An Interprofessional Student-led Fall Prevention Intervention using Motivational Interviewing Strategies

Primary Contact and Title: Susan K. Patton, Assistant Clinical Professor & Jean Henry, Associate Professor
Primary Contact E-mail: skpatton@uark.edu & ljhenry@uark.edu
Primary Contact Phone Number: 479-769-4143

Project Summary (200 word maximum)
The purpose of this transdisciplinary project is to develop and implement an intervention, using motivational interviewing (MI) skills, to increase engagement and commitment of older adults in fall prevention behaviors. Motivational interviewing is a clinical approach that utilizes the principles of expressing empathy and avoiding arguing, developing discrepancy, rolling with resistance, and supporting self-efficacy to help people with chronic conditions make behavioral changes to support better health. Four faculty members, from nursing and public health/exercise science, and two graduate students will receive MI training and become ‘trainers’; annually, they will teach the skills to 200 undergraduate and graduate students. Working together in clinical and community settings in Northwest Arkansas, interdisciplinary student teams will conduct fall assessments and utilize MI skills to make recommendations for lifestyle and environmental modifications. Graduate students will work with faculty to design and implement evaluation protocol, to assess effectiveness and efficacy of the project. In order to ensure fidelity of the MI intervention, a recognized expert in MI will be an active consultant during the design and intervention of the project. The primary aims of the project are to increase interdisciplinary understanding, provide students with the professional skill of motivational interviewing, and reduce falls in older adults.

Is this: a new program

Please list media sites (if any) utilized by your project or program to publicize the project/program, i.e., website, social media, etc.
Photographs and stories about nursing and public health students working with older adults in the community will be featured in social media and local newspapers. The project will be promoted to older adults in the community through the Senior Activity Centers located throughout Northwest Arkansas. Faculty will also collaborate with the Age Friendly Fayetteville initiative to promote the fall prevention project. Additional outlets include UARK Newswire; COEHP newsletter; public radio; the Office for Studies on Aging website, Facebook page and Twitter page; and the Age Friendly Fayetteville Facebook page.

If your project is funded, describe innovative ways how the WGC will be recognized in the success/completion of your project:
In order to recognize WGC in the success of the program and increase awareness of fall prevention in the community, students will offer falls assessments and recommendations for prevention to WGC members. Pictures of students engaged in this service learning project funded by WGC will be featured on the WGC website, U of A website, Senior Center websites, and local community websites such as the Fayetteville, Arkansas website: http://www.fayetteville-ar.gov/. We also plan to evaluate the project and publish findings in peer-reviewed journals.

Grant Proposal

What is the specific scholarly or community needs your grant request addresses? (100 word maximum)
Annually, 1/3 of older adults fall; 20-30% of falls result in injuries that limit mobility, contribute to social isolation, result in institutionalization, and cause premature death. Nationally, the percentage of adults 65 and older who fall ranges from 14.5%-34%. Currently, Arkansas ranks 50th at 34%. UARK health professions students learn evidence-based protocols to identify older adults at risk of falling, and recommend prevention strategies such as home safety and regular exercise. However, there is evidence that uptake/engagement rates by older adults are less than 50%. Additionally, interprofessional approaches are increasingly essential in improving effectiveness of interventions.

How does your proposed project or program assess how these needs will be redressed?
(100 word maximum)
MI has been used effectively by healthcare professionals to advocate for a variety of positive health behavior changes. In our program, MI is used to explore ambivalence of older adults in relation to fall prevention. Through open-ended questions and reflective listening, students gain understanding of the importance of change to the older adult and the confidence the patient has in making the desired change. Seniors’ uptake and engagement rates in fall prevention behaviors will be assessed. Formal program evaluation – effectiveness and satisfaction in both students and seniors – will be designed and conducted by graduate students.

Describe any unique and/or innovative aspects of your project or program that improves what is already known about your area of inquiry. (100 word maximum)
Whereas it is recognized that fall prevention strategies should be grounded in evidence-based principles of behavior change, effectiveness of MI for fall prevention in community dwelling older adults has not been thoroughly examined. A service learning project delivered by students aimed at fall prevention of older adults using MI strategies is unique. The opportunity to learn and apply skills of MI will enhance general health promotion skills of students for application to other health behaviors. The interprofessional approach enables students to learn about and from one another, working across professional boundaries to plan and provide integrated services to seniors.

Please list up to five (5) expected outputs and outcomes with corresponding measurements (Please note: just listing outputs is not sufficient.)
1. Output: Students conduct motivational interviewing with community dwelling older adults / Outcome: Increased student efficacy and performance of MI skills / Measurement: MI Treatment Integrity Tool (MITI)
2. Output: Students work in interprofessional teams for training and direct-service activities / Outcome: Improved student understanding of and satisfaction with transdisciplinary approach to learning / Measurement: focus group debrief and survey developed and implemented by faculty at end of training and at degree completion (approximately 100 students each semester or 200 annually).
3. Output[J1]: Assessment teams (faculty and students) conduct MI about fall risk assessments with older adults / Outcome: Increased number of older adults in Northwest Arkansas will be assessed for fall risk / Measurement: Data on falls assessments will be completed and analyzed by faculty researchers.
4. Output: Interprofessional student teams educate older adults in personalized fall prevention strategies, based on results of assessment / Outcome: Increased uptake of fall prevention strategies by older adults / Measurement: surveying older adults at completion of assessment, and at 6 months and 12 months post-program.
5. Output: Interprofessional student teams educate older adults in personalized fall prevention strategies / Outcome: Reduced fall rates of older adults in Northwest Arkansas / Measurement: secondary data from the Arkansas Department of Health. This outcome is long term. Although data will be reviewed for program evaluation, it will not be available during the time frame of the WGC grant.

Document if there are other programs/projects that attempt to address the same needs as your proposal. If so, describe whether and how you will collaborate with them.(100-word maximum)
Sharon Tucker, PhD, RN, is a recognized expert in MI with published research using MI to improve self-management and patient outcomes in chronic obstructive pulmonary disease and childhood obesity in nurse led and student nurse led school based programs. Her current project at Ohio State utilizes MI to engage hospitalized patients in fall prevention. Plans are to collaborate by adopting her protocol and replicating it in NWA.
Currently, nursing students conduct falls assessments on older adults. Our project incorporates MI and public health students.
We will collaborate with the Office for Studies on Aging to promote and evaluate the project.

Demographic Considerations

First generation students engaged in the project: Yes
Number of current UA students engaged in the project: 200 per year
Geographic region served: Northwest Arkansas

Budgetary Considerations

Have you received WGC Funding before? No

Please provide the year(s) and project name(s)

Total proposed budget for project or program: (proposed budgets of more than $20K will not be considered; in typical years WGC proposals fall within in the $5-10K range)
$10,000

Please list total funding commitments from external or campus sources to date: 5,000

How much, if any, of your request involves funding for the following?
Student Compensation:
Equipment:

Total funds requested from WGC Grant: $5,000

If this project or program will continue after WGC grant money has been spent, please describe how you will continue to fund this project or program (100-word maximum)
Moving forward, having faculty and graduate students trained in MI will enable continued integration of MI into the nursing, public health, and exercise science curricula. Trained faculty and graduate students will continue to teach the MI strategies to students (approximately 200 each semester) after the WGC grant money has been spent. The community networks established through the grant program will ensure continuing fall prevention programming outlets for older adults. In the event that there is turnover of faculty, appropriate departmental funds can be identified to train additional faculty in MI techniques.