Acceptability of fall prevention strategies for older people with vision impairment

Figure 1

Figure 2

Themes identified using the components of the behaviour change wheel (BCW)_

BCW Component	Construct	Subset	Themes
Sources of behaviour	Capability	Psychological	‘Falls are just bad luck!’
		Physical	‘Exercise will hurt’
			Competing priorities Vision loss limits safety and mobility
	Motivation	Reflective	‘Already doing enough’
			Belief in own ability ‘Use it or lose it’
		Automatic	Closed to trying new things Depressive mood state
	Opportunity	Physical	‘I can’t get to the venue’ ‘I don’t want to be a burden on my loved ones’
		Social	Stigma of participating in falls prevention program Benefits of participating in groups
Intervention Functions	Environmental restructuring		Preference for home modifications Preference for home-based programs Reduced mobility due to uneven footpaths
	Education		No awareness of fall prevention programs
	Persuasion, Incentivization & Coercion		Doctor’s influence
	Enablement		Consistent and supportive interventions.

The script used in each focus group and semi-structured interview, including ice-breaker question, areas of discussion and associated prompts_

Ice-breaker question
‘To start with, I want you to introduce yourselves, one at a time using your first name only, and tell the group if you have experienced having a fall or fear having a fall, been injured having a fall or know of someone who has had a fall over the age of 60 years.’
Area of discussion	Prompts used
Vision loss increases the risk of falling	Is there an increased risk of falling because of vision loss? What are your current challenges and coping skills? What is the impact of injurious and non-injurious falls?
Awareness of preventative strategies to minimise harm from falling	What are the attitudes and opinions of current programs? Under what circumstances would you participate or not participate? Would you be willing to engage in group or individual exercise programs or would you prefer to have modifications made to reduce risk of falls in your environment?
Description of three different fall prevention strategies and environmental modifications	The Otago Exercise Programme E.g. What are your likes and dislikes of a home-based exercise program? Tai Chi group classes E.g. What are your thoughts on group programs, location, transportation and timing? Home modifications E.g. What have you tried already? What has worked and what hasn’t worked and what would you like to change in your home?
Adherence to exercise programs	What are your preferred physical activities and what do you do at the moment? What are the barriers to exercise? What are the psychological barriers to physical exercise? What are the psychological benefits to exercise? What are your opinions on well-designed appropriate programs aimed at older people who have a vision impairment to reduce the risk of falls?

Characteristics of the study population_

Age	76 ± 8 (range 63–;91)
Gender	16 female, 3 male
Vision condition	6 age-related macular degeneration (AMD), 5 cataract, 2 cataract and glaucoma, 1 cataract and AMD, 1 cataract, glaucoma and retinitis pigmentosa, 1 cataract and undisclosed, 1 glaucoma and AMD, 1 glaucoma, 1 undisclosed
Housing	17 house, 2 unit
Lives alone	11 (58%)
Mobility limited due to vision loss	5 (26%)
Mobility aids	4 support cane, 3 walking/rollator frame, 2 human guide, 1 long cane, 1 quad stick, 8 none