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Queensland Stay On Your Feet® - Toolkit Phase 2 Decision making

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Decision making

Decisions need to be based on evidence about what is effective, and what will do more good than harm. This is known as evidence based decision making or making decisions based on the best available knowledge [210]. Using evidence to make decisions requires you to:

  • obtain evidence that a problem exists
  • access reliable information to identify effective interventions, practices and programs
  • explore what is preventing change, including considering barriers and enablers
  • evaluate the length of time taken for stakeholders and the target group to adopt effective interventions [210].

Making a decision

Decisions need to be made at the individual, organisational and community level. There are two broad decisions that will need to be made when working on falls prevention and healthy active ageing. These are:

  • which risk factor/s to focus on
  • which intervention/s to implement.

The decision making process

Making decisions is not always easy, as a range of factors need to be taken into consideration when deciding a course of action. The following BRACE model (Benefits, Risks, Acceptability, Cost and Evidence) may assist with the decision making process [213].

 B  Benefits  Probability a protective/promotive factor will result in a positive health event or outcome for individuals, an organisation and/or the community. For example, distributing the positive results of other healthy active ageing programs throughout older people's information networks.
 R  Risk  Probability a hazard will result in an adverse health event or outcome (including physical, psychological, social, emotional or economic harm). Undertaking a risk/benefit analysis or a safety audit of shopping centres are examples.
 A  Acceptability  Whether the people who are affected by the intervention accept it. Involving people who are affected in choosing the right intervention is recommended. For example, will older people attend a physical activity group when they don't consider themselves 'that old'?
 C  Cost  Almost all interventions incur a cost. Undertaking a cost/benefit analysis is recommended (net cost of intervention vs health benefits). For example, one study found their exercise program needed 14 people to participate to prevent one fall.
 E  Evidence  Identifying alternative evidence based actions, based on research and what exists in the community. Note that evidence can be based on either efficacy (scientific research and analysis) or effectiveness (success in real life situations). For individuals, this is could be a falls risk assessment.

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Using grid analysis for decision making

By placing the factors in the BRACE model into a grid, you can conduct an analysis to help you make a decision. This technique is called a 'grid analysis'.

A grid analysis requires a number of steps. A spreadsheet has been developed to help you conduct a falls prevention grid analysis using the instructions below.

  1. List the relative weight or importance (1 being least important, 5 being most important) under each of the identified falls risk factors, both personal and environmental. This weighting should be based on local data and trends.
  2. Insert your various proposed falls prevention strategies (one per row).
  3. Assign a 'local priority rating' against each strategy and under each risk factor (0 being low priority, 3 being high priority).
  4. Multiply the relative weight by the local priority rating.
  5. Add all scores for a particular falls prevention strategy to give you a total score.
  6. The strategies with the highest total scores should have the most support and the best chance of impacting on the most important risk factors.

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Falls prevention grid analysis example

In this example, polypharmacy, poor nutrition and diet have been identified from local data as the most important local falls risk factors. Four strategies have been proposed and assigned a local priority rating under each risk factor. The scores are then totalled and analysed. In this example, it appears that working with the local Meals on Wheels service is the best strategy to address falls prevention.

Falls prevention analysis

Falls risk factor

P: Polypharmacy 

P: Nutrition & diet

Totals

Relative weight

3

4

Proposed falls prevention strategies

LPR

Subtotal

LPR

Subtotal

Local pharmacy medications returns campaign

2

6

1

4

10

Local GP program to encourage medication reviews

3

9

1

4

13

Production of cookbook for older, single people

1

3

3

12

15

Local work with Meals on Wheels to improve nutritional content of meals

2

6

3

12

18

Derived from [21, 211]

For more information on grid analysis, see grid analysis decision making technique.

Additional decision making resources

To find out more about using a thorough academic process to review community interventions, see National Public Health Partnership: Evidence on Public Health Interventions.

To find out more about using a thorough process for decision making for organisations and the community, see National Public Health Partnership: Deciding and Specifying an Intervention Portfolio.

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Last updated: 7 August 2012