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You are here: Home Modules Main Case Examples The Fall Prevention and the Elderly Program Developing an integrated conceptual framework
Developing an integrated conceptual framework Print E-mail

Ontario Public Health PractionersFor a more detailed illustration, see Module 2.

We have used several integrated conceptual frameworks to guide our selection of intervention options. Developing these frameworks has involved identifying relevant and complementary theoretical models arising from various levels of the socio-ecological system. The integrated conceptual framework for our initial research drew upon a number of theories including biological risk factors for falls, social learning theory and community organizing theory (Edwards, 2000b). In our current work, examining strategies to increase the accessibility and use of assistive devices, we have developed an integrated framework based on a more diverse set of theories that address health behaviour change, policy change, organizational theory, social marketing, community organization and innovation diffusion. An incremental approach is required to tackle the various elements of an integrated conceptual framework. The identification of priority intervention options for assistive devices has involved discussions with our public health colleagues, the regional fall prevention coalition and, more recently, other partners (Canadian Association of Occupational Therapists). We have used a population health perspective, and considered how to optimize the reach of our interventions. Given the magnitude of the problem (Aminzadeh et al., 2001), and the limited clinical resources for one-on-one interventions such as home visits, it became apparent that interventions would need to target the point of access for the purchase of assistive devices; social norms regarding assistive device use; and in the longer-term, policy initiatives at municipal, provincial and national levels. We are now examining the impact of a community action approach on increasing access to assistive devices by targeting retailers, hoteliers and builders in four Canadian municipalities (Boudreau et al., 2003).

Preventing falls and the elderly — Optimizing impact with synergies

Researching the power of synergies among different interventions was no part of the Community Health Research Unit’s plan for our falls-prevention project. Rather, our initial randomized controlled trial of two fall-prevention interventions (Edwards et al., 1995) tried to minimize contextual influences — that is, reduce the potential for co-interventions. We randomized 48 apartment buildings into three groups, a control group, the ‘falls clinic and risk reduction’ group and the ‘community action’ group. We deliberately didn’t set up a regional fall prevention coalition or do political advocacy during the intervention trial. We thought they might act as co-interventions, adversely influencing the results of the study. Now we see these co-interventions would likely have been synergistic — they would have added strength to the intervention.

We could have achieved several things if we’d included community advocacy initiatives in our work. Regional advocacy strategies led by a coalition would have provided experience for community organizers. Public health officials and partner organizations could have signalled their political support for local advocacy through the policy work of the coalition. Since policy change is usually incremental and long-term, it’s unlikely a community coalition could have produced a substantial co-intervention during the 24 months of our study. But it might have had time to created cross-level synergies in the community-action buildings. Allowing synergistic strategies gives planners and evaluators the chance to document how synergies happen and how community-wide processes can become part of intervention programs.

Last Updated on Monday, 01 June 2009 07:52