Fall prevention education with protection motivation theory to reduce fall risk among Malay older people in Sarawak, Malaysia

Sarawak has the highest proportion of its population that is 55 years of age or older, compared to other states in Malaysia. One of the effects of ageing and its correlations with pre-existing comorbidities that have various negative health effects is falls. Despite the widespread implementation of fall prevention education programmes, the majority of existing designs lack sufficient guidance from evidence-based educational frameworks. Thus, by taking into account threat and coping appraisals, fall prevention education supported by the Protection Motivation Theory helps explain the complexities of motivation by highlighting how people evaluate the seriousness of a threat, their vulnerability to it, how they make decisions about the evaluations, and how they can manage and mitigate the threat. Therefore, this study aimed to assess the effectiveness of fall prevention education integrated with Protection Motivation Theory in promoting fall risk awareness, protection motivation, coping appraisal, threat appraisal and fear, as well as to reduce the fall risk scores among community￾dwelling older people in Sarawak. The study processes, including the recruitment of participants, implementation of fall prevention education integrated with Protection Motivation Theory and data collection, were conducted from September 2022 to April 2023. The study's design used a parallel, two-arm randomised controlled trial (RCT) with a pre-test, 1-month post-test and 3-month follow-up using multistage random sampling. Descriptive and inferential analyses were employed, such as mean, standard deviation, frequency, percentage, an Independent t-test, chi-square, multiple linear regression, bivariate correlation and two-way mixed within- and between-subjects analysis of covariance. The study demonstrated that 168 older people living in the community agreed to participate. The findings adjusted to gender, living arrangement, number of falls and history of falls, showed that this study promotes protection motivation, coping appraisal, fear and threat appraisal across the three time points among older people in Sarawak communities in reducing their fall risk with statistically significant findings for protection motivation (time: p<.001, group: p=.007), coping appraisal (time: p<.001, group: p<.001) and fear (time: p=.006, group: p=.018). Therefore, the outcomes of this study underscore the importance of developing fall prevention education underpinned by theoretical frameworks for positive behavioural change among community-dwelling older people. Furthermore, findings also emphasised that the study helped them to recognise their fall risks and engage in preventive behaviour to reduce them.

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