Co-designing an exercise and fall prevention program for older people from culturally and lingistically diverse backgrounds

We are using an Integrated Knowledge Translation approach with 5 stages to develop an exercise program to increase sustained engagement with tailored exercise to reduce falls in older people (aged 65 years and older) from culturally and linguistically diverse (CALD) communities. The program will be co-designed with key stakeholders and will identify and address the enablers and barriers to exercise for falls prevention for older people from CALD communities. The intervention will be based on existing evidence and incorporates the following: - individually tailored, progressive exercise including balance and functional training. - targeted towards people living in the community. - include behaviour change strategies to support long term engagement. - deliverable via a combination of telehealth, individual in-home sessions, and community-based group sessions. Stages 1, 3 and 5 are completed by the research team, which includes researchers, clinicians who work with older people from CALD communities (geriatricians, physiotherapists), representatives from organisations that work with people from CALD communities and older people from CALD communities. Stages 2 and 4 involve recruitment of participants, who include older people from Italian, Arabic speaking and Chinese communities, care givers for people from these communities, health care workers & service providers for these communities and policy makers. Stage 1: Research team designs specific of research, including specific question and approach. This involves 3 workshops conducted via zoom. Stage 2: Five to seven workshops with approximately 50-70 older people/ caregivers, conducted in person. Led by an experienced facilitator and supported by Interpreters and bicultural workers. Three to four workshops with health care workers/service providers/ policy makers. Conducted either via zoom or in person. Workshops will run for 2 to 2.5 hours. Seeding questions for workshops were developed and informed by the Theoretical Domains Framework and designed to explore important domains that impact behaviour change. Stage 3: The research team maps findings from Stage 2 to the taxonomy of behavior change techniques to identify solutions to incorporate into the intervention. The intervention will also be mapped to the TIDierR Checklist. This will be done over two to three workshops. Stage 4a. The intervention prototype will be presented to participants for review and feedback over 2 to 4 workshops. Based on the feedback, the research team will determine what adaptations are required before being tested by participants Stage 4b- Eight to ten older adults will be recruited to trial one to two individual (i.e. 1:1) sessions. The sessions will be delivered to each participant by one of two physiotherapists. While the actual session length will be determined through the co-design process, we anticipate it will take 45 minutes to an hour. Participants will complete a semi structured interview (30 – 45 minutes) or participate in a small focus group depending on their personal preference, to collect quantitative and qualitative data on components of implementability, including acceptability, fidelity and feasibility of the intervention. As we are only trialling one to two sessions, we will not be assessing adherence; this will be evaluated in subsequent trials Stage 5: Stage 4 workshop summaries and interview feedback will be reviewed by the research team. A modified nominal group technique will be used to priorities and achieve consensus on the final design of the intervention