MPH 590 Module 5 Capstone Project Results Example

What Happened: Reach, Outcomes and Delivery of a Community Balance Program

Student Name

Master of Public Health Program, Aspen University

MPH 590: Public Health and Health Education Capstone

Instructor Name

Month Day, Year

What Happened: Reach, Outcomes and Delivery of a Community Balance Program

This section reports the results of the falls prevention project, organized by the RE-AIM dimensions of reach, effectiveness, adoption, implementation and maintenance (Glasgow et al., 1999). Results are presented without interpretation, which follows in the discussion. All figures refer to the first 12-week program cycle.

Reach

In all, 212 older adults enrolled in 14 classes across seven sites. Clinic referrals accounted for 96 participants, or 45%, and community outreach for 116, or 55%. Participants' mean age was 76.4 years; 78% were women; 81% were white, 11% Black, 6% Hispanic and 2% of other backgrounds. About 60% lived alone. Nearly half of participants had never attended a senior center program before.

Attendance

Participants attended a mean of 18.6 of 24 sessions. In total, 151 participants, or 71%, attended at least 18 sessions and were classified as completers. The most common reasons for dropping out were illness, transportation problems and family obligations. Reminder calls before the first two weeks of classes appeared to help, as early absences dropped after they began.

Balance and Mobility

Among completers, mean Timed Up and Go time improved from 13.8 seconds, with a standard deviation of 4.1, at enrollment to 11.9 seconds, with a standard deviation of 3.6, at week 12. The mean improvement of 1.9 seconds had a standard deviation of 2.6, giving a paired t of about 8.98 with 150 degrees of freedom, P below .001, and a 95% confidence interval for the improvement of 1.48 to 2.32 seconds.

Fear of Falling

At enrollment, 97 of the 151 completers, 64%, said they were worried about falling; at week 12, 62, or 41%, did. Forty-four participants moved from worried to not worried and nine from not worried to worried, a McNemar chi-square of about 23.1, P below .001. Falls efficacy scores improved in parallel.

Self-Reported Falls

Of the 151 completers, 138 were reached for the three-month follow-up. They reported 43 falls in the three months before the program, 0.31 falls per person, and 23 in the three months after, 0.17 per person. The share reporting at least one fall declined from 24% to 14%. These figures are descriptive and based on recall.

Results Summary

The table summarizes key results.

Adoption

Of nine organizations approached to host classes, seven agreed. Two declined because of space limits. Of ten trained instructors, nine taught at least one class. All four clinics that agreed to screen continued referring throughout the cycle.

Implementation

Fidelity observations found that 13 of 14 classes delivered at least 80% of core elements, with a mean of 89%. The class below the threshold had a new instructor who skipped the progression of forms; coaching corrected this. Delivery costs totaled about $38,500, or roughly $180 per enrolled participant.

Maintenance

Before the internship ended, the Area Agency on Aging committed aging services funds for ten classes in the following year, and three sites asked to continue hosting. Two instructors agreed to become lead instructors to mentor new ones. The second cycle's classes were scheduled to begin within two months, limiting the gap in service for new referrals.

Unexpected Findings

Participants referred by clinics were older and more likely to have fallen in the past year than self-referred participants, suggesting that clinic screening reached higher-risk adults. Transportation was the leading barrier at the two rural sites.

Comparison With Published Results

The balance improvement and reduction in fear are consistent with gains reported in trials of balance-focused exercise, which on average reduce the rate of falls (Sherrington et al., 2019), and with the direction of results for the tai ji quan program in its original trial (Li et al., 2018). The project's fall data, however, come from a short, uncontrolled follow-up and cannot be compared directly with trial effect sizes.

Participant Feedback

At the final session, participants completed a short satisfaction survey. Of 151 completers, 94% rated the program good or excellent and 89% said they would recommend it to a friend. Common comments praised instructors' patience and the social connection of the group; suggestions included longer programs and more convenient times.

Differences by Site

Attendance varied by site, from 62% completion at one rural church to 82% at a senior center with a dedicated coordinator. Improvements in Timed Up and Go times were similar across sites, suggesting that the program worked comparably where participants attended.

Missing Data

Timed Up and Go data were complete for all 151 completers. Falls follow-up was missing for 13 completers who could not be reached. Enrollment characteristics of those lost to follow-up were similar to those reached, though they were slightly older.

Comparison of Referral Groups

Clinic-referred participants had a mean age of 78.1 years compared with 75.0 for self-referred participants, and 61% of clinic-referred participants reported a fall in the past year compared with 38% of self-referred participants. Completion rates were similar in both groups.

Costs

Total delivery costs of about $38,500 included $12,000 for instructor certification training, $16,000 for instructor stipends, $4,200 for materials and printing, $3,800 for evaluation support and $2,500 for site supplies and refreshments. In-kind space and staff time from partners were not included in this figure.

Summary of Results

Across RE-AIM dimensions, the first cycle met its reach target, retained most participants, delivered the program faithfully, showed improvements in mobility and confidence and secured continued funding, with transportation and diversity of reach as the main shortfalls.

Conclusion

The first program cycle reached 212 older adults, most of whom completed the program, with improvements in mobility and confidence and fewer self-reported falls. Delivery was largely faithful to the program design, partners adopted it and funding for a second year was secured. The discussion interprets these results and their limits.

References

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/ajph.89.9.1322

Li, F., Harmer, P., Fitzgerald, K., Eckstrom, E., Akers, L., Chou, L.-S., Pidgeon, D., Voit, J., & Winters-Stone, K. (2018). Effectiveness of a therapeutic Tai Ji Quan intervention vs a multimodal exercise intervention to prevent falls among older adults at high risk of falling: A randomized clinical trial. JAMA Internal Medicine, 178(10), 1301-1310. https://doi.org/10.1001/jamainternmed.2018.3915

Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. E. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2019(1), Article CD012424. https://doi.org/10.1002/14651858.CD012424.pub2