Queensland Stay On Your Feet® Toolkit

• Queensland Stay On Your Feet® Home
• Toolkit
  • Model diagram
  • Model's explanation
• Background
• Phase 1 - Investigate
  • What is the problem?
  • What are the impacts of the problem?
  • Why does the problem occur?
  • Where does the problem occur?
  • When does the problem occur?
  • What is the current context?
  • What is already happening?
• Phase 1 - Materials
  • Collecting information
  • Fear of falling
  • Risk factors
  • Key documents
  • Community stocktake
• Phase 2 - Plan
  • What can be done?
  • What do we know about the target group?
  • Who can be involved?
  • How do we keep the work going?
  • How will we measure progress?
• Phase 2 - Materials
  • Key stakeholders
  • Roles and responsibilities
  • Good working relationships
  • What works?
  • Decision making
  • Goals, objectives, strategies
  • Community planning meetings
  • Reach and marketing
  • Social marketing plan
  • Key messages
  • Community engagement
  • Partnerships
• Phase 3 - Implement
  • Are we testing before we act?
  • What can we achieve now and later?
  • Are there opportunities to explore?
  • How are we monitoring progress?
  • Are we talking with others about our work?
  • Are we measuring our efforts?
• Phase 3 - Materials
  • Communicating
  • Awareness raising
  • Communication plan
  • Community progress meetings
  • Ambassadors
  • Physical activity
  • Sports tours
  • Come and try days
  • Case studies
• Phase 4 - Review
  • Process evaluation
  • Impact evaulation
  • Outcome evaluation
  • Share and celebrate
  • What happens next?
• Phase 4 - Materials
  • Process evaluation tools
  • Impact evaluation tools
  • Outcome evaluation tools
• Acknowledgements

Goals, objectives and strategies

To solve the problem identified during Phase 1, you will need to identify your falls prevention project/program's goals, objectives and strategies.

Always try and keep a 'line of sight' between the goal, objectives and strategies, as they are all interconnected. The goals, objectives and strategies diagram shows how goals, objectives and strategies build toward success.

What is a goal?

A goal is the desired, measurable, long-term improvement, change or outcome of the project/program [17]. Goals should define a specific change within a specified timeframe.

Writing a SMART goal

A goal should be specific, measurable, achievable, realistic and timely, or 'SMART' [17].

S	Specific	Specify the problem (falls), the target group (people aged over 65 years) and the location or setting (for example: local government area).
M	Measurable	State the amount of change you are seeking within a given timeframe (for example: a 10 per cent decrease in falls by 2010).
A	Achievable	Ensure the goal is attainable and has been agreed by key stakeholders and the target group.
R	Realistic	Ensure the goal can be achieved using available resources.
T	Timely	Ensure the goal can be achieved within the allocated timeframe.

An example of a SMART goal is:

• "To reduce the number of falls presenting to the Gum Tree Hospital Emergency Department by 10 per cent in people aged 65-75 years who are living independently in the community of Gum Tree City Council by December 2015."

A goal 'to reduce falls in older people' is not SMART because certain elements are not defined. The questions below remain unanswered:

• What type of fall - falls that presented to the emergency department or falls that were admitted to hospital?
• What age group of people - 60 to 65 years, 65 to 75 years, or 75 years and over?
• What timeframe - within three years, five years or 10 years?
• What location - a suburb, local government area or health district?
• How much will falls be reduced - by 5 per cent, 10 per cent or 20 per cent? Is this realistic and achievable, based on what other programs have achieved?

Writing a goal using FLIP

Queensland Health's Tropical Population Health Network has developed a seven step process for program planning called FLIP. This process helps you write goals, objectives and strategies by 'flipping' over the problem and turning it into SMART goals, objectives and strategies. For more information:

• FLIP explanation
• FLIP worksheet.

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What is an objective?

An objective describes the desired effect the project/program will have on the target group's behaviour [17]. Objectives relate to the risk factors and causes of the problem and are the smaller steps that you need to undertake in order to achieve the overall goal. There are usually a number of objectives needed to achieve one goal.

Objectives are informed by what is already being done in the community, and evidence about which interventions work to reduce falls.

Objectives may focus on filling gaps, strengthening what is already being done and ensuring that the key elements of the model or framework you have chosen to work within are addressed. For example, if using the ecological model, objectives would cover individual, social and physical environmental issues.

The following are well-known and accepted injury and falls prevention models:

• Haddon's Matrix and Countermeasures
• E's of injury prevention
• Ecological model.

Objectives describe what changes are needed to happen in relation to the risk factors and what there will be in place at the end of the project/program. As falls are caused by multiple risk factors (also known as multi-factorial), a number of objectives are needed to reduce falls.

Writing objectives

Like goals, objectives also need to be SMART. When writing objectives, use the SMART model or alternatively, the FLIP process which works by defining the cause of the problem and then flipping it over to identify the right actions and objectives.

For example:

• In Gum Tree City Council, one third of falls presenting to the emergency department are people over 65 years of age who have tripped down stairs. There were multiple causes of these trips including poor vision and stairs without double handrails and non-slip contrast strips on stair edges. In addition, a community survey revealed that the community thought falls were a normal part of ageing.

Writing SMART behavioural objectives

Examples of behavioural objectives that do not include the SMART elements are:

• To increase the number of older adults who have their vision checked by an optometrist every year.
• To increase the number of optometrists who provide advice to their clients that vision is a risk factor for falls and suggest strategies to reduce the risk after treatment or a change in eye glasses.

Examples of SMART behavioural objectives are:

• By 2010, the number of older adults living in the Gum Tree City Council area who have their vision checked each year by an optometrist will have increased by 25 per cent from the baseline.
• By 2010, 80 per cent of optometrists working in the Gum Tree City Council area will provide advice to their clients that vision is a risk factor for falls and suggest strategies to reduce the risk after treatment or a change in eye glasses.

Writing SMART environmental objectives

An example of an environmental objective that does not include the SMART elements is:

• To increase the number of homes that have installed non-slip contrast stair edges and double hand rails.

An example of a SMART environmental objective is:

• By 2010, 30 per cent of older adults (240 people) living in Gum Tree City Council area will have installed non-slip contrast stair edges and double hand rails on the steps and stairs in their homes.

The achievement of objectives is measured by impact evaluation methods.

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What is a strategy?

A strategy is what is actually going to be provided or delivered during the project/program. The strategy states when, what and how objectives are going to be achieved [17].  Effective falls prevention requires a range of integrated strategies, which is also known as a multi-strategic approach.

The effectiveness of strategies is measured by process evaluation methods.

To develop strategies, determine:

• what will need to be done? For example: develop vision and falls education session for older adults
• how it will be done? For example: a 45 minutes session with an expert guest speaker with afternoon tea following the session
• who can help with the strategy? For example: key stakeholders such as the Optometrist Association, the College of Ophthalmologists, Lions Club, Probus, etcetera.
• when will it be done? For example: training session developed by March, pilot testing in April and sessions during May to November.

Always try to keep a "line of sight" between the strategies, the objectives and the goal.

Measuring your success

To measure whether you are reaching your goal, you first need to determine a baseline measure for your goal. This varies depending on your goal. For example, a goal of reducing falls presenting to emergency department will require the review of emergency department presentation data for falls before, during and after your project/program.

Use outcome evaluation methods to measure if the project/program goal was achieved.

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