651858.CD005108.pub2 Google Scholar
  16. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 9(11):CD007146. doi: 10.1002/14651858.CD007146.pub3 Google Scholar
  17. Haines TP, Hill A-M, Hill KD, McPhail S, Oliver D, Brauer S, Hoffman T, Beer C (2011) Patient education to prevent falls among older hospital inpatients: a randomized controlled trial. Arch Intern Med 171(6):516–524. doi: 10.1001/archinternmed.2010.444 CrossRefGoogle Scholar
  18. Haines TP, Day L, Hill KD, Clemson L, Finch C (2014) “Better for others than for me”: a belief that should shape our efforts to promote participation in falls prevention strategies. Arch Gerontol Geriatr 59(1):136–144. doi: 10.1016/j.archger.2014.03.003 CrossRefGoogle Scholar
  19. Hill A-M, McPhail S, Hoffmann T, Hill K, Oliver D, Beer C, Brauer S, Haines TP (2009) A randomized trial comparing digital video disc with written delivery of falls prevention education for older patients in hospital. J Am Geriatr Soc 57(8):1458–1463. doi: 10.1111/j.1532-5415.2009.02346.x CrossRefGoogle Scholar
  20. Hill A-M, Hoffmann T, Beer C, McPhail S, Hill KD, Oliver D, Brauer S, Haines TP (2011) Falls after discharge from hospital: is there a gap between older peoples’ knowledge about falls prevention strategies and the research evidence? Gerontologist 51(5):653–662. doi: 10.1093/geront/gnr052 CrossRefGoogle Scholar
  21. Hill A-M, Etherton-Beer C, Haines TP (2013) Tailored education for older patients to facilitate engagement in falls prevention strategies after hospital discharge—a pilot randomized controlled trial. PLoS ONE 8(5):e63450. doi: 10.1371/journal.pone.0063450 CrossRefGoogle Scholar
  22. Hill A-M, McPhail SM, Waldron N, Etherton-Beer C, Ingram K, Flicker L, Bulsara M, Haines TP (2015) Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet 385(9987):2592–2599. doi: 10.1016/S0140-6736(14)61945-0 CrossRefGoogle Scholar
  23. Hughes K, van Beurden E, Eakin E, Barnett L, Patterson E, Backhouse J, Jones S, Hauser D, Beard J, Newman B (2008) Older persons’ perception of risk of falling: implications for fall-prevention campaigns. Am J Public Health 98(2):351–357. doi: 10.2105/ajph2007.115055 CrossRefGoogle Scholar
  24. Huijg JM, Gebhardt WA, Crone MR, Dusseldorp E, Presseau J (2014) Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research. Implement Sci 9(1):1–16. doi: 10.1186/1748-5908-9-11 CrossRefGoogle Scholar
  25. Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG) (2006) Designing theoretically-informed implementation interventions. Implement Sci 1:4. doi: 10.1186/1748-5908-1-4 CrossRefGoogle Scholar
  26. Kempton A, Van Beurden E, Sladden T, Garner E, Beard J (2000) Older people can stay on their feet: final results of a community-based falls prevention programme. Health Promot Int 15(1):27–33. doi: 10.1093/heapro/15.1.27 CrossRefGoogle Scholar
  27. Khong L, Farringdon F, Hill KD, Hill A-M (2015) “We are all one together”: peer educators’ views about falls prevention education for community-dwelling older adults—a qualitative study. BMC Geriatr 15(28):1–10. doi: 10.1186/s12877-015-0030-3 Google Scholar
  28. Khong L, Bulsara C, Hill KD, Hill A-M (2016) How older adults would like falls prevention information delivered: fresh insights from a World Café forum. Ageing Soc. doi: 10.1017/s0144686x16000192 Google Scholar
  29. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174. doi: 10.2307/2529310 CrossRefGoogle Scholar
  30. Lee DC, Day L, Hill K, Clemson L, McDermott F, Haines TP (2013) What factors influence older adults to discuss falls with their health-care providers? Health Expect 18(5):1593–1609. doi: 10.1111/hex.12149 CrossRefGoogle Scholar
  31. Lee DC, Brown T, Stolwyk R, O’Connor DW, Haines TP (2016) Are older adults receiving evidence-based advice to prevent falls post-discharge from hospital? Health Educ J 75(4):448–463. doi: 10.1177/0017896915599562 CrossRefGoogle Scholar
  32. Liang K-Y, Zeger SL (1986) Longitudinal data analysis using generalized linear models. Biometrika 73(1):13–22. doi: 10.2307/2336267 CrossRefGoogle Scholar
  33. Merriam SB, Bierema LL (2014) Adult learning: linking theory and practice. Jossey-Bass Inc (Wiley), San Francisco, CAGoogle Scholar
  34. Michie S, Johnston M (2012) Theories and techniques of behaviour change: developing a cumulative science of behaviour change. Health Psychol Rev 6(1):1–6. doi: 10.1080/17437199.2012.654964 CrossRefGoogle Scholar
  35. Michie S, van Stralen MM, West R (2011) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 6(1):42. doi: 10.1186/1748-5908-6-42 CrossRefGoogle Scholar
  36. Nyman SR, Victor CR (2012) Older people’s participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane Systematic Review. Age Ageing 41(1):16–23. doi: 10.1093/ageing/afr103 CrossRefGoogle Scholar
  37. Peel NM (2011) Epidemiology of falls in older age. Can J Aging 30(1):7–19. doi: 10.1017/S071498081000070X CrossRefGoogle Scholar
  38. Peel NM, Warburton J (2009) Using senior volunteers as peer educators: what is the evidence of effectiveness in falls prevention? Aust J Ageing 28(1):7–11. doi: 10.1111/j.1741-6612.2008.00320.x CrossRefGoogle Scholar
  39. Portney LG, Watkins MP (2009) Foundations of clinical research: applications to practice, 3rd edn. Pearson/Prentice Hall, Upper Saddle RiverGoogle Scholar
  40. QSR International Pty Ltd (2012) NVivo 10 qualitative data analysis softwareGoogle Scholar
  41. Simoni JM, Franks JC, Lehavot K, Yard SS (2011) Peer interventions to promote health: conceptual considerations. Am J Orthopsychiatry 81(3):351–359. doi: 10.1111/j.1939-0025.2011.01103.x CrossRefGoogle Scholar
  42. Stevens JA, Ballesteros MF, Mack KA, Rudd RA, DeCaro E, Adler G (2012) Gender differences in seeking care for falls in the aged medicare population. Am J Prev Med 43(1):59–62. doi: 10.1016/j.amepre.2012.03.008 CrossRefGoogle Scholar
  43. Walter SD, Eliasziw M, Donner A (1998) Sample size and optimal designs for reliability studies. Stat Med 17(1):101–110. doi: 10.1002/(SICI)1097-0258(19980115) CrossRefGoogle Scholar
  44. Williamson DS, Bangdiwala SI, Marshall SW, Waller AE (1996) Repeated measures analysis of binary outcomes: applications to injury research. Accid Anal Prev 28(5):571–579CrossRefGoogle Scholar
  45. Yardley L, Bishop F, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C, Cuttelod T, Horne M, Lanta K, Holt AR (2006) Older people’s views of falls-prevention. Interventions in six European countries. Gerontologist 46(5):650–660. doi: 10.1093/geront/46.5.650 CrossRefGoogle Scholar
  46. Yardley L, Donovan-Hall M, Francis K, Todd C (2007) Attitudes and beliefs that predict older people’s intention to undertake strength and balance training. J Gerontol Ser B Psychol Sci Soc Sci 62(2):P119–P125CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.School of Physiotherapy, Institute for Health ResearchThe University of Notre Dame AustraliaFremantleAustralia
  2. 2.School of EducationThe University of Notre Dame AustraliaFremantleAustralia
  3. 3.School of Physiotherapy and Exercise ScienceCurtin UniversityPerthAustralia

Personalised recommendations