Objective / Description

The overall objective of the project is the reduction of the number of falls and fall related injuries in older people. This is hopefully achieved by increasing physical activity, awareness raising and the creation of activity inspiring surroundings. Local participant engagement is key to success of the project. This approach leads to the hope that the local adaptation of the structure of the intervention will ensure smooth implementation in the intervention region. Furthermore, existing activities and networks are supposed to be used and strengthened in order to achieve long-term sustainability.

A steering committee has the responsibility to make fundamental decisions e.g. the prioritization of contents. Contents and possible action are planned to be worked out by theme related focus groups. Actions then implemented by teams.

Procedure

• Initial discussions about initiation of the project with the municipality (mayor and senior citizens' office), the biggest health insurance company and the geriatric department of the district hospital were essential. Positive feedback and a strong interest in participation in the project was shown, thus Reutlingen was chosen as an intervention region.
• After selection and project presentations, the most important participants in decision-making of the municipality were invited to participate in the steering committee.
• Planning and completion of focus groups
• Chosen projects were initiated by the implementation teams

Stakeholders and their tasks

Steering Committee

Responsible for setting the general course, e.g. the contents' prioritization or the selection of implementation strategies. The committee contains the most important local stakeholders in decision-making:

• Municipality (mayor, senior citizens' office, department of sports)
• Local health insurance companies (AOK, BoschBKK)
• Geriatric department of the district hospital
• Local medical council, local public health department
• Local sports clubs' working-group
• Housing association
• Local council of senior citizens
• Counsel of welfare organizations and ambulatory care services
• Community college

Focus Groups

The purpose of the focus groups is to inform the development and selection of contents and possible implementation strategies of the programme. Several persons from the sector are supposed to be included: (1) older people, (2) people working professionally or voluntarily with older people, and (3) local experts, who have an overview of possibilities and structures concerning the respective topics. These topics are:

• Exercise classes
  Participants in the focus group: sports clubs, local sports clubs' working-group, German Red Cross, health insurance companies, churches, senior citizens' office
• Healthcare system
  Participants: physiotherapy, geriatric department of the district hospital, health insurance companies, medical professionals, medical supply stores, pharmacies, community nurses
• People in need of care and help
  This focus group was realized within a local conference on nursing. Participants among others were: ambulatory and in-patient care services, health insurance companies, senior citizens' office, geriatric department of the district hospital, medical profession
• Housing
  Participants: architects, shareholders' association for housing and landed property, senior citizens' office, volunteer network for living consulting, occupational therapy
• Social Marketing
  Participants: External experts in media
• City and traffic planning / public transport
  Participants: occupational therapy, volunteer network for living consulting, society for public transport, senior citizens' office, department for traffic & city planning, volunteers

Implementation Teams

The implementation strategies, which were chosen as priorities by the steering committee are translated into practice as projects. These projects can be looked at in detail in the section "construction kit" (e.g. web based overview of exercise classes, education concepts for various target groups, day of action, poster campaign and press relations)

Results

The steering committee met five times. Six focus groups met once each. The identified ideas are summarized in the "construction kit".

Experiences / Advice

In total, the response to the project and its direct involvement of the local stakeholders was highly positive. The development of possible options of implementation within focus groups can be recommended completely. Nevertheless, in the beginning only a small number of focus groups/topics should be conducted/addressed. Due to the limited staff and the predetermined project period some topics could not be dealt with (e.g. city and traffic planning, housing, ways of access to migrants and deprived groups).

• The inclusion of local decision-makers into the steering committee is of great importance. However, the thoughts that were brought forward during the meetings were in general more of a universal nature. Assurances and decisions that pointed the way were identified in bilateral conversations. The steering committee expressed the wish to maintain the periodic meetings even after the project time had expired.
• To motivate local participants, organizations and institutions to cooperate and explain the matter's relevance, personal meetings and conversations are more suitable than postal or telephone approaches.
• Many activities within the municipality are based on voluntary commitment. Yet, this group of people is only able to donate a limited amount of time and action capacity. Thus, the participation of full-time employees who are permitted a certain amount of authority has a positive effect.
• Three focus groups haven’t been implement: (1) access to migrants and other hard to reach groups, (2) retail trade and (3) a small project taking a district approach. The reasons for this were the limited period of time and staff capacity, other key areas, plus missing interest on part of local stakeholders.
• When the focus groups took place, it was pointed out to the participants explicitly that they were supposed to think freely and creatively without taking into account questions about finances or feasibility.
• To initiate and translate activities and processes into practice, the implementation groups needed to be closely accompanied by and under the overall control of the project employees. At this stage, there could often be detected a lack of initiative of one's own. Furthermore, a responsible person to take the initiative and instruct activities should be available at all times.