Understanding falls and its prevention among adults with visual impairment through behavior change models.

Significance: This study used behavior change models to understand the perspectives of falls among patients with visual impairment who are at greater risk of falls. Resulting themes on barriers and facilitators led to the identification of a "SMART" intervention strategy that remains to be tested as a fall-reducing behavior.

Purpose: This study explored the perspectives of adults with visual impairment on falls and proposed falls prevention strategies using behavior change models.

Methods: Participants 18 years or older who were diagnosed with low vision or blindness from a tertiary eye hospital in India and had a history of falls in the previous year were recruited. "Reduction of falls" was defined as a behavior, and interview questions were designed to explore awareness, context, and consequences of falls to determine barriers and facilitators that could help reduce falls. The interviews were audio-recorded, transcribed, translated into English, and analyzed using thematic analysis. The results were linked to the Theoretical Domains Framework and the Behavior Change Wheel, under different levels of a The Socio-Ecological Model. Intervention functions from the Behavior Change Wheel were identified using the APEASE criteria (affordability, practicability, effectiveness/cost-effectiveness, acceptability, safety/side effects, and equity) to finalize behavior change techniques.

Results: Themes on barriers and facilitators at individual, family, and societal levels were identified from 36 semistructured telephone interviews. Key barriers were fear of falling, social stigma and lack of training in using assistive devices, not considering falls as a major concern, environmental hazards, and loss of support from caregivers. Key facilitators were consciously monitoring falls, undergoing orientation and mobility training, getting assistance for outdoor mobility, and self-confidence.

Conclusions: This study proposed a five-step "SMART" intervention strategy for prevention of falls to be prospectively tested. SMART include Support from caregivers and use of assistive devices, Monitoring of falls, Awareness about falls, Reduction of hazards, and Training for safe mobility.