Background: Falls are the leading cause of injury-related morbidity and mortality in the elderly in the United States. Fall-related injury and death are projected to increase with the aging of the US population. Although there are evidence-based strategies aimed at reducing the falls, there remains a need for studies to determine the success of the implementation strategies used.

Methods: A prospective, mixed methods, controlled before-and-after study design was used to examine the effect of the STEADI education implementation strategy (STEADI Edu) in four primary care clinics at an academic medical center in a rural state in the southern U.S. The clinics were randomized into two arms, control (usual implementation) and intervention (STEADI Edu). The study lasted approximately one month. Data was collected at multiple times within the study, including 30 days prior, immediately before and after as well as at 30 days following STEADI Edu. The data collection methods included self-reported quantitative instruments including the Continuing Professional Development Reaction Questionnaire, STEADI Knowledge Test, and data extracted from medical records. Verbatim transcriptions from semi-structured interviews regarding the individual’s experiences with the implementation process were obtained.

Results: In total, the quantitative data was obtained from 29 participants and 10 participants were interviewed. Although we found a statistically significant difference within the education arm between immediate pretests and posttests/surveys mean scores, there was no statistically significant difference between the study arms’ knowledge, intent to use STEADI, or use behaviors 30 days post intervention Although the knowledge mean score increased by 1.19 (p 0.02), there was no statistical difference between the study groups over time. The mean with regards to intent to use was statistically significant immediately post education with mean 0.64 (p 0.01), however, there was no statistical difference between the study groups over time. The three major themes identified included usual implementation, factors associated with successful implementation, and factors associated with unsuccessful implementation.

Conclusions: For successful implementation of the STEADI toolkit, in addition to the use of education and written materials, other facilitation strategies should be utilized. It is also essential that the facility obtain key stakeholder buy-in for the new initiative, including the patient and every level of healthcare provider.