http://hdl.handle.net/20.500.12904/10281 2026-03-10T15:16:26Z http://hdl.handle.net/20.500.12904/20048 A Qualitative evaluation exploring co-production of falls management in care homes Hallam-Bowles, Fran; Kilby, Alice; Gordon, Adam; Timmons, Stephen; Logan, Pip; Rees, Lindsay; Lawry, Will; CHAFFINCH stakeholder group; Robinson, Katie ABSTRACT Background Co-production approaches are increasingly used in research but are rarely evaluated in care home settings. This study explored factors influencing key principles of co-production in a series of workshops around falls management in care homes. Methods Stakeholders (care home residents and relatives, care home staff, and health and social care staff) participating in co-production workshops as part of a research study were invited to take part in this qualitative evaluation. The workshops were developing a model to implement falls training in care homes as part of a systemic action research study. Non-participant observations of workshops explored stakeholder interactions. Stakeholders participated in reflection meetings about their experiences of co-production. Framework analysis mapped key themes to the National Institute for Health and Care Research's (NIHR) principles of co-production. Results Nine themes were identified. Sharing power was affected by two themes: opportunities to challenge dominant voices, resulting from the influence of the research team and separate stakeholder groups, and integrating a disjointed system. Including all perspectives and skills was influenced by two themes: involvement of key stakeholders and a flexible approach. Respecting and valuing knowledge was impacted by two themes: respecting and utilising expertise and experience, and confidence. Two themes relating to reciprocity were identified: benefits and potential harms. One theme related to building and maintaining relationships: team dynamics. Conclusions Co-production in this context is complex and affected by multiple factors. Separate stakeholder groups, a flexible approach and recognising different experiences and expertise facilitated co-production in line with its key principles. Potential reputational risks, confidence levels and limited involvement of residents, relatives and care home staff in a variety of roles were identified as barriers. Future studies in care homes should consider organisational power dynamics and create safe spaces, providing opportunities for inclusive participation. Patient and Public Contribution A collaborator group, including a patient and public involvement and engagement (PPIE) advisor and health and social care professionals, contributed to the research methods, presentation of findings and authorship. Care home residents informed the design of the co-production workshops. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). Health Expectations published by John Wiley & Sons Ltd. 2025-01-01T00:00:00Z http://hdl.handle.net/20.500.12904/19772 Exploring the organisation and delivery of falls management in care homes for older people in England Robinson, Katie; Logan, P L; Gordon, A L; Timmons, S; Masud, T; Rees, L; Kilby, Alice; Lawry, W; Hallam-Bowles, F BACKGROUND: To explore the organisational context of English care homes in delivering falls management and identify barriers and facilitators to help design future service delivery. METHODS: Non-participant observations and semi-structured interviews in one region of England with care home staff, commissioners and individuals involved in the organisation of falls management, care home managers, care home owners and residents. Barriers and facilitators were identified by thematic analysis and mapped against the Consolidated Framework for Implementation Research (CFIR). RESULTS: 17 interviews were undertaken including staff and a resident from three care homes. Delivering falls management in care homes was complex and challenged by difficulties in integration across a disjointed system, workforce challenges and managing complexity of resident needs with multiple competing priorities. Facilitators included consistent and regular multi-disciplinary support, valuing team working within the care home, and between the care home and external agencies, and the ability to retain care home staff who developed and honed skills over time and who valued their advocacy role for residents. Variation in care home environments, and access to healthcare support were highlighted. CONCLUSIONS: The delivery of falls management in care homes is complex and involves a number of interacting systems. Implementation strategies to support future delivery need to consider the pressure on care homes and wider systems, workforce challenges and variation between settings. 2025-01-01T00:00:00Z http://hdl.handle.net/20.500.12904/19594 Are accelerometers a useful way to measure activity in care home residents? Robertson, Kate Introduction: Accurate measurement of activity in care home residents is important for monitoring and evaluating interventions for activity promotion. Accelerometers provide a potential method. However, their usefulness in this population has not been well documented. We aimed to explore the feasibility of these in care home residents. Method: Mobile residents who had fallen in the past year, were asked to wear a tri-axial accelerometer (ActivPAL3TM) on the lower thigh for 7 days. Care staff were trained in device application. Users' skin and problems with use were checked daily. Activity data sought were: step count, time sedentary, time standing and Metabolic Equivalent of Task. Care records were checked for falls. Results: 10/16 residents agreed to wear accelerometers. 7 wore them for 7 days and the remainder for 4, 5 and 6 days respectively. No falls were recorded. Data indicated 1 resident continuously standing which was disconfirmed through observation. Problems were: data disturbance through removal/fidgeting, hydrofilm dressing flaccidity, premature detachment, care staff non-compliance to waterproof continuous wear, resident skin check non-compliance, prior leg ache attributed to accelerometers (with no worsening), pink skin and activity restriction by care staff. The accelerometers and attachment materials total cost was £2062.59. 2014-01-01T00:00:00Z http://hdl.handle.net/20.500.12904/17062 A realist evaluation of a multifactorial falls prevention programme in care homes Robertson, Kate BACKGROUND: falls in care homes are common, costly and hard to prevent.Multifactorial falls programmes demonstrate clinical and cost-effectiveness, but the heterogeneity of the care home sector is a barrier to their implementation. A fuller appreciation of the relationship between care home context and falls programme delivery will guide development and support implementation. METHODS: this is a multi-method process evaluation informed by a realist approach.Data include fidelity observations, stakeholder interviews, focus groups, documentary review and falls-rate data. Thematic analysis of qualitative data and descriptive statistics are synthesised to generate care home case studies. RESULTS: data were collected in six care homes where a falls programme was trialled. Forty-four interviews and 11 focus groups complemented observations and document review.The impact of the programme varied. Five factors were identified: (i) prior practice and (ii) training may inhibit new ways of working; (iii) some staff may be reluctant to take responsibility for falls; (iv) some may feel that residents living with dementia cannot be prevented from falling; and, (v) changes to management may disturb local innovation.In some care homes, training and improved awareness generated a reduction in falls without formal assessments being carried out. CONCLUSIONS: different aspects of the falls programme sparked different mechanisms in different settings, with differing impact upon falls.The evaluation has shown that elements of a multifactorial falls programme can work independently of each other and that it is the local context (and local challenges faced), which should shape how a falls programme is implemented. © The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com. This is an Open Access ar ticle distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com 2022-01-01T00:00:00Z