Acceptability, appropriateness and costs of a tailored implementation strategy for the national falls prevention recommendations in Norwegian municipalities—a process evaluation of the FALLPREVENT trial

Background Falls prevention interventions are effective, but their uptake in clinical practice is limited. To improve uptake tailored implementation strategies are recommended, and we need knowledge on feasibility of the strategies in municipal healthcare. A cluster-randomised trial set in Norwegian municipalities evaluated a tailored implementation strategy, featuring leader commitment, resource teams, regional and local meetings and support. The trial found increased adherence to falls prevention recommendations, improved implementation experience and high fidelity among participants to the intervention. We examined the acceptability, appropriateness and delivery costs of the implementation strategy.

Methods We interviewed 13 mid-level managers and conducted nine focus groups with 29 health care professionals (HCPs) from the resource teams leading the implementation within each municipality, prior to thematic analysis. We estimated implementation strategy costs based on personnel time and associated delivery resources.

Result Mid-level managers and HCPs from the resource teams experienced challenges in securing leadership commitment, negotiating change across management levels and promoting shared opinions on falls prevention. The multidisciplinary resource teams and supporting seminars and tools were perceived as useful in tailoring local implementation of falls prevention recommendations. Personnel costs accounted for 80% of the total intervention costs of EUR 81 558 and costs per municipality of EUR 6274.

Conclusions The tailored implementation strategy was perceived as acceptable and appropriate for implementing national falls prevention recommendations. However, effectiveness may have been reduced by inconsistent manager commitment and limited personnel capacity.