Evaluation of content validity and feasibility of the World Falls Guidelines’ three key questions to identify falls among older adult users of home care services in Norway

Abstract Background Falls among older adults (65 + years) is an important issue in municipal home care. Screening using the World Falls Guidelines’ three key questions (3KQ) is recommended to identify older adults at increased fall risk, but the 3KQ has not been formally tested by healthcare practit...

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Main Authors: Rune Solli, Linda Aimée Hartford Kvæl, Nina Rydland Olsen, Therese Brovold
Format: Article
Language:English
Published: BMC 2025-03-01
Series:BMC Health Services Research
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Online Access:https://doi.org/10.1186/s12913-025-12606-y
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author Rune Solli
Linda Aimée Hartford Kvæl
Nina Rydland Olsen
Therese Brovold
author_facet Rune Solli
Linda Aimée Hartford Kvæl
Nina Rydland Olsen
Therese Brovold
author_sort Rune Solli
collection DOAJ
description Abstract Background Falls among older adults (65 + years) is an important issue in municipal home care. Screening using the World Falls Guidelines’ three key questions (3KQ) is recommended to identify older adults at increased fall risk, but the 3KQ has not been formally tested by healthcare practitioners (HCPs) working in Norwegian municipal home care. The aim of this study was to evaluate the content validity and the feasibility of the 3KQ among HCPs in home care services. Methods Participants were 10 multidisciplinary HCPs working in home care and in low-threshold services of Oslo, Norway. We evaluated the content validity of the 3KQ through individual think-aloud interviews. Next, feasibility was evaluated as follows: We trained HCPs in how to use the 3KQ. HCPs then screened older adults using the 3KQ during a six-week test period, and took pocket-notes of older adults’ answers. We conducted two focus groups to explore HCPs’ experiences with using the 3KQ. We analysed interview data using reflexive thematic analysis. Results Content validity evaluation revealed that HCPs found the 3KQ easy to understand, and potentially timesaving. They experienced the tool as applicable among home care users, and it was particularly useful among new users. Still, HCPs emphasised the necessity of their training on how to best ask the questions and determine appropriate actions based on users’ responses. We identified three main themes from the feasibility evaluation: (1) Promoting awareness and action: using the 3KQ helps put falls on the agenda in municipal home care, (2) Obtaining reliable answers: integrating the 3KQ into daily practice is important, and (3) Unlocking insights: the 3KQ as a gateway to supplementary information from users. Most older adults had increased fall risk according to the 3KQ. Conclusions The 3KQ appears feasible for Norwegian municipal home care and may be of value for HCPs who screen new users and users of low-threshold services. Integrated use of the 3KQ may enhance awareness, promote reliable answers, and provide supplementary information useful for decision-making. The study findings may benefit HCPs and managers in home care services, and other stakeholders in implementing fall prevention guidelines in primary care. Trial registration Open Science Framework Identifier https://doi.org/10.17605/OSF.IO/2JFHV . Registered: 11th January 2023.
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spelling doaj-art-e9f3e2c5adca43299dff0d42b89a7fec2025-08-20T04:01:25ZengBMCBMC Health Services Research1472-69632025-03-0125111310.1186/s12913-025-12606-yEvaluation of content validity and feasibility of the World Falls Guidelines’ three key questions to identify falls among older adult users of home care services in NorwayRune Solli0Linda Aimée Hartford Kvæl1Nina Rydland Olsen2Therese Brovold3Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan UniversityDepartment of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan UniversityDepartment of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied SciencesDepartment of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan UniversityAbstract Background Falls among older adults (65 + years) is an important issue in municipal home care. Screening using the World Falls Guidelines’ three key questions (3KQ) is recommended to identify older adults at increased fall risk, but the 3KQ has not been formally tested by healthcare practitioners (HCPs) working in Norwegian municipal home care. The aim of this study was to evaluate the content validity and the feasibility of the 3KQ among HCPs in home care services. Methods Participants were 10 multidisciplinary HCPs working in home care and in low-threshold services of Oslo, Norway. We evaluated the content validity of the 3KQ through individual think-aloud interviews. Next, feasibility was evaluated as follows: We trained HCPs in how to use the 3KQ. HCPs then screened older adults using the 3KQ during a six-week test period, and took pocket-notes of older adults’ answers. We conducted two focus groups to explore HCPs’ experiences with using the 3KQ. We analysed interview data using reflexive thematic analysis. Results Content validity evaluation revealed that HCPs found the 3KQ easy to understand, and potentially timesaving. They experienced the tool as applicable among home care users, and it was particularly useful among new users. Still, HCPs emphasised the necessity of their training on how to best ask the questions and determine appropriate actions based on users’ responses. We identified three main themes from the feasibility evaluation: (1) Promoting awareness and action: using the 3KQ helps put falls on the agenda in municipal home care, (2) Obtaining reliable answers: integrating the 3KQ into daily practice is important, and (3) Unlocking insights: the 3KQ as a gateway to supplementary information from users. Most older adults had increased fall risk according to the 3KQ. Conclusions The 3KQ appears feasible for Norwegian municipal home care and may be of value for HCPs who screen new users and users of low-threshold services. Integrated use of the 3KQ may enhance awareness, promote reliable answers, and provide supplementary information useful for decision-making. The study findings may benefit HCPs and managers in home care services, and other stakeholders in implementing fall prevention guidelines in primary care. Trial registration Open Science Framework Identifier https://doi.org/10.17605/OSF.IO/2JFHV . Registered: 11th January 2023.https://doi.org/10.1186/s12913-025-12606-yImplementationFall preventionClinical decision supportCommunity dwelling older peopleThree key questionsContent validity
spellingShingle Rune Solli
Linda Aimée Hartford Kvæl
Nina Rydland Olsen
Therese Brovold
Evaluation of content validity and feasibility of the World Falls Guidelines’ three key questions to identify falls among older adult users of home care services in Norway
BMC Health Services Research
Implementation
Fall prevention
Clinical decision support
Community dwelling older people
Three key questions
Content validity
title Evaluation of content validity and feasibility of the World Falls Guidelines’ three key questions to identify falls among older adult users of home care services in Norway
title_full Evaluation of content validity and feasibility of the World Falls Guidelines’ three key questions to identify falls among older adult users of home care services in Norway
title_fullStr Evaluation of content validity and feasibility of the World Falls Guidelines’ three key questions to identify falls among older adult users of home care services in Norway
title_full_unstemmed Evaluation of content validity and feasibility of the World Falls Guidelines’ three key questions to identify falls among older adult users of home care services in Norway
title_short Evaluation of content validity and feasibility of the World Falls Guidelines’ three key questions to identify falls among older adult users of home care services in Norway
title_sort evaluation of content validity and feasibility of the world falls guidelines three key questions to identify falls among older adult users of home care services in norway
topic Implementation
Fall prevention
Clinical decision support
Community dwelling older people
Three key questions
Content validity
url https://doi.org/10.1186/s12913-025-12606-y
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