Occupational therapist led environmental assessment and modification to prevent falls: Review of current practice in an Australian rural health service.

Introduction: Environmental assessment and modification is an effective approach to reducing falls, particularly when provided by occupational therapists to high risk populations. Environmental assessment and modification has been incorporated into many national and international falls prevention guidelines, however, evidence suggests that it is not being implemented in practice. The aim of this study is to identify factors that support the local adoption of best practice environmental assessment for falls prevention within a rural health service.

Methods: A concurrent mixed methods study using the Integrated Promoting Action on Research Implementation in Health Services framework was employed. The setting was a health service in Queensland, encompassing rural and regional populations. An audit, based on best practice, was conducted on eligible medical charts. An online survey of occupational therapists' knowledge, attitudes, confidence and experience of environmental assessment and modification was completed. Focus group discussions were also carried out. Quantitative data were presented using descriptive statistics and discussions were thematically analysed.

Results: Twenty-four occupational therapists were identified as meeting the inclusion criteria. Fourteen participated in the survey and 12 of those surveyed also participated in the focus groups. Fifty-eight patients' medical charts were audited, which included entries from occupational therapists who completed the survey and focus groups and some who did not. Survey results identified that most occupational therapists were aware of, confident, and experienced in environmental assessment and modification for falls prevention. Chart audits, however, revealed that none of the patients received this intervention. Thematic analysis of focus group discussions identified three key themes which influenced uptake of environmental assessment and modification: confidence in, and awareness of evidence; key stakeholders' support and knowledge of occupational therapy; and, perceived impact of time and resources required for implementation. Results also suggested that several contextual issues unique to rural and regional service delivery influenced uptake, including: geographical and sociocultural diversities of communities being served; differing organisational structures which result in occupational therapists being line managed by other professions; and, limited access to professional development. Availability of local peer support, and engagement of multiple stakeholders from various professions were highlighted as key facilitators to support change.

Conclusion: Occupational therapists reported that they carried out best practice environmental assessment and modification for falls prevention but the medical chart audit provided no evidence of this happening in practice. This discrepancy requires further investigation. This study provided an understanding of factors that influence whether occupational therapists implement best practice environmental assessment and modification in a rural health service. Findings could be used to guide the translation of evidence into practice across similar settings.