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Abstract
Although older adults have the highest rates of traumatic brain injury (TBI) incidence, mostly from falls, little research has examined rehabilitative approaches for fall prevention in older adults. Health-behavior changes can help older adults maintain health, safety, and independence and are critical in implementing rehabilitation strategies. Therefore, this mixed-method intervention study examined behavior change and individual health beliefs around fall prevention, as well as the feasibility of the intervention. Participants used mental contrasting with implementation intentions (MCII) to increase adoption and execution of fall prevention recommendations. Behavior change was evaluated in active, passive, and generalized changes. Guided by the Health Belief Model (HBM), the intersection of health beliefs (HB) and behavior changes was also examined. Sixteen older adults participated (10 without TBI and 6 with TBI). There was an unbalanced control group with 2 participants without TBI and 1 with TBI. Question one explored MCII as a strategy for behavior change. Participants in the experimental group demonstrated more change in all types of behavior than control group (65.4% vs 33.3%), and 42.5% generalized MCII. Between injury status, more participants without TBI completed reoccurring events (70%) and passive behaviors (2.8) than the TBI group (16.7%; 1.5). Question two addressed HB related to fall prevention. Despite similar increases in all HBM constructs in all conditions, people with TBI reported more self-efficacy than those without TBI (U=11.0, z=-2.06, p=.039). Interviews captured how MCII was used for behavior change, as well as how beliefs were related to fall prevention. Finally, question three targeted feasibility of MCII. Clinicians rated the intervention (out of 5) as acceptable: 4.6(.53), appropriate: 4.4(.63), and feasible: 4.6(.53). Similarly, participants in both injury status groups rated MCII as acceptable: 4.8(.40), appropriate: 4.9(.23) and feasible: 4.9(.37). Lastly, people with TBI required more modifications to treatment (e.g., repeating instructions) to participate successfully in MCII (U=11.3, z=-2.0, p=.043). Results suggest MCII may be an acceptable intervention for fall prevention, especially for participants with TBI. Discussions on how health beliefs interact with behavior change, as well as direct instruction for behavior change, can benefit older adults and their participation in fall prevention.