A Primary School-based Educational Program to Improve Fall Skills; Process Evaluation Alongside a Cluster Randomized Controlled Trial

Abstract

In this study, the process evaluation of an educational program to improve fall skills in primary school age children was conducted alongside a cluster randomized controlled trial using the RE-AIM framework. Thirty-three schools participated in a cluster-randomized controlled trial. Seventeen schools were randomly allocated to the intervention group. Injuries were registered during a school year. Fall skills were assessed using self-reports and a fall skills test. And questionnaires were used to evaluate experiences of both children and teachers with the educational program. All children participating in physical education lessons were reached. The program was effective in increasing self-perceived fall–skills and the score on a fall-skills test (0.94 points), but the change in fall-related injury rates did not reach significance. Fourteen percent of invited schools was willing to Adopt the educational program. And although participating teachers were positive about the educational program, 89% failed to implement the exercises as intended. Lastly, 54% of the teachers intended to maintain the educational program in their regular teaching routine. Given that many teachers failed to implement the intervention as intended, it is promising that fall skills in children did significantly improve after the intervention. The reason why this did not result in corresponding decrease in fall related injury risk remains unclear. Adjusting the educational program to better fit the needs of teachers potentially increases adoption of the program which could result in a more effective educational injury prevention program.