Journal of Nursing and Health Studies

Qualitative research to inform economic modelling: A case study in older people's views on implementing the NICE falls prevention guideline

World Summit on Occupational Health and Public Safety
February 09-10, 2022 | Webinar

Joseph Kwon, Yujin Lee, Tracey Young, Hazel Squires, Janet Harris

University of Sheffield, UK

ScientificTracks Abstracts: J Nurs Health Stud

Abstract

Background: High prevalence of falls among older persons makes falls prevention a public health priority. Yet community-based falls prevention face complexity in implementation and any commissioning strategy should be subject to economic evaluation. The study aims to capture the views of older people on implementing the National Institute for Health and Care Excellence (NICE) guideline on community-based falls prevention and explore how the qualitative data can be used to inform commissioning strategies and conceptual modelling of falls prevention economic evaluation in local setting. Methods: Focus group and interview participants (n=27) were recruited from Sheffield, England, and comprised falls prevention service users and eligible nonusers. Topics concerned key components of the NICE-recommended falls prevention pathway, including falls risk screening, multifactorial risk assessment and treatment uptake/adherence. Views on other falls prevention topics were also invited. Framework analysis was applied, involving data familiarisation, identifying themes, indexing, charting and mapping and interpretation. The qualitative data were mapped to three frameworks: (1) Facilitators/barriers to implementing the NICE-recommended pathway and contextual factors (2) Intervention-related causal mechanisms for formulating commissioning strategies spanning context, priority setting, need, supply and demand (3) Methodological and evaluative challenges for public health economic modelling Results: Two cross-component factors were: health motives of older persons; and professional competence. Participants highlighted intersect oral approaches and prioritising the vulnerable groups. The commissioning strategy should consider socioeconomic, linguistic, geographical, legal and cultural contexts, priority setting challenges, supply-side mechanisms spanning provider/organisation, funding and policy and health/non-health demand motives. Methodological and evaluative challenges identified included: incorporating non-health outcomes and societal intervention costs; considering dynamic complexity; considering social determinants of health; and conducting equity analyses. Conclusions: Holistic qualitative research can inform how commissioned falls prevention can be feasible and effective. Qualitative data can inform commissioning strategies and conceptual modelling for economic evaluations of falls prevention and other geriatric interventions.

Biography

Joseph Kwon is currently near completing his PhD in Public Health, Economics and Decision Science at School of Health and Related Research, University of Sheffield, funded by Wellcome Trust. The PhD research focuses on community-based prevention of falls among older persons as a case study in economic modelling of geriatric public health interventions. The model seeks to capture the dynamic interplay between falls incidence and multivariate frailty progression and track diverse outcomes important to older persons, including health (QALY), healthcare cost, productivity, private care expenditure and informal caregiver burden. It incorporates multiple prevention pathways - reactive for those admitted to A&E/hospital for falls, proactive for those screened by GP to be at high falls risk, and self-referred for those who enrol in community exercises without professional referrals and capacity limits that reflect the constraints faced in real commissioning settings.