7 Optimizing and implementing a community-based group fall prevention program | 143 Such fear may negatively affect self-confidence, and this could be more thoroughly addressed. Furthermore, exercises should focus more on activities of daily living and real situations in practice, and there could be more variation in the exercises according to therapists: “I notice that I think it’s too bad that: okay, we are practicing this now, but what is it good for in everyday life. Or people, for example, are afraid to ride a bicycle or do certain activities and I also miss the link with that.” [therapist] With respect to structure, a consistent and continuous schedule of training sessions is important. Therapists noticed that it is confusing when in the first four weeks there is one training session per week while the last ten weeks include two training sessions per week. Some therapists mentioned that the number of information meetings is too much. There should also be a regular start of the program, for example every three months, so potential participants should not wait too long before the program starts: “You lose a lot of people because for In Balance, you can’t enrol during the course. Then you have organized one and then people have to wait a long time if they are just too late, so that you lose a lot of people again. So actually, you would like some continuity really just every 2 weeks, month, whatever, something somewhere.” [stakeholder, working at a municipality] Awareness, confidence and physical effects A crucial factor for adherence is that FPP participants perceive some degree of training effects. Specific effects that were addressed are more self-consciousness, physical effects such as balance and strength, and mental effects. Awareness of fall risk in daily life activities was important according to participants, therapists as well as stakeholders. Awareness can affect multiple domains, for example at the physical domain, such as being aware of the way of moving and walking, and being aware of one’s own body, strength and posture. But it is also important to be more aware and have more attention for what someone is doing (e.g., walking the stairs), that someone is not able to do things as fast as before, and about one’s own fall risk and physical activity (e.g., do not walk or do daily tasks in a hurry, but pay attention to it, and plan actions). Moreover, FPP participants also noticed more awareness of their environment, for example making adaptations within and outside of the house and being more attentive to the surroundings: “I was even picking things up off the floor in someone else’s house at one point. That is not the intention either, but you’re much more aware of: that can be dangerous.” [female participant]
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