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Journal of Sport and Health Science 3 (2014) 32e33
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Commentary

Can an evidence-based fall prevention program be translated for use

in culturally diverse communities?
David A. Sleet*, Grant T. Baldwin
Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
Received 9 November 2013; revised 18 November 2013; accepted 19 November 2013

Older adult falls are a significant public health problem, but
one that is amenable to preventive interventions.1,2 Despite the
progress made in identifying risk factors, developing effica-
cious health-related interventions, and promoting evidence-
based programs in the community, much work remains
before these strategies are broadly available and effectively
used to reduce fall-related injuries.3 As Newton and Scott-
Findlay4 have pointed out, the translation of basic scientific
knowledge into clinical studies, and the transformation of
clinical studies into improvements in health services and
public health practices, remain major obstacles to widespread
adoption.
Donaldson and Finch5 have shown the feasibility of
applying implementation science to sports injury prevention,
and Li et al.6,7 demonstrated how an exercise and balance
program (Tai Ji Quan) can successfully be translated into a
community program and implemented in either community or
clinical settings. Equally important was the fact that Li and his
colleagues showed that program fidelity and adherence to their
intervention was maintained, at least over the short term, to
prevent older adult falls. Manson et al.8 showed positive re-
sults in taking a Tai Ji Quan program to low-income older
adults, concluding that “non-(Tai Ji Quan) culturally related
ethnic groups did not experience a barrier to participation in an
older low-socioeconomic population sample”. However, the
sample consisted of only 56 participants who were recruited
into a 16-week program, and no attempt was made to translate
the findings to the wider multi-ethnic community through the
use of existing stakeholders.
* Corresponding author.
E-mail address: dds6@cdc.gov (D.A. Sleet)
Peer review under responsibility of Shanghai University of Sport
Production and hosting by Elsevier
The article Implementing an evidence-based Tai Ji Quan
program in a multicultural setting: A pilot dissemination
project9 by Fink and Houston in this special issue of Journal
of Sport and Health Science extends these findings and takes
the next step. Specifically, the authors demonstrate that it is
possible to scale up an effective health-related fall prevention
program in a community of older adults with differing cul-
tural backgrounds, provided that the intervention meets three
criteria:
(1) Native language: The intervention must be translated and
delivered to participants in their native language. It is also
important for program leaders to be bilingual.
(2) Community organization engagement: The intervention
must be implemented by a broadly imbedded community
organization such as an Area Agency on Aging.
(3) Program fidelity: The intervention must be delivered with
fidelity to specified research-tested protocols.
The work by Fink and Houston9 shows that interventions
proven effective using randomized control trials require
additional adaptation and translation for use outside the
research setting, but by adhering to these three elements a
community-based organization can successfully implement a
Tai Ji Quan program even in a multicultural setting.
Another important component of this program was the
use of community-level infrastructures and delivery sys-
tems. In the study, the Minnesota Area Agency on Aging
served in a coordinating role to help community-level
organizations such as the Lao Advancement Organization
of America and the Korean Service Center implement the
program. Other community groups with wide reach, such as
public health departments, community-based health asso-
ciations, faith-based organizations, and aging services pro-
viders or senior centers, were also instrumental in achieving
participation and community uptake. This “system inte-
gration” is essential for widespread adoption and
sustainability.

2095-2546 Copyright Ó 2014, Shanghai University of Sport. Production and hosting by Elsevier B.V. Open access under CC BY-NC-ND license.
http://dx.doi.org/10.1016/j.jshs.2013.11.001
Commentary: older adult falls
The Minnesota program also demonstrated the importance
of “knowledge brokers” to bridge the gap between knowledge
generated from research and applications of knowledge to
community programs involving older adults from different
cultural backgrounds and languages. Local community orga-
nizations served as knowledge brokers to:
 provide resources such as technical assistance, training,
incentives, and peer support;
 link program developers with bilingual program leaders;
 translate program materials into relevant native languages
of participants.
Sleet et al.10 have highlighted the importance of following
the rigorous public health model in older adult fall prevention
programs, in which a lynchpin to successfully reducing older
adult falls is the utilization of RCT-tested interventions in
program delivery. The Tai Ji Quan program used by Fink and
Houston9 meets these criteria, and its multi-ethnic applica-
bility makes it especially appealing.
It is equally important for rigorous falls screening to occur
within healthcare provider settings to triage and refer older
adults to an appropriate community-based program like Tai Ji
Quan. The Centers for Disease Control and Prevention
developed the Stopping Elderly Accidents, Deaths, and In-
juries toolkit to foster this screening, treatment, and referral.11
Among the many benefits of this approach is that it can help
integrate clinical medicine and public health and assure
improved patient outcomes. It can also provide substantial cost
savings to society.
In evaluating the impact of efforts to translate, disseminate,
and implement evidence-based fall prevention programs, more
attention to research models such as RE-AIM12,13 might be
considered. RE-AIM can help measure a program’s reach in
the target population, efficacy and effectiveness of the
implementation/dissemination strategies, extent of the adop-
tion by the target audience, consistency and fidelity of inter-
vention delivery, and elements necessary for maintenance.
Glasgow and colleagues14 have already demonstrated that RE-
AIM can be used successfully in a low-income community for
weight loss and hypertension self-management.
Translation research like this can also help identify char-
acteristics of the implementation process that are critical to
assure uptake, adoption, and maintenance of fall prevention
behaviors embedded in programs such as Tai Ji Quan. This is
an encouraging step forward.
33
Disclaimer
The findings and conclusions in this report are those of the
author and do not necessarily represent the official position of
the Centers for Disease Control and Prevention.
References
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