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Falls prevention and conversation—what's the link?

What did a bunch of researchers and physiotherapists, together with a group of vibrantly-clad physiotherapy student volunteers and around 50 community-dwelling older individuals get up to on a fine Perth spring day in October this year? Gather in a café, of course, for good company, stimulating conversation and a morning tea to rival many a high tea. This wasn’t any ordinary café, rather a World Café forum, asking ‘Are we sending the right message about falls?’

Wind the clock back a couple of years to an earlier World Café forum in Perth, and themes of ‘independence’, ‘having fun’ and ‘contribution’ are identified as key life values by a gathering of individuals aged 60 years and over. That event sought to explore how these individuals would prefer to seek and receive falls-related information and how they would like falls prevention education to be delivered.

Qualitative research findings demonstrate that many older adults possess low levels of falls and falls prevention knowledge, believe that falls prevention is not personally relevant to them (including a study, that showed that 40 per cent of people who had reported a fall still perceived themselves as having a low risk of falling (Hughes et al 2008)), and have low motivation to engage in falls prevention strategies (Haines et al 2014, Hill et al 2011). We understand that falls are a significant issue; however, the extent and potential life-altering consequences are not understood by many Australians. The statistics can be startling:
  • one in three community-dwelling adults aged 65 years and over fall each year (anzfallsprevention.org/info)
  • over 98 000 older people in 2012–2013 were admitted to hospital with falls-caused injuries (Henley & Harrison 2015) 
  • nationally, over 3000 people aged 65 years and over die each year as a result of a fall, compared to around 300 from a motor vehicle accident (Pointer 2015).
 The Café of 2015 also identified that information relating to falls prevention was only sought after the individual fell and that we needed to make something to alert older people before they fell (Khong et al 2016). The research team, led by Associate Professor Anne-Marie Hill, APA Gerontological Physiotherapist, responded, and the result is a series of three videos aiming to ‘raise awareness—so that individuals seek sources of information about staying on our feet’. These videos formed the basis of discussion for World Café 2017—a case of meaningful conversations leading to actions and change.

What is a World Café?

Hearing about the Café for the first time, you may have a somewhat quizzical look on your face, followed by a series of questions fuelled by curiosity. Briefly, World Café is:

..an easy-to-use method for creating a living network of collaborative dialogue around questions that matter in service to real work...built on the assumption that people already have within them the wisdom and creativity to confront even the most difficult challenges; that the answers we need are available to us; and that we are wiser together than we are alone. (World Café Community Foundation)

There are seven design principles of World Cafés which enable the group to explore such questions in a compelling manner and encourage contribution of everyone’s views, thoughts, feelings and opinions. It enables us to connect diverse perspectives and to share insights and patterns to make a collective discovery —in this case, about falls prevention.

The Café was led by researchers and physiotherapists Anne-Marie Hill and Dr Lex De Jong from Curtin University, with moderator support from me. Data collection was led by research officer Tammy Weselman, analysis was supported by Dr. Jacqui Francis-Coad, APA Gerontological Physiotherapist, and evaluations conducted by Chiara Naseri, APAM. The event was also supported by Injury Matters (represented by Juliana Summers and Chloe Macri) which leads dissemination of falls prevention resources throughout WA (see stayonyourfeet.com.au).

Researchers and physiotherapists also gave their time as table hosts, guiding participants through a series of questions, encouraging participation and capturing their views. Student volunteers assisted with food and beverage service and a range of supports (such as escorting in and out of the venue), highly valued by the participants.

World Café 2017

World Café 2017 commenced with participants completing a series of forms, such as those to capture their baseline characteristics andknowledge statements. Six to seven participants sat around each table, with a table host and plenty to eat and drink.

Four rounds of 20-minute discussions, each separated by brief reflections, punctuated the day. Lex’s use of instant feedback capture through rolling summaries projected to both screens, throughout each discussion round, was excellent. Real-time responses could be seen by all, resulting in participants echoing sentiments of ‘being heard’ and ‘having their opinions valued’, as well as stimulating opportunities for widening and deepening of conversation threads. The rounds were as follows:
  • current falls prevention resources focus
  • video 1—the aim being to show that falls can happen to anyone 
  • video 2—the message being that most falls happen at home 
  • video 3—seniors dancing to the rhythm of lively music, challenging us to think about exercise and activity in a different way. 
Towards the end, participants completed knowledge statements and video evaluations, followed by Anne-Marie and Lex leading summaries of information collated for each round and moderator supported reflection with the group. The event closed with completion of evaluation forms and closing remarks from AnneMarie. As physiotherapists, the principle of engaging directly with the people with whom we enter into a partnership of healthcare and wellbeing allows us to begin to see the world through their eyes and enriches our professional perspectives. Together, through co-design, we can create a shared solution to problems we both encounter.

In conclusion, I would like to stress that this article is simply a reflection, a sharing, of an inspiring World Café event. Perhaps we can all explore further the power of conversation, especially conversation scaffolded by well-structured questions and a sound process. This Café was in the context of falls—as physiotherapists, we can be catalysts and co-designers in the contexts of leadership, strategy, work culture and so much more.

Email inmotion@physiotherapy.asn.au for references.
Vanessa Jessup, APAM, APA Gerontology group National Chair

 

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