7 Optimizing and implementing a community-based group fall prevention program | 147 Awareness, confidence and physical effects Self-awareness appeared to be an important aspect as indicated by FPP participants, therapists and stakeholders in this study. The proces of growing awareness and corresponding actions can be divided into three stages: ignoring (continuing a risky activity), gaining insight (realizing the danger in a certain situation) and anticipating (thinking ahead and acting in advance) (287). Increasing awareness is paired with recognizing one’s fall risk and anticipating on situations in daily life. Self-awareness of fall risk is also associated with engagement and motivation in the FPP, because individuals who do not recognize their fall risk or impairments are less likely to appreciate the need and benefits of a fall prevention program (288). The group intervention may help with the awareness process due to mutual experience sharing; participants observe their own behaviour as well as the environment around them by exchanging experiences (287). Training with peers Training in a group seemed to be a crucial aspect of the FPP. The social component of the FPP leads to team spirit and willingness to help each other, resulting in more motivation and, subsequently, improved program adherence. This is in line with previous research indicating that social contact is a facilitator for adherence (289). Participants in group interventions can encourage each other and boost intrinsic motivation to keep exercising (290). We also found that people learn from each other when sharing experiences, which is important to enhance self-efficacy (290, 291). Moreover, group exercise has other benefits such as social integration (41, 289, 290). A group program can also improve quality of life and health effects (292, 293). Funding and costs An overarching topic is a lack of uniformity between different FPP groups, for which funding and costs is an important aspect. Variations existed in funding and individual contribution between locations. More uniformity between groups is recommended so that for example the own contribution does not depend on the location where a participant wants to follow the FPP. We found that most older adults, therapists and stakeholders prefer an own contribution when participating in the FPP, because it increases motivation to continue the FPP. However, previous research among older adults showed 41% of the participants indicated not willing or able to pay for a fall prevention program (292). This shows that paying a contribution can also be a barrier for participating in a FPP, especially for older adults with a lower socioeconomic status (294). Long-term continuation Continuing exercising after the FPP is important for maintaining and increasing long-term effects (295). A recommendation from the focus groups is to organise follow-up meetings to refresh the information and exercises learned during the FPP. Ideally there is a smooth
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