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

What happened as a result of our work (Outcome evaluation)

C. What happened as a result of our work (Outcome evaluation)

Outcome evaluation observes whether your project/program has met its goals of reducing falls, fall related injury, deaths (mortality) and disabilities (morbidity) and increasing healthy active ageing.

It also determines whether any aspects of the project/program are sustainable [22, 23, 24].

Outcome evaluation is measured at the completion of the project and can be followed up every one, two, five or 10 years [4]. For ongoing programs, it can be measured on a regular basis.

Research suggests that it is unwise to have reduced injury rates as a sole outcome measure as this requires very large sample sizes and the assistance of skilled epidemiologists [17].

If there are less than two years of falls prevention activity, a statistically significant reduction in falls is unlikely. Impact evaluation is an important step, allowing other changes such as knowledge, attitudes and behaviour to be detected earlier [29].

You can also look at the outcome of your project/program more broadly, by considering multiple measures [90 ] such as:

• health outcomes
• quality of life outcomes
• economic outcomes
• community and social outcomes
• sustainability outcomes.

Health outcomes
Health outcomes may include the following information, some of which may be available from hospital data and emergency department presentations:

• reduction in self-reported falls using a diary (a diary is needed for recall purposes)
• reduction in hospital emergency department presentations for falls
• reduction in fall related hospital admissions
• reduction in fall related injuries
• reduction in hip fractures.

For more information on the costs of falls, visit: Falls statistics

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Quality of life outcomes

Quality of life is another health outcome measure as it considers the participant's perception of their health and wellbeing. Measuring outcomes in quality of life is relevant, as falls, fractures and fear of falling all have a significant impact on an individual's physical, social and psychological functioning [27].

When selecting quality of life tools you will need to consider what has been recommended for falls prevention but also which tool is more commonly used in Australia so that you can have comparable data.

The Australian World Health Organisation (WHO) Quality of Life (QoL) Field Centre at the University of Melbourne, Department of Psychiatry is one of a number of organisations worldwide allowed to license the use of the WHOQoL Instruments. There are two Assessment of Quality of Life (AQoL) instruments - the AQoL and the AQoL-2.

They both measure the value of restrictions imposed on different aspects of life by ill health. These can be accessed preferably from the WHOQoL website by completing a registration form or telephone the University of Melbourne on 03 8344 4000.

Australian World Health Organisation Quality of Life Field Centre (WHOQoL) website

One of the eight recommendations from Falls Network Europe (ProFaNE) and the Outcomes Consensus Group in 2005  was to use the Health Related Quality of Life Short Form 12 (SF12) version 2 as the preferred instrument. This tool is available for use by registering with Quality Metric Health Outcome Solutions on their website: Health Related Quality of Life Short Form (SF12)

Economic outcomes

Falls contribute to a large amount of costs, including:

• direct health care costs such as hospital costs, doctor’s visits, nursing care, rehabilitation, outpatient clinics and diagnostic tests [71]
• indirect costs such as the loss to society of the paid and unpaid productive efforts of both the person who fell and their carer [72]
• lifetime costs (the combination of the direct costs plus the indirect costs) [72].

For more information on the costs of falls, visit: Falls statistics

An economic evaluation of your work will help to identify the actual costs of conducting the project/program compared with the benefits provided. This information is vital to deciding whether to continue support for this project/program and to assist other organisations choose which intervention to undertake with limited resources [87].

At a minimum, the project/program can report on the actual costs of the intervention. This would include the following costs:

• labour eg. project/program staff, administration support, consultant fees, external labour provided by other organisations [87]
• consumables eg. project/program resources, brochures, checklists, booklets, equipment, venue hire, travel costs and catering [87]
• capital eg. buildings and infrastructure such as walking paths and hand rails
• overheads eg. superannuation payments, insurance costs, telephone and photocopying
• in-kind support - it is a good idea to also calculate the value of in-kind support such as free office space or venues for conducting exercise classes or volunteers, as other projects/programs may not have access to this which will increase their costs.

Estimating the economic cost/benefits of falls prevention projects/programs has some limitations as the costs of falls are only estimates, and this cost changes due to inflation and other health care cost variations [71]. Conducting a comprehensive economic analysis may require epidemiological assistance due to its complexity.

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Community and social outcomes
Evaluating community and social outcomes is important as it helps to determine if the project/program and the desired health behaviour and outcomes will be maintained. For example, if the social attitude is that it is too late for people over 60 years to get any benefit from exercise then people over 60 years will not be supported by society, family, friends and carers to undertake physical activity.

Measuring community and social outcomes may include:

• changes in other people’s attitudes to falls and healthy active ageing
• changes in relevant services eg. more physical activity programs
• more relevant products available eg. shops stocking safer footwear
• support systems eg. council bus providing transport to physical activity programs
• changes  to the environment eg. footpaths being repaired or built, increased public seating, handrails and non-slip edges on all stairs and ramps
• reduced social isolation and improved community connectedness through regular community events and activities
• improved quality of life.

Sustainability outcomes
Evaluating sustainability includes determining if the changes made by your project/program will be maintained [22, 89, 90]. To determine sustainability of your project/program ask the following questions.

• Who has heard of the project/program? eg. five years after the Stay on Your Feet project in Northern NSW, 80% of the 117 general practitioners surveyed had heard of the project [96].
• Has the project/program influenced practice? eg. five years after the Stay on Your Feet project in Northern NSW, 74% of the 117 general practitioners surveyed (who had heard of the project) thought that it had influenced their practice [96].
• What practices have changed as a result of the project/program? eg. five years after the Stay on Your Feet project in Northern NSW, 75% of the 117 general practitioners surveyed (who had heard of the project) said the most common activity undertaken was "checking the potential for medications to contribute to falls risk in older patients" [96:pp 284].
• What skills remain in the community? [22] eg. fitness leaders were trained by the Queensland Stay on Your Feet Wide Bay/Burnett trial project to continue running Nordic Pole walking, Life Ball and Tai Chi for Arthritis following the project’s completion.
• What structures are in place? [22 ] eg. the Queensland Stay on Your Feet Wide Bay/Burnett trial project influenced the inclusion of falls prevention strategies into five local government plans for the first time.
• What networks are in place? [22] eg. the development and ongoing operation of the Wide Bay Physical Activity Taskforce and the North Burnett Sport and Recreation Council.
• What products are in place? [22] eg. the Queensland Stay on Your Feet Wide Bay/Burnett trial project influenced retail shops to stock shoes with a safer design.
• What services are in place? eg. the Queensland Stay On Your Feet Wide Bay/Burnett trial project influenced the provision of more physical activity programs for older people such as Life Ball, Tai Chi for Arthritis and Nordic Pole walking.
• What polices are in place? [22] eg. development and implementation of sport and recreational plans and trained health service providers incorporating falls prevention training into their practice.
• What external investment in the project/program has occurred by other organisations? [105] eg. as a result of the Queensland Stay of Your Feet Wide Bay/Burnett trial project, the Department of Local Government Planning Sport and Recreation included physical activity options for older people into their existing regional sports tour.
• Do participants and stakeholders feel that they now own the project/program?
  [105] eg. participants and stakeholders take a lead role in progressing the project/program without a reliance on a project/program coordinator.
• What human, financial and/or infrastructure resources are being used by other organisations? [105] eg. there are ongoing community service announcements with local media regarding falls prevention and healthy active ageing.

The evaluation planning worksheet and the list of evaluation tools will be useful for keeping track of all the evaluation questions. This may need to be modified to meet your project/program evaluation goals.

evaluation planning worksheet
evaluation tools

For suggested methods of collecting outcome information, visit: Outcome evaluation tools

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