Health professional perspectives on vision screening in older adults who attend hospital following a fall: a focus group study

Health professional perspectives on vision screening in older adults who attend hospital following a fall: a focus group study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Health professional perspectives on vision screening in older adults who attend hospital following a fall: a focus group study Aishah Baig, Kate Radford, Alison Cowley, Jignasa Mehta, Adam Gordon This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8425555/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background The assessment and management of impaired vision is included in falls prevention guidance, however implementation is inconsistent. We conducted focus groups to explore the perspectives of Health Care Professionals (HCP) on vision screening in older adults attending acute hospitals following a fall. Methods A focus group study was undertaken with HCPs from a single acute hospital trust. Semi-structured topic guides were informed by the Consolidated Framework for Implementation Research (CFIR). Transcripts were first inductively then deductively coded using CFIR constructs. Demographic data was collected and summarised. Results Five focus groups were conducted with 19 HCPs overall. Six interconnecting themes were identified, mapped to 14 CFIR constructs, relating to barriers and facilitators to vision screening. Barriers encompassed: lack of training, referral networks to manage impaired vision and prioritisation of task-focussed, rather than person-centred, care in the acute setting. Facilitators included: perceived mission alignment, adequate training, tools, guidance on roles, responsibilities and management pathways, integration of eye care professionals in multidisciplinary falls care and time in job plans. Conclusions HCPs were motivated to vision screen and felt it aligned with person-centred falls care, however there were individual and contextual barriers related to staff capability and opportunity to implement vision screening in the acute setting. Multi-component and multi-level interventions and implementation strategies are needed to integrate eye care professionals into the falls MDT, engage supportive leaders, develop an effective vision screening assessment, define roles, responsibilities and management pathways, organise individual training and time allocation for staff to perform screening. Falls Vision screening Vision Ageing Figures Figure 1 Figure 2 Key summary points Aim: This study aimed to explore barriers and facilitators to vision screening in older adults attending hospital following a fall, from the perspectives of the falls MDT in an acute hospital. Findings: Perceived capability and confidence, lack of referral networks and integration of eye care professionals in falls MDTs were key barriers to vision screening. Vision screening aligned with perspectives of person-centred falls care but conflicted with task-focussed acute care. Message: Staff training, integrated screening tools, clear guidance, support in job plans and implementation planning with eye care professionals, could facilitate vision screening for older adults attending hospital following a fall. Introduction Globally, falls occur at least once a year in approximately a third of people aged ≥65 years and the prevalence increases with age.[1-5] Falling can have serious physical[6-9] [10-13] and psychosocial implications for affected individuals [14-21] with loss of independence[20-27], increased disability[28-30] and mortality.[31] Worldwide, health and social care services face mounting costs related to falls management,[22, 32-39] due to ageing populations and the expected increase in number of falls.[40, 41] Impaired vision almost doubles the risk of falling[42-47] and is more prevalent in older adults acutely admitted to hospital with falls, compared to those admitted without falls[48-50] and non-fallers in the community.[50-52] People who fall and attend an Emergency Department (ED) or who are hospitalised following a fall are at increased risk for further falls and fall-related readmissions.[53-55] Opportunistic assessment and prompt management of impaired vision in older people attending acute hospitals following a fall, may help reduce recurrent falls risk and the associated burden on health and social care services.[56] As part of multifactorial falls risk assessment, national and international guidance recommends assessing and managing impaired vision in older adults who attend a healthcare setting following a fall.[4, 40] However, implementation of these guidelines in acute hospitals is inconsistent.[57-59] Survey studies and qualitative research have explored barriers and facilitators to health care professionals (HCP) implementing falls prevention practice guidelines and falls risk screening in hospital wards, outpatient clinics and ED.[60-65] Barriers reported include: limited time, resources, communication between disciplines, patient motivation and health status, staff and patient knowledge, availability of support staff and champions, lack of ownership, lack of positive reinforcement and forgetting or being complacent about guidelines.[60-65] Facilitators included: innovation appropriateness, importance and attractiveness of innovations to users, patient and staff education and training, reminders, auditing practice, feedback, champions, use of data to inform practice change, leadership with clear goals and commitment to falls prevention.[60-65] Barriers and facilitators to hospital vision screening for falls prevention has scarcely been studied. A survey of 49 hospital HCPs working across 17 Belgian geriatric medicine wards, evaluated the feasibility of implementing a multidisciplinary practice guideline for inpatient falls prevention. The study included geriatricians, nurses, occupational therapists and physiotherapists. Compared to other falls risk factors, including mobility impairments, medications and postural hypotension, HCPs felt vision impairment was the risk factor they felt least capable of, or responsible for, assessing and managing[61]. Barriers and facilitators to vision screening in people attending hospital following a fall, need to be better understood as an initial step towards developing appropriate interventions to improve routine vision screening. Determinant frameworks facilitate a better understanding of the contextual factors influencing uptake of evidence-based practice in the real world.[66-68] The Consolidated Framework for Implementation Research (CFIR) is one of the most widely-used frameworks for implementation research in healthcare settings,[69-75] providing a structured approach to identifying barriers and facilitators to implementation. CFIR now incorporates the ‘Capability, Opportunity and Motivation’ components of the COM-B Model, as constructs within the ‘Characteristics’ subdomain.[76] COM-B, which forms the basis of the ‘Behaviour Change Wheel’, helps understand how human behaviours are generated through interplay between individual capability, opportunity and motivation.[77] This study aimed to use CFIR to explore barriers and facilitators to vision screening in older adults attending hospital following a fall, from the perspectives of the falls Multidisciplinary Team (MDT) in an acute hospital. Methods A case study approach was used to purposively recruit HCPs at a single large National Health Service (NHS) teaching hospital in the East Midlands of the UK. Participants were recruited via posters, staff newsletters and bulletins, and cascaded via email to relevant clinical teams. Participants were eligible if they were aged 18 years or older and involved in the care of older adults who attend hospital following a fall, in their current or previous role at the hospital. Focus groups were organised until data saturation was reached.[78] Five 60-90 minute in-person focus groups were held in a hospital meeting or training room between February and June 2025. Only participants and facilitators were present at focus groups. Participants initially completed a demographic questionnaire asking about age, gender, ethnicity, highest educational qualification, current profession, years of relevant experience, last eye test and ocular history. A semi-structured topic guide was informed by CFIR supported discussions. The topic guide was reviewed by the research team, stakeholders, patient and public involvement (PPI) advisory group and colleagues prior to use (Appendix 1.). Participants discussed: the role of impaired vision in falls, the importance of assessing vision in hospital for older adults attending following a fall, barriers and facilitators to doing so, and the involvement of Eye Care Professionals (ECP) in falls management. Data were recorded digitally and handwritten field notes taken by facilitators. All participants provided informed consent before participating. The study received approvals from the Health Research Authority (HRA), Health and Care Research Wales (HCRW) and the East Midlands - Nottingham 2 Research Ethics Committee and adheres to the Declaration of Helsinki. The study protocol was published on ClinicalTrials.gov, ID: NCT06645080. Research team and reflexivity Author AB conducted the focus groups as part of a PhD study. AC was co-facilitator and a member of the PhD supervisory team. AC has extensive experience in focus group research, particularly in rehabilitation and dementia. Both facilitators were female, AB is an orthoptist and AC a physiotherapist. Both have shared experience working at the hospital and caring for older people following a fall. This helped create a comfortable non-judgmental environment, enabling participants to speak openly.[79, 80] KR, AG and JM were members of the supervisory team and have expertise in mixed-methods research related to the healthcare of older people. KR is a female professor in rehabilitation research and occupational therapist by background. AG is a male professor in care of older people and a geriatrician. JM is a female lecturer in orthoptics. The team are geographically dispersed and reflect some of the professions within a falls MDT and ophthalmology. Data analysis Demographic data was inputted onto Microsoft Excel and summarised using descriptive statistics. The first two focus group recordings were manually transcribed verbatim by AB. Subsequent recordings were transcribed using an automated transcription service. All transcripts were anonymized and cleaned by AB. Transcripts were not returned to participants for correcting. Transcripts were coded inductively using thematic framework analysis then deductively using CFIR. Inductive coding enabled data-led theme development and a deeper exploration of themes in relation to the case study.[81] Deductive coding using CFIR, ensured key contextual factors influencing implementation were not missed.[76] Inductively developed themes were mapped to deductively coded CFIR constructs. Initially, two transcripts were coded independently by AB and AC. Coding partners met to compare codes and develop a thematic framework, which was then applied to the remaining transcripts by AB.[82] (Appendix 2.). Themes were refined by the coding partners, research team, stakeholders and PPI advisory group. A matrix thematically charted data, for each focus group (Appendix 3.). Coding partners kept a diary of reflexive notes, which together with field notes, were integrated into the results and discussion.[82] Participants were not asked to provide feedback on findings before reporting. This study is reported following the Consolidated criteria for Reporting Qualitative research (COREQ).[83] Results Participant characteristics Nineteen participants were recruited, comprising two males and 17 females. Participants were aged between 18 and 54 and eight were of non-white ethnicity. They came from a range of professional backgrounds, were mostly employed in inpatient settings and had varying experience caring for older people and people who had fallen (Table 1 ). Eleven participants reported having an eye test in the past two years and these participants had glasses prescribed, which they wore at least sometimes. Table 1 Demographics of included participants Demographics Participants (n = 19) Gender Female 17 (89.5%) Male 2 (10.5%) Age (years) 18–24 4 (21.1%) 25–34 4 (21.1%) 35–44 9 (47.4%) 45–54 2 (10.5%) Ethnicityd White (British) 11 (57.9%) Asian 4 (21.1%) Black/ African/ Caribbean 3 (15.8%) Mixed/ multiple ethnic groups 1 (0.8%) Profession Physiotherapist 6 (31.6%) Healthcare assistant 5 (26.3%) Nurse 3 (15.8%) Occupational therapist 2 (10.5%) Physiotherapy assistant 1 (0.8%) Advanced clinical nurse practitioner 1 (0.8%) Orthoptist 1 (0.8%) Years of experience working with older patients Less than a year 3 (15.8%) 1 to 2 3 (15.8%) 2 to 5 4 (21.1%) 5 to 10 4 (21.1%) 10 or more 5 (26.3%) Years of experience working within falls MDT Less than a year 3 (15.8%) 1 to 2 3 (15.8%) 2 to 5 6 (31.6%) 5 to 10 4 (21.1%) 10 or more 3 (15.8%) Primary work setting Inpatient 16 (84.2%) Outpatient 3 (15.8%) Key: MDT-Multi Disciplinary Team Thematic findings Data saturation was reached after five focus groups. Six overlapping themes were identified, related to HCP’s views on vision screening in older adults who attend hospital following a fall. These encompassed: current practice, acute pressures, priorities in acute care, roles and responsibilities, knowledge gap and confidence, networks and pathways (Fig. 1). Themes mapped to 14 different CFIR constructs also shown in Fig. 1, including all three COM-B components embedded as constructs within CFIR. Figure 2 shows the CFIR constructs coded from the data and the CFIR domains they belonged to. Most data was coded against constructs from the ‘Inner setting’ and ‘Individuals’ domains. Table 2 presents the themes, sub-themes, mapped CFIR constructs and example findings summarised from the data highlighting the key barriers and facilitators to vision screening. Themes and mapped CFIR-constructs from Fig. 1 are further described below. Additional data supporting each theme can be found in Appendix 3. Table 2 Key barriers and facilitators identified from thematic findings with mapped CFIR constructs Theme Theme definition Subthemes Mapped CFIR construct B/F Example finding summarised from data Networks and pathways Networking and communication between the falls MDT and ECPs. Unclear management pathways • Partnerships and connections • Communications • Relational connections • Opportunity • Motivation B The falls MDT don’t know how to refer to an eye care professional if they detect a vision problem. Unfamiliarity with eye care professionals • Access to knowledge and information • Relational connections • Opportunity B The falls MDT do not have established communication networks or points of contact with the ophthalmology department. Priorities in acute care Individual and collective perceptions of vision screening in older adults who attend hospital following a fall and the priority of vision screening in acute care. Importance of vision in falls • Mission alignment • Motivation F Participants agreed impaired vision was an important falls risk factor. Acute conditions take priority • Relative priority • Opportunity • Motivation B Impaired vision was not viewed as an acute condition. Therefore, it could be managed in the community. Prompts to consider vision • Relative priority • Opportunity F Incorporating a vision assessment onto existing (electronic) falls checklists would remind staff to complete it. Importance of assessing vision in hospital • Mission alignment • Motivation F Participants agreed that impaired vision can affect hospital rehabilitation and have knock-on effects on health outcomes. Overprotecting inpatients • Recipient-centeredness • Opportunity B Staff doing things for patients may make it difficult to identify those that are struggling with their vision. Knowledge gap and confidence Limited training and confidence amongst HCPs in assessing vision. Training gap across staff groups • Access to knowledge and information • Capability • Motivation B Staff do not receive training on how to assess vision. Preferred training modes F There are opportunities to train staff in existing departmental weekly/monthly teaching sessions. Assessing vision in cognitively impaired patients B Staff felt it would be difficult to assess vision in cognitively impaired patients. Physical resources • Physical and Information Technology Infrastructure • Capability • Motivation F A physical aid, such as an (electronic) vision screening tool would help guide staff vision assessments. Acute pressures Working pressures in acute settings affected the opportunity of staff to assess vision in older adults who attend hospital following a fall. Equipment and space availability • Physical infrastructure • Available resources • Opportunity • Motivation B Not having readily available vision assessment equipment would deter staff from assessing vision. Time and staffing burden • Available resources • Compatibility • Opportunity • Motivation B A lengthy vision assessment would be difficult to integrate into already busy job plans. Current practice HCPs described their current practice in relation to the assessment of vision in older adults who attend hospital following a fall. Clinical impact of formal assessment • Innovation complexity • Access to knowledge and information • Recipient-centeredness • Capability • Motivation B Current assessments have low clinical impact as they are not thorough enough. Informal observational assessment • Mission alignment • Recipient-centeredness • Capability • Motivation F Staff detect impaired vision through observational assessments. Roles and responsibilities Perceptions of the roles responsibilities of HCPs in the falls MDT related to vision screening in older adults who attend hospital following a fall. Roles of falls MDT • Work infrastructure • Opportunity B No clear responsibility for assessing vision. • Work infrastructure • Mission alignment • Compatibility • Opportunity • Motivation F Shared responsibility would improve screening coverage. Patient knowledge and engagement in self-care • Local attitudes • Motivation B Patients don’t adhere to advice regarding vision. Key: B-Barrier, F-Facilitator, MDT-Multi Disciplinary Team, ECP-Eye Care Professional, HCP-Health Care Professional Networks and pathways This theme related to lack of networking and communication between the falls MDT and ECPs. Despite support for multidisciplinary falls management and collaboration with ECPs, participants often lacked understanding of different ECP roles. Communication between ward-based staff and ECPs, who were predominantly outpatient-based, was limited. [FG5 Physiotherapist1] “You tend to see like, the similar people, like you see people like therapies and then like SALT and dietetics. And it is. It is literally just if you see someone more often, you're gonna remember,” This theme crosscut the Outer setting, Inner setting and Individual CFIR domains, as participants were unsure about when and how to refer patients to hospital or community eye services. It was largely seen as the medical team’s role to liaise with ECPs if needed. Lack of clear referral criteria and management pathways for impaired vision were viewed as significant deterrents to assessing vision, rendering assessments ‘tokenistic’ without clear routes for forward referral. Clear referral criteria and a recognized point of contact were seen as facilitators to vision screening. [FG1 Physiotherapist1] “…a lot of the time people aren’t comfortable with doing certain assessments because, ok if you find out there’s a deficit, now what?...when we ask questions it’s really important that that’s then relevant and followed-up and we’re not just asking questions for questions sake.” This theme mapped to multiple CFIR constructs, including: ‘Partnerships and Connections’, ‘Relational Connections’ and ‘Communications’. These constructs relate to internal and external networks, relationships and information sharing practices between the hospital falls MDT, and hospital and community eye services.[ 76 ] This theme also mapped to the ‘Access to Knowledge and Information’ construct, which refers to accessing guidance and training to implement practices,[ 76 ] including guidance on referral criteria and management pathways for impaired vision. Priorities in acute care Participants from all professional backgrounds believed vision to be an important falls risk factor, but one that did not receive enough attention in acute care. This mapped to the ‘Relative Priority’ and ‘Mission Alignment’ CFIR constructs. ‘Relative Priority’ relates to the importance given to assessing vision compared to other initiatives[ 76 ].’Mission Alignment’ refers to the degree to which assessing vision aligns with the perceived purpose, or goals, of the hospital falls MDT.[ 76 ] The relative priority of assessing vision in acute falls care was low compared with other assessments, such as blood pressure or medication reviews. This was said to be because impaired vision was infrequently considered to be the reason for admission or the fall, an acute condition, or one that affected hospital discharge. Managing these other conditions was considered to be more aligned with the mission of the falls MDT in an acute hospital than vision assessment. [FG5 Healthcare Assistant1] “I'm just thinking about lots of different other aspects that might affect a patient. For example, like I said, pressure sores and things like pain or… the condition of why they're there. So, I guess vision, even though it does come in briefly. I'm thinking about lots of other things that must be done for the patient .” Glasses were often said to be used as a visible cue prompting staff to investigate impaired vision, or remind patients to wear their own glasses. To prompt staff to complete vision assessments, participants suggested adding vision assessments to existing mandatory falls assessment checklists. Participants felt corrected vision could aid inpatient rehabilitation, diagnosing multifactorial causes for falls and considering unexplained deficits in other areas, such as mobility. The patient’s functional independence and quality of hospital stay could also be impacted by impaired vision. “Knock-on” effects of impaired vision included: effects on eating, drinking, taking medication, mobility and causing anxiety, which could potentially lead to malnutrition, dehydration and deconditioning. [FG1 Healthcare Assistant 1] “Cos if the vision isn’t all that great, it all has a knock on effect, in the sense of like not being able to take the medication or malnutrition because they’re not eating or…dehydration because they’re not seeing their drink to drink it….” This theme also mapped to the ‘Recipient Centeredness’ construct, relating to the shared values, beliefs and norms of the falls MDT to support and care for patients.[ 76 ] Staff adapted the ward environment to protect and support patients. They ensured that objects patients needed and mobility aids were within reach and closely supervised patients when mobilising. Staff felt more inclined to do things for patients than to give them independence, in order to keep patients safe or save time. This was also thought to be expected by the patients. Participants appreciated that this culture might make it difficult to determine which patients were struggling with impaired vision without a routine vision assessment. [FG2 Physiotherapist 1] “It's (vision) probably not like the first thing that comes to mind for me when I think of like… What's going to cause someone to fall? Especially like on a ward environment when people are maybe overprotected a little bit and are always walking around with someone….” [FG2 Healthcare Assistant 1] “…we are making sure that all the things near their bed like the water, food, everything…” Knowledge gap and confidence Regardless of the number of years of experience or level of seniority, participants described limited training about vision. Individuals spoke of not feeling capable or confident to adequately assess vision, or manage impairments appropriately, particularly in patients with impaired cognition, who make up a significant proportion of their work. This theme mapped to CFIR’s ‘Access to ‘Knowledge and Information’ construct. [FG3 Physiotherapy assistant 1] “I've been HCOP, with HCOP for 11 years now. I've never really had specific teaching on eyesight…” [FG2 Physiotherapist 1] “Especially like lots of cognitive(ly impaired) patients. I don't know how I'd possibly try and do like a mini eye test.” Participants were keen to learn and confident that training needs could be accommodated by protected teaching time. Participants recommended resources such as information posters for staff and patients, patient information leaflets and an electronic vision assessment tool to help guide assessments, incorporated into existing falls checklists. The ‘Physical and Information Technology Infrastructure’ constructs mapped here, as they capture material components or technological systems that might support vision screening in the acute hospital setting.[ 76 ] Acute pressures The lack of readily available vision assessment equipment, competing tasks, staff shortages and limited time were said to affect the opportunity of staff to assess vision. This mapped to the ‘Available Resources’ and ‘Physical Infrastructure’ CFIR constructs, which together relate to the availability of physical space, materials and equipment to support implementation of vision screening.[ 76 ] [FG1 Occupational Therapist 1] “…just getting you to do another, another thing in a list of a hundred jobs I’m tryna do” The ‘Compatibility’ construct, which is concerned with the fit of vision screening with current “workflows, systems and processes”[ 76 ] was also mapped to this theme. Participants reflected on the current organisational climate i.e. the limited resources of their acute setting, to suggest that a brief bedside vision assessment that does not require specialist equipment, could aid compatibility with their current ways of working. Current practice Within this theme, participants described current practice in relation to the assessment of vision in older adults attending hospital following a fall. Current nursing protocols and falls checklists used by participants in this study incorporate a basic vision assessment, e.g. presence or absence of glasses. These assessments are performed 2-hourly throughout the day. Therapist assessments are not repeated but ask broad questions about visual issues. Many participants felt assessments were unhelpful in understanding the patient’s true level of vision. [FG1 Healthcare Assistant 2] “You’re not really using that (assessment)... or actually know the truth about it (vision),” Some participants’ displeasure was evident in their tone, facial expressions and language, describing the assessments as “tokenistic” , a “ritual” and “ticking a box” . The assessments were described as “not person-centred”, which related to the ‘Mission Alignment’ and ‘Recipient-Centeredness’ constructs, as person-centred care is integral to how HCPs construct their worldview.[ 76 ] The lack of depth of assessments reduced the impact on clinical practice and their person-centredness. This mapped to the ‘Innovation Complexity’ construct, which relates to scope and degree of complexity of the vision screening assessment. Participants suggested a more in-depth vision assessment, at critical time points, such as at admission, would have more clinical impact. Nurses, HCAs and therapists realised through discussion that they regularly performed observational assessments of functional vision and adapted the ward environment accordingly, as mentioned previously. Observations included: how steadily the patient mobilised, how accurately they reached for objects, their eye-contact and interactions with members of staff. [FG3 Physiotherapy assistant 1] “But it's it's just one of those things that you don't actually think about. So, thinking about it. We actually do it on the every day, quite regularly. You don't realise it's, I don't know.” Roles and responsibilities When justifying responsibility for assessing vision in this patient group, Nurses, HCAs and therapists in this study compared compatibility of assessing vision within their job roles and how well vision assessments aligned with their professional goals. These discussions mapped to the ‘Compatibility’ and ‘Mission Alignment’ constructs. For example, physiotherapists believed that impaired vision affected safe mobilisation and was therefore their responsibility. Whilst nurses and HCAs felt many patients may be missed due to the limited working hours of therapists and that they may have greater opportunity to assess patients. Nursing staff also felt that they see patients more regularly and built closer relationships with them, allowing them to gain a better understanding of the patient’s level of vision. [FG2 Physiotherapist 1]: “I think if anything it could be more, … like a therapy thing just because like in theory we're the ones saying how someone should be mobilising. And if we think that they're not safe to mobilise a certain way because of vision, maybe that should be on us to like assess and to hand that over to like nurses and HCAs.” [FG2 Healthcare Assistant 2]: “…as healthcare assistants you're the first ones really because you guys might not get round to that patient until because you have a list don't you go round to.” Participants concluded that vision assessments should be a shared responsibility between staff groups, as this would improve screening coverage, reduce burden on any single staff group and be more likely to detect and manage vision problems. A simple vision assessment that could be performed by any HCP in the falls MDT was therefore suggested as a facilitator for vision screening. This theme mapped directly to CFIR’s ‘Work Infrastructure’ construct, which considers staffing levels, tasks and responsibilities of individuals and teams to support vision screening.[ 76 ] No participants mentioned the role of ECPs when discussing responsibility to vision screen. Participants also expressed that patients should take greater responsibility for having their eyes tested in the community, reminding themselves to wear glasses and communicating their visual needs to HCPs. However, they were also aware of potential barriers to doing this. Mapping to COM-B constructs Three themes (Current practice, Networks and pathways, Knowledge gap and confidence) mapped to the ‘Capability’ component of the COM-B model. This relates to “competence, knowledge and skills” staff need to implement vision screening.[ 76 ] The remaining three themes (Acute pressures, Priorities of acute care, Roles and responsibilities), mapped to ‘Opportunity’, reflecting whether staff have the “availability, scope and power” to implement vision screening.[ 76 ] The ‘Motivation’ construct refers to the drive and commitment to implement vision screening.[ 76 ] Barriers related to staff capability and opportunity, described above, affected commitment and implementation, therefore, all six themes mapped to ‘Motivation’. Discussion This study aimed to use CFIR to explore barriers and facilitators to vision screening in older adults attending hospital following a fall, from the perspectives of the falls MDT in an acute hospital. The themes and CFIR constructs identified in this study highlighted three overarching discourses related to factors affecting vision screening in older adults attending hospital following a fall. Firstly, lack of education and training on vision relevant to falls for non-ECPs. Secondly, the role of ECPs in the falls MDT, including lack of referral networks and integration in the team. Thirdly, prioritisation of task-focussed, rather than person-centred falls care in the acute setting. The most important barrier to assessing and managing impaired vision was a lack of knowledge and training resulting in lack of perceived capability and confidence. This is consistent with findings of a survey of ward-based geriatricians, occupational therapists, physiotherapists and nurses who identified vision impairment as the falls risk factor they felt least capable to assess and manage.[61] Nurses, physiotherapists and occupational therapists also identified the main individual-level barrier affecting implementation of the Competence, Rehabilitation of Sight after Stroke (KROSS) visual assessment tool in Norwegian stroke rehabilitation units as perceived capability and competence.[84] Non-medical members of the falls MDT rarely communicated with the ophthalmology department and did not consider ECPs as core members of the falls MDT. This led to reluctance to assess vision as HCPs did not know how to manage and refer patients with impaired vision to ECPs appropriately. Vision assessment tools and guidelines developed by ECPs have been successful in enabling vision screening and management by non-ECPs such as medical students, physicians, nurses, physiotherapists, occupational therapists and assistant nurses. This includes the Visual Impairment Screening Assessment (VISA) tool for patients following stroke and brain injuries[85, 86], National Institute for Health and Care Excellence NG236 Stroke Rehabilitation in Adults guideline[87, 88], and KROSS visual assessment tool.[89] The Look out! Bedside vision check[90] was also developed collaboratively with ECPs to prevent inpatient falls, but has not yet been validated. Where capacity permits, hospital ECPs such as orthoptists have also performed vision screening in older adults who attend hospital following a fall, specifically following neck of femur fracture.[91] Despite not feeling capable of assessing and managing impaired vision, nursing staff and therapists in our study believed that vision screening in falls was their shared responsibility. This is in contrast to the study by Milisen et al, where participants of all professionals backgrounds felt that compared to other falls risk factors, they felt least responsible for assessing and managing impaired vision.[61] This may have been related to lack of perceived capability, however reasons for feeling least responsible were not given. Participants in our study expressed how detecting and managing impaired vision in falls patients aligned with individual and organisational goals, including: ensuring patient safety, rehabilitation, discharge preparation, improving health outcomes and quality of hospital stay. Vision screening was also considered more compatible with job plans when different staff groups worked together, as therapists may miss patients outside of their daytime working hours that nurses could capture. This echoes the findings of earlier work using the KROSS visual assessment tool in stroke units.[84], where unclear responsibilities, lack of interdisciplinary collaboration to share responsibility and workload and lack of integration of ECPs in the stroke MDT, were barriers to vision screening. HCPs were motivated to implement vision screening in falls as they felt understanding the visual status of patients aligned with their person-centered priorities of patient safety, rehabilitation, improved health outcomes and quality of hospital stay for the patient. Participants relied on observational assessments of vision and expressed dissatisfaction with formal assessments of vision that lacked depth for detecting and managing impaired vision. Participants perceived formal vision assessments as a task they had to complete in line with local protocols but that had little if any clinical impact. They described a task-focussed organisational culture prioritising the management of acute conditions, the primary reason for admission, or those affecting discharge. This presented a barrier to implementation, as impaired vision did not fit these categories and created tension between commitment to person-centred care and feeling compelled to be task-focussed to meet organisational demands. Findings from the current study can inform the development of interventions and implementation strategies for improving routine vision screening in older adults attending hospital following a fall. Thus improving acute hospital management of impaired vision contributing to falls. Lack of knowledge, perceived capability and confidence was related to the ‘Access to knowledge and information’ and ‘Capability’ constructs, suggesting the need for effective training and access to relevant guidance and resources to increase staff competence, confidence and successful implementation.[92-95] Lack of referral networks, integration of ECPs into the falls MDT and undefined roles related to multiple CFIR constructs, including ‘Mission Alignment’, ‘Compatibility’, ‘Work infrastructure’, ‘Relational connections’ and ‘Communication’. Successful implementation of innovations may be influenced by the innovation’s perceived alignment with organisational goals and a feeling of shared responsibility.[96] Implementation has also been found to be positively influenced by coordination and collaboration between specialities,[97] clearly defined roles[98, 99] and quality of communication within an organisation[95]. These reduce confusion and empower staff with guidance and support networks. Finally, conflict between person-centred care and being task-focussed also related to multiple CFIR constructs, including ‘Mission Alignment’, ‘Compatibility’, ‘Recipient Centeredness’, ‘Motivation’ and ‘Available Resources’. Patient-centred care[100] has been found to be a predictor of implementation success, as has perceived mission alignment,[101] as the innovation then receives buy in and commitment from staff. Findings mapped to COM-B components could be used with the Behaviour Change Wheel to design interventions aimed at changing individual behaviours.[77] Whilst findings mapped to other CFIR constructs could be applied with compatible tools, such as the Expert Recommendations for Implementing Change for implementation strategy planning and design.[71, 102] The perspectives of the medical team and patients also need to be explored to ensure all relevant stakeholders are involved for successful implementation planning.[103] The key strengths of this study related to the combined inductive and deductive coding using CFIR, which enabled a comprehensive approach to data analysis.[81] A case-study approach, meanwhile, supported in-depth understanding of barriers in the acute hospital context,[104, 105] making findings transferable to similar settings. Group heterogeneity and small group sizes were also a strength of this study. Our participants were heterogenous in professional background, years of experience, age and ethnicity, reflecting the mix of HCPs involved in the care of older adults. This added richness to the data and allowed a more holistic approach to the subject. As with Dahlin-Ivanoff we found that small heterogenous groups were dynamic and easier to manage contributions of participants.[106, 107] Key limitations of the study relate to the findings coming from a single hospital, which is likely to limit generalisability and the fact that we weren’t able to recruit from the full multidisciplinary team, particularly our inability to recruit any doctors to the study. While their perspectives would have been useful, as they take overall responsibility for patient care, medical staff may have introduced a power imbalance and influenced freedom of expression. Although nurses and allied health professionals may be more likely to perform vision screening, medical support or lack thereof, could influence uptake of this in practice. Conclusion Focus groups with HCPs identified barriers and facilitators to vision screening in older adults attending acute hospitals following a fall. HCPs were motivated to vision screen and felt it aligned with person-centred falls care, however individual and contextual barriers related to staff capability and opportunity in the acute setting affected implementation. There is a need for multi-component and multi-level interventions and implementation strategies to: integrate ECPs into the falls MDT, engage supportive leaders, develop an effective vision screening assessment with accompanying guidance, define roles, responsibilities and management pathways, organise individual training and time allocation for staff to perform screening. Declarations Funding This work was supported by Vivensa Foundation [ARHV23\1] Competing interests The authors have no competing interests to declare that are relevant to the content of this article. Ethics approvals This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the the Health Research Authority (HRA),Health and Care Research Wales (HCRW) and the East Midlands - Nottingham 2 Research Ethics Committee [REC reference: 25/EM/0001, 06/12/2024] Consent Informed consent was obtained from all individual participants included in the study. Data availability statement The authors confirm that the data supporting the findings of this study are available within the article and/or its appendices. Authors contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Aishah Baig and Alison Cowley. The first draft of the manuscript was written by Aishah Baig and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Supervision was provided by authors Kate Radford, Alison Cowley, Jignasa Mehta and Adam Gordon. References Bergen, G., M.R. Stevens, and E.R. Burns, Falls and Fall Injuries Among Adults Aged ≥65 Years - United States, 2014. MMWR Morb Mortal Wkly Rep, 2016. 65 (37): p. 993-998. Salari, N., et al., Global prevalence of falls in the older adults: a comprehensive systematic review and meta-analysis. J Orthop Surg Res, 2022. 17 (1): p. 334. Alqahtani, B.A., et al., Prevalence of falls among older adults in the Gulf Cooperation Council countries: A systematic review and meta-analysis. Archives of Gerontology and Geriatrics, 2019. 83 : p. 169-174. NICE. Falls in older people: assessing risk and prevention. Clinical guideline [CG161] . 2013 01/07/2022]; Available from: https://www.nice.org.uk/Guidance/CG161. Masud, T. and R.O. Morris, Epidemiology of falls. Age Ageing, 2001. 30 Suppl 4 : p. 3-7. Cummings, S.R., et al., Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev, 1985. 7 : p. 178-208. Keene, G.S., M.J. Parker, and G.A. Pryor, Mortality and morbidity after hip fractures. Bmj, 1993. 307 (6914): p. 1248-50. NICE, NICE impact falls and fragility fractures . 2018. Svedbom, A., et al., Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos, 2013. 8 (1): p. 137. Kanis, J.A., et al., A meta-analysis of previous fracture and subsequent fracture risk. Bone, 2004. 35 (2): p. 375-82. Klotzbuecher, C.M., et al., Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res, 2000. 15 (4): p. 721-39. Rubenstein, L.Z., C.M. Powers, and C.H. MacLean, Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Ann Intern Med, 2001. 135 (8 Pt 2): p. 686-93. Lenze, E.J., et al., Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture. Int J Geriatr Psychiatry, 2004. 19 (5): p. 472-8. Delbaere, K., et al., Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study. Bmj, 2010. 341 : p. c4165. Friedman, S.M., et al., Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc, 2002. 50 (8): p. 1329-35. Gagnon, N., et al., Affective correlates of fear of falling in elderly persons. Am J Geriatr Psychiatry, 2005. 13 (1): p. 7-14. Hajek, A. and H.-H. König, The association of falls with loneliness and social exclusion: evidence from the DEAS German Ageing Survey. BMC Geriatrics, 2017. 17 (1): p. 204. Howland, J., et al., Fear of falling among the community-dwelling elderly. J Aging Health, 1993. 5 (2): p. 229-43. Hadjistavropoulos, T., K. Delbaere, and T.D. Fitzgerald, Reconceptualizing the role of fear of falling and balance confidence in fall risk. J Aging Health, 2011. 23 (1): p. 3-23. Harding, S. and A. Gardner, Fear of falling. Australian Journal of Advanced Nursing, 2009. 27 : p. 94-100. Legters, K., Fear of falling. Phys Ther, 2002. 82 (3): p. 264-72. Alexiou, K.I., et al., Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clin Interv Aging, 2018. 13 : p. 143-150. Dyer, S.M., et al., A critical review of the long-term disability outcomes following hip fracture. BMC Geriatrics, 2016. 16 (1): p. 158. Evitt, C.P. and P.A. Quigley, Fear of falling in older adults: a guide to its prevalence, risk factors, and consequences. Rehabil Nurs, 2004. 29 (6): p. 207-10. Kosorok, M.R., et al., Restricted activity days among older adults. Am J Public Health, 1992. 82 (9): p. 1263-7. Salkeld, G., et al., Quality of life related to fear of falling and hip fracture in older women: a time trade off study. Bmj, 2000. 320 (7231): p. 341-6. Tinetti, M.E. and C.S. Williams, The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci, 1998. 53 (2): p. M112-9. James, S.L., et al., The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017. Inj Prev, 2020. 26 (Supp 1): p. i3-i11. Kwan, M.M., et al., Falls incidence, risk factors, and consequences in Chinese older people: a systematic review. J Am Geriatr Soc, 2011. 59 (3): p. 536-43. Gill, T.M., et al., Association of injurious falls with disability outcomes and nursing home admissions in community-living older persons. Am J Epidemiol, 2013. 178 (3): p. 418-25. Hartholt, K.A., et al., Mortality From Falls Among US Adults Aged 75 Years or Older, 2000-2016. Jama, 2019. 321 (21): p. 2131-2133. Luebbert, S., et al., Falls in Senior Adults: Demographics, Cost, Risk Stratification, and Evaluation. Mo Med, 2022. 119 (2): p. 158-163. Burns, E.R., J.A. Stevens, and R. Lee, The direct costs of fatal and non-fatal falls among older adults - United States. J Safety Res, 2016. 58 : p. 99-103. Heinrich, S., et al., Cost of falls in old age: a systematic review. Osteoporos Int, 2010. 21 (6): p. 891-902. Ou, W., et al., Hospitalization costs of injury in elderly population in China: a quantile regression analysis. BMC Geriatr, 2023. 23 (1): p. 143. Ganz, D.A. and N.K. Latham, Prevention of Falls in Community-Dwelling Older Adults. N Engl J Med, 2020. 382 (8): p. 734-743. Florence, C.S., et al., Medical Costs of Fatal and Nonfatal Falls in Older Adults. J Am Geriatr Soc, 2018. 66 (4): p. 693-698. Camp, K., S. Murphy, and B. Pate, Integrating Fall Prevention Strategies into EMS Services to Reduce Falls and Associated Healthcare Costs for Older Adults. Clin Interv Aging, 2024. 19 : p. 561-569. Haddad, Y.K., et al., Healthcare spending for non-fatal falls among older adults, USA. Inj Prev, 2024. 30 (4): p. 272-276. Montero-Odasso, M.M., et al., Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review. JAMA Netw Open, 2021. 4 (12): p. e2138911. NICE, Surveillance of Falls in Older People: Assessing Risk and Prevention (NICE Guideline CG161) . 2019, NICE: London. Mehta, J., Impact of vision on falls and fear of falling in older adults . 2020, University of Liverpool: Liverpool. Legood, R., P. Scuffham, and C. Cryer, Are we blind to injuries in the visually impaired? A review of the literature. Inj Prev, 2002. 8 (2): p. 155-60. Dhital, A., T. Pey, and M.R. Stanford, Visual loss and falls: a review. Eye, 2010. 24 (9): p. 1437-1446. Reed-Jones, R.J., et al., Vision and falls: a multidisciplinary review of the contributions of visual impairment to falls among older adults. Maturitas, 2013. 75 (1): p. 22-8. Black, A. and J. Wood, Vision and falls. Clin Exp Optom, 2005. 88 (4): p. 212-22. Saftari, L.N. and O.-S. Kwon, Ageing vision and falls: a review. Journal of Physiological Anthropology, 2018. 37 (1): p. 11. Grisso, J.A., et al., RISK-FACTORS FOR FALLS AS A CAUSE OF HIP FRACTURE IN WOMEN. New England Journal of Medicine, 1991. 324 (19): p. 1326-1331. Tran, T.H., et al., [Visual impairment in elderly fallers]. J Fr Ophtalmol, 2011. 34 (10): p. 723-8. Jack, C.I., et al., Prevalence of low vision in elderly patients admitted to an acute geriatric unit in Liverpool: elderly people who fall are more likely to have low vision. Gerontology, 1995. 41 (5): p. 280-5. Ardaneh, M., M. Fararouei, and J. Hassanzadeh, Factors Contributing to Falls Leading to Fracture among Older Adults. Journal of Population Ageing, 2023. 16 (1): p. 121-135. Chew, F.L.M., et al., The association between various visual function tests and low fragility hip fractures among the elderly: A Malaysian experience. Age and Ageing, 2010. 39 (2): p. 239-245. Hoffman, G.J., et al., Posthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older. JAMA Netw Open, 2019. 2 (5): p. e194276. Hollinghurst, R., et al., Annual risk of falls resulting in emergency department and hospital attendances for older people: an observational study of 781,081 individuals living in Wales (United Kingdom) including deprivation, frailty and dementia diagnoses between 2010 and 2020. Age Ageing, 2022. 51 (8). Curran-Groome, W., et al., Risk Factors of Recurrent Falls Among Older Adults Admitted to the Trauma Surgery Department. Geriatr Orthop Surg Rehabil, 2020. 11 : p. 2151459320943165. Montero-Odasso, M., et al., World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing, 2022. 51 (9). Lamb, S.E., et al., A national survey of services for the prevention and management of falls in the UK. BMC Health Services Research, 2008. 8 (1): p. 233. RCP, Falling standards, broken promises Report of the national audit of falls and bone health in older people . 2011, RCP: London. RCP, National Audit of Inpatient Falls Annual Report Autumn 2022 . 2022. Koh, S.S., et al., Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals. BMC Health Serv Res, 2008. 8 : p. 105. Milisen, K., et al., Feasibility of implementing a practice guideline for fall prevention on geriatric wards: A multicentre study. International Journal of Nursing Studies, 2013. 50 (4): p. 495-507. Davenport, K., et al., Fall Prevention Knowledge, Attitudes, and Behaviors: A Survey of Emergency Providers. West J Emerg Med, 2020. 21 (4): p. 826-830. Parks, A., et al., Barriers and enablers that influence guideline-based care of geriatric fall patients presenting to the emergency department. Emerg Med J, 2019. 36 (12): p. 741-747. Ayton, D.R., et al., Barriers and enablers to the implementation of the 6-PACK falls prevention program: A pre-implementation study in hospitals participating in a cluster randomised controlled trial. PLoS One, 2017. 12 (2): p. e0171932. Barmentloo, L.M., et al., Barriers and Facilitators for Screening Older Adults on Fall Risk in a Hospital Setting: Perspectives from Patients and Healthcare Professionals. Int J Environ Res Public Health, 2020. 17 (5). Bauer, M.S. and J. Kirchner, Implementation science: What is it and why should I care? Psychiatry Research, 2020. 283 : p. 112376. Eccles, M.P. and B.S. Mittman, Welcome to Implementation Science. Implementation Science, 2006. 1 (1): p. 1. Bauer, M.S., et al., An introduction to implementation science for the non-specialist. BMC Psychology, 2015. 3 (1): p. 32. Breimaier, H.E., et al., The Consolidated Framework for Implementation Research (CFIR): a useful theoretical framework for guiding and evaluating a guideline implementation process in a hospital-based nursing practice. BMC Nurs, 2015. 14 : p. 43. Rangachari, P., S.S. Mushiana, and K. Herbert, A scoping review of applications of the Consolidated Framework for Implementation Research (CFIR) to telehealth service implementation initiatives. BMC Health Serv Res, 2022. 22 (1): p. 1450. Kirk, M.A., et al., A systematic review of the use of the Consolidated Framework for Implementation Research. Implementation Science, 2016. 11 (1): p. 72. Lyu, J., et al., Facilitators and barriers to implementing patient-reported outcomes in clinical oncology practice: a systematic review based on the consolidated framework for implementation research. Implement Sci Commun, 2024. 5 (1): p. 120. Lam, H., et al., Identifying actionable strategies: using Consolidated Framework for Implementation Research (CFIR)-informed interviews to evaluate the implementation of a multilevel intervention to improve colorectal cancer screening. Implement Sci Commun, 2021. 2 (1): p. 57. Dias, E.M., et al., Barriers to and facilitators of implementing colorectal cancer screening evidence-based interventions in federally qualified health centers: a qualitative study. BMC Health Serv Res, 2024. 24 (1): p. 797. Birken, S.A., et al., Criteria for selecting implementation science theories and frameworks: results from an international survey. Implement Sci, 2017. 12 (1): p. 124. Damschroder, L.J., et al., The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci, 2022. 17 (1): p. 75. Michie, S., M.M. van Stralen, and R. West, The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 2011. 6 (1): p. 42. Hennink, M.M., B.N. Kaiser, and V.C. Marconi, Code Saturation Versus Meaning Saturation: How Many Interviews Are Enough? Qual Health Res, 2017. 27 (4): p. 591-608. Greenebaum, J.B., Managing Impressions: “Face-Saving” Strategies of Vegetarians and Vegans. Humanity & society, 2012. 36 (4): p. 309-325. Allen, L., Managing masculinity: Young men's identity work in focus groups. Qualitative research, 2005. 5 (1): p. 35-57. Craven, K., et al., Embedding mentoring to support trial processes and implementation fidelity in a randomised controlled trial of vocational rehabilitation for stroke survivors. BMC Medical Research Methodology, 2021. 21 (1): p. 203. Gale, N.K., et al., Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 2013. 13 (1): p. 117. Tong, A., P. Sainsbury, and J. Craig, Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 2007. 19 (6): p. 349-357. Mathisen, T.S., et al., Barriers and facilitators to the implementation of a structured visual assessment after stroke in municipal health care services. BMC Health Serv Res, 2021. 21 (1): p. 497. Rowe, F.J., et al., Vision Screening Assessment (VISA) tool: diagnostic accuracy validation of a novel screening tool in detecting visual impairment among stroke survivors. BMJ Open, 2020. 10 (6): p. e033639. Rowe, F.J., et al., Visual Impairment Screening Assessment (VISA) tool: pilot validation. BMJ Open, 2018. 8 (3): p. e020562. NICE. NG236: Stroke rehabilitation in adults . 2023 02/10/2025]; Available from: https://www.nice.org.uk/guidance/ng236. NICE, Stroke rehabilitation in adults (update) [C] Evidence reviews for the clinical and costeffectiveness of routine specialist orthoptist assessment 2023. p. 1-48. Falkenberg, H., et al., Validation of the interdisciplinary Norwegian vision assessment tool KROSS in stroke patients admitted to hospital or rehabilitation services. Discover Health Systems, 2024. 3 . RCP, Look Out! Bedside vision check for falls prevention: assessment tool. , RCP, Editor. 2017. Baig, A., et al., Vision Screening in Older Adults Admitted with a Fragility Hip Fracture: A Healthcare Quality Improvement Report. Br Ir Orthopt J, 2023. 19 (1): p. 96-107. Grol, R.P., et al., Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q, 2007. 85 (1): p. 93-138. Dy, S.M., et al., A framework to guide implementation research for care transitions interventions. J Healthc Qual, 2015. 37 (1): p. 41-54. Ashok, M., et al., Framework for Research on Implementation of Process Redesigns. Qual Manag Health Care, 2018. 27 (1): p. 17-23. Greenhalgh, T., et al., Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q, 2004. 82 (4): p. 581-629. Simpson, D.D. and D.F. Dansereau, Assessing organizational functioning as a step toward innovation. Sci Pract Perspect, 2007. 3 (2): p. 20-8. Feldstein, A.C. and R.E. Glasgow, A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. Jt Comm J Qual Patient Saf, 2008. 34 (4): p. 228-43. Bodenheimer, T. and C. Sinsky, From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med, 2014. 12 (6): p. 573-6. Bodenheimer, T., E.H. Wagner, and K. Grumbach, Improving primary care for patients with chronic illness. Jama, 2002. 288 (14): p. 1775-9. Oswald, J.M., et al., Practice-research integration in the residential treatment of patients with severe eating and comorbid disorders. Psychotherapy (Chic), 2019. 56 (1): p. 134-148. Helfrich, C.D., et al., Determinants of Implementation Effectiveness: Adapting a Framework for Complex Innovations. Medical Care Research and Review, 2007. 64 (3): p. 279-303. Waltz, T.J., et al., Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implement Sci, 2019. 14 (1): p. 42. O'Cathain, A., et al., Guidance on how to develop complex interventions to improve health and healthcare. BMJ Open, 2019. 9 (8): p. e029954. Crowe, S., et al., The case study approach. BMC Medical Research Methodology, 2011. 11 (1): p. 100. Yin, R.K., Case study research, design and method . 4th edition ed. 2009, London: Sage. Dahlin-Ivanoff, S., et al., Research collaboration with older people as a matter of scientific quality and ethics: a focus group study with researchers in ageing and health. Research Involvement and Engagement, 2024. 10 (1): p. 6. Ivanoff, S.D. and J. Hultberg, Understanding the multiple realities of everyday life: basic assumptions in focus-group methodology. Scand J Occup Ther, 2006. 13 (2): p. 125-32. Supplementary Files AnonymousTopicGuideFocusGroupsHPv1.020241017.docx Matrix.docx Thematicframework.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revisions 12 Feb, 2026 Reviewers agreed at journal 05 Jan, 2026 Reviewers invited by journal 29 Dec, 2025 Editor assigned by journal 26 Dec, 2025 First submitted to journal 22 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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10:39:33","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":199814,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8425555/v1/4f75c6289835d4ef857dbfce.html"},{"id":99291964,"identity":"f7ee6d90-f172-4482-b9de-1ca4cc48c38e","added_by":"auto","created_at":"2025-12-31 10:39:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":325420,"visible":true,"origin":"","legend":"\u003cp\u003eDiagram of the six inductively derived overlapping themes that were mapped to deductively coded CFIR constructs\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eKey: White circles- six overlapping themes. Coloured areas- mapped CFIR constructs. Orange, green and purple areas- highlight where themes map to ‘Capability’, ‘Opportunity’ and ‘Motivation’ (COM-B) constructs specifically. All themes mapped to the construct ‘Motivation’, therefore it was placed at the intersection of all the themes. Blue area- other CFIR constructs that were mapped to themes, as indicated by dashed lines.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8425555/v1/5194baf969ffef09deb3927e.png"},{"id":99291955,"identity":"b7814287-4c53-4062-b1dd-175864f7a772","added_by":"auto","created_at":"2025-12-31 10:39:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":164456,"visible":true,"origin":"","legend":"\u003cp\u003eCFIR constructs coded from the data from each CFIR domain\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8425555/v1/d1738ce5886d764623d8aab7.png"},{"id":99324404,"identity":"4edfbc0c-5a78-4cea-8f12-a5dfaf40382f","added_by":"auto","created_at":"2025-12-31 16:47:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1597916,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8425555/v1/a9f5a956-3cc0-4681-a63d-a7d42f16d531.pdf"},{"id":99291977,"identity":"4eef6678-c8e3-444b-81d6-01eb4ff8c9b8","added_by":"auto","created_at":"2025-12-31 10:39:29","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":23510,"visible":true,"origin":"","legend":"","description":"","filename":"AnonymousTopicGuideFocusGroupsHPv1.020241017.docx","url":"https://assets-eu.researchsquare.com/files/rs-8425555/v1/f87188a73f5cdc9f48f0a9be.docx"},{"id":99291979,"identity":"be4cbed7-b3cd-4011-b4dc-0527748c1ef0","added_by":"auto","created_at":"2025-12-31 10:39:29","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":65216,"visible":true,"origin":"","legend":"","description":"","filename":"Matrix.docx","url":"https://assets-eu.researchsquare.com/files/rs-8425555/v1/7893afc2f17e44abd21efacd.docx"},{"id":99321051,"identity":"1e5ed7a9-1d02-49ef-a939-4733451893f1","added_by":"auto","created_at":"2025-12-31 16:39:08","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":30824,"visible":true,"origin":"","legend":"","description":"","filename":"Thematicframework.docx","url":"https://assets-eu.researchsquare.com/files/rs-8425555/v1/17ce1f33bf23b542948c7354.docx"}],"financialInterests":"","formattedTitle":"Health professional perspectives on vision screening in older adults who attend hospital following a fall: a focus group study","fulltext":[{"header":"Key summary points","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eAim:\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis study aimed to explore barriers and facilitators to vision screening in older adults attending hospital following a fall, from the perspectives of the falls MDT in an acute hospital.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eFindings:\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003ePerceived capability and confidence, lack of referral networks and integration of eye care professionals in falls MDTs were key barriers to vision screening. Vision screening aligned with perspectives of person-centred falls care but conflicted with task-focussed acute care.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eMessage:\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eStaff training, integrated screening tools, clear guidance, support in job plans and implementation planning with eye care professionals, could facilitate vision screening for older adults attending hospital following a fall.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eGlobally, falls occur at least once a year in approximately a third of people aged \u0026ge;65 years and the prevalence increases with age.[1-5] Falling can have serious physical[6-9]\u0026nbsp;[10-13]\u0026nbsp;and psychosocial implications for affected individuals\u0026nbsp;[14-21]\u0026nbsp;with loss of independence[20-27], increased disability[28-30]\u0026nbsp;and mortality.[31]\u0026nbsp;Worldwide, health and social care services face mounting costs related to falls management,[22, 32-39]\u0026nbsp;due to ageing populations and the expected increase in number of falls.[40, 41]\u003c/p\u003e\n\u003cp\u003eImpaired vision\u0026nbsp;almost doubles the risk of falling[42-47] and\u0026nbsp;is more prevalent in older adults acutely admitted to hospital with falls, compared to those admitted without falls[48-50]\u0026nbsp;and non-fallers in the community.[50-52]\u0026nbsp;People who fall and attend an Emergency Department (ED) or who are hospitalised following a fall are at increased risk for further falls and fall-related readmissions.[53-55]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOpportunistic assessment and prompt management of impaired vision in older people attending acute hospitals following a fall, may help reduce recurrent falls risk and the associated burden on health and social care services.[56]\u0026nbsp;As part of multifactorial falls risk assessment, national and international guidance recommends assessing and managing impaired vision in older adults who attend a healthcare setting following a fall.[4, 40]\u0026nbsp;However,\u0026nbsp;implementation of these guidelines in acute hospitals is inconsistent.[57-59]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSurvey studies and qualitative research have explored barriers and facilitators to health care professionals (HCP) implementing falls prevention practice guidelines and falls risk screening in hospital wards, outpatient clinics and ED.[60-65] Barriers reported include: limited time, resources, communication between disciplines, patient motivation and health status, staff and patient knowledge, availability of support staff and champions, lack of ownership, lack of positive reinforcement and forgetting or being complacent about guidelines.[60-65] Facilitators included: innovation appropriateness, importance and attractiveness of innovations to users, patient and staff education and training, reminders, auditing practice, feedback, champions, use of data to inform practice change, leadership with clear goals and commitment to falls prevention.[60-65]\u003c/p\u003e\n\u003cp\u003eBarriers and facilitators to hospital vision screening for falls prevention has scarcely been studied. A survey\u0026nbsp;of 49 hospital HCPs working across 17 Belgian geriatric medicine wards, evaluated the feasibility of implementing a\u0026nbsp;multidisciplinary\u0026nbsp;practice guideline for inpatient falls prevention. The study included geriatricians, nurses, occupational therapists and physiotherapists.\u0026nbsp;Compared to other falls risk factors, including mobility impairments, medications and postural hypotension, \u0026nbsp;HCPs felt vision impairment was the risk factor they felt least capable of, or responsible for, assessing and managing[61].\u0026nbsp;Barriers and facilitators to vision screening in people attending hospital following a fall,\u0026nbsp;need to be better understood as an initial step towards developing appropriate interventions to improve routine vision screening.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDeterminant frameworks \u0026nbsp;facilitate a better understanding of the contextual factors influencing uptake of evidence-based practice in the real world.[66-68] The Consolidated Framework for Implementation Research (CFIR) is one of the most widely-used frameworks for implementation research in healthcare settings,[69-75] providing a structured approach to identifying barriers and facilitators to implementation. CFIR now incorporates the \u0026lsquo;Capability, Opportunity and Motivation\u0026rsquo; components of the COM-B Model, as constructs within the \u0026lsquo;Characteristics\u0026rsquo; subdomain.[76] COM-B, which forms the basis of the \u0026lsquo;Behaviour Change Wheel\u0026rsquo;, helps understand how human behaviours are generated through interplay between individual capability, opportunity and motivation.[77] This study aimed to use CFIR to explore barriers and facilitators to vision screening in older adults attending hospital following a fall, from the perspectives of the falls Multidisciplinary Team (MDT) in an acute hospital.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA case study approach was used to purposively recruit HCPs at a single large National Health Service (NHS) teaching hospital in the East Midlands of the UK.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants were recruited via posters, staff newsletters and bulletins, and cascaded via email to relevant clinical teams. Participants were eligible if they were aged\u0026nbsp;18 years or older and involved in the care of older adults who attend hospital following a fall, in their current or previous role at the hospital.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFocus groups were organised until data saturation was reached.[78] Five 60-90 minute in-person focus groups were held in a hospital meeting or training room between February and June 2025. Only participants and facilitators were present at focus groups.\u0026nbsp;Participants initially completed a demographic questionnaire asking about age, gender, ethnicity, highest educational qualification, current profession, years of relevant experience, last eye test and ocular history.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA semi-structured topic guide was informed by CFIR supported discussions. The topic guide was reviewed by the research team, stakeholders, patient and public involvement (PPI) advisory group and colleagues prior to use (Appendix 1.). Participants\u0026nbsp;discussed: the role of impaired vision in falls, the importance of assessing vision in hospital for older adults attending following a fall, barriers and facilitators to doing so, and the involvement of Eye Care Professionals (ECP) in falls management. Data were recorded digitally and handwritten field notes taken by facilitators.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll participants provided informed consent before participating. The study received approvals from the Health Research Authority (HRA), Health and Care Research Wales (HCRW) and the East Midlands - Nottingham 2 Research Ethics Committee and adheres to the Declaration of Helsinki. The study protocol was published on ClinicalTrials.gov, ID: NCT06645080.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch team and reflexivity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor AB conducted the focus groups as part of a PhD study. AC was co-facilitator and a member of the PhD supervisory team. AC has extensive experience in focus group research, particularly in rehabilitation and dementia. Both facilitators were female, AB is an orthoptist and AC a physiotherapist. Both have shared experience working at the hospital and caring for older people following a fall. This helped create a comfortable non-judgmental environment, enabling participants to speak openly.[79, 80]\u0026nbsp; KR, AG and JM were members of the supervisory team and have expertise in mixed-methods research related to the healthcare of older people. KR is a female professor in rehabilitation research and occupational therapist by background. AG is a male professor in care of older people and a geriatrician.\u0026nbsp;JM\u0026nbsp;is a female lecturer in orthoptics. The team are geographically dispersed and reflect some of the professions within a falls MDT and ophthalmology.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eData analysis\u003c/h2\u003e\n\u003cp\u003eDemographic data was inputted onto Microsoft Excel and summarised using descriptive statistics.\u0026nbsp;\u0026nbsp;The first two focus group recordings were manually transcribed verbatim by AB. Subsequent recordings were transcribed using an automated transcription service. All transcripts were anonymized and cleaned by AB. Transcripts were not returned to participants for correcting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTranscripts were coded inductively using thematic framework analysis then deductively using CFIR. Inductive coding enabled data-led theme development and a deeper exploration of themes in relation to the case study.[81] Deductive coding using CFIR, ensured\u0026nbsp;key contextual factors influencing implementation were not missed.[76]\u0026nbsp;Inductively developed themes were mapped to deductively coded CFIR constructs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInitially, two transcripts were coded independently by AB and AC.\u0026nbsp;Coding partners met to compare codes and develop a thematic framework, which was then applied to the remaining transcripts by AB.[82]\u0026nbsp;(Appendix 2.).\u0026nbsp;Themes were refined by the coding partners, research team, stakeholders and PPI advisory group. A matrix thematically charted data, for each focus group (Appendix 3.).\u0026nbsp;Coding partners kept a diary of reflexive notes, which together with field notes, were integrated into the results and discussion.[82]\u0026nbsp;Participants were not asked to provide feedback on findings before reporting.\u003c/p\u003e\n\u003cp\u003eThis study is reported following the Consolidated criteria for Reporting Qualitative research (COREQ).[83]\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eParticipant characteristics\u003c/h2\u003e\n \u003cp\u003eNineteen participants were recruited, comprising two males and 17 females. Participants were aged between 18 and 54 and eight were of non-white ethnicity. They came from a range of professional backgrounds, were mostly employed in inpatient settings and had varying experience caring for older people and people who had fallen (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Eleven participants reported having an eye test in the past two years and these participants had glasses prescribed, which they wore at least sometimes.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographics of included participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDemographics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eParticipants (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(89.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026ndash;34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u0026ndash;44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(47.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u0026ndash;54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eEthnicityd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhite (British)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(57.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAsian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlack/ African/ Caribbean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMixed/ multiple ethnic groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"7\"\u003e\n \u003cp\u003eProfession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysiotherapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealthcare assistant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(26.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOccupational therapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysiotherapy assistant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdvanced clinical nurse practitioner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrthoptist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eYears of experience working with older patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess than a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 to 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 to 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 to 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(26.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eYears of experience working within falls MDT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess than a year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 to 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 to 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 to 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePrimary work setting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(84.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eKey: MDT-Multi Disciplinary Team\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eThematic findings\u003c/h3\u003e\n\u003cp\u003eData saturation was reached after five focus groups. Six overlapping themes were identified, related to HCP\u0026rsquo;s views on vision screening in older adults who attend hospital following a fall. These encompassed: current practice, acute pressures, priorities in acute care, roles and responsibilities, knowledge gap and confidence, networks and pathways (Fig. 1). Themes mapped to 14 different CFIR constructs also shown in Fig. 1, including all three COM-B components embedded as constructs within CFIR. Figure \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows the CFIR constructs coded from the data and the CFIR domains they belonged to. Most data was coded against constructs from the \u0026lsquo;Inner setting\u0026rsquo; and \u0026lsquo;Individuals\u0026rsquo; domains.\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the themes, sub-themes, mapped CFIR constructs and example findings summarised from the data highlighting the key barriers and facilitators to vision screening. Themes and mapped CFIR-constructs from Fig. 1 are further described below. Additional data supporting each theme can be found in Appendix 3.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eKey barriers and facilitators identified from thematic findings with mapped CFIR constructs\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTheme\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTheme definition\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSubthemes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMapped CFIR construct\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eB/F\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExample finding summarised from data\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eNetworks and pathways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eNetworking and communication between the falls MDT and ECPs.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnclear management pathways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Partnerships and connections\u003c/p\u003e\n \u003cp\u003e\u0026bull; Communications\u003c/p\u003e\n \u003cp\u003e\u0026bull; Relational connections\u003c/p\u003e\n \u003cp\u003e\u0026bull; Opportunity\u003c/p\u003e\n \u003cp\u003e\u0026bull; Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe falls MDT don\u0026rsquo;t know how to refer to an eye care professional if they detect a vision problem.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnfamiliarity with eye care professionals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Access to knowledge and information\u003c/p\u003e\n \u003cp\u003e\u0026bull; Relational connections\u003c/p\u003e\n \u003cp\u003e\u0026bull; Opportunity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe falls MDT do not have established communication networks or points of contact with the ophthalmology department.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003ePriorities in acute care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eIndividual and collective perceptions of vision screening in older adults who attend hospital following a fall and the priority of vision screening in acute care.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImportance of vision in falls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Mission alignment\u003c/p\u003e\n \u003cp\u003e\u0026bull; Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParticipants agreed impaired vision was an important falls risk factor.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcute conditions take priority\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Relative priority\u003c/p\u003e\n \u003cp\u003e\u0026bull; Opportunity\u003c/p\u003e\n \u003cp\u003e\u0026bull; Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImpaired vision was not viewed as an acute condition. Therefore, it could be managed in the community.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrompts to consider vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Relative priority\u003c/p\u003e\n \u003cp\u003e\u0026bull; Opportunity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncorporating a vision assessment onto existing (electronic) falls checklists would remind staff to complete it.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImportance of assessing vision in hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Mission alignment\u003c/p\u003e\n \u003cp\u003e\u0026bull; Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParticipants agreed that impaired vision can affect hospital rehabilitation and have knock-on effects on health outcomes.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverprotecting inpatients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Recipient-centeredness\u003c/p\u003e\n \u003cp\u003e\u0026bull; Opportunity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStaff doing things for patients may make it difficult to identify those that are struggling with their vision.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eKnowledge gap and confidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eLimited training and confidence amongst HCPs in assessing vision.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTraining gap across staff groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u0026bull; Access to knowledge and information\u003c/p\u003e\n \u003cp\u003e\u0026bull; Capability\u003c/p\u003e\n \u003cp\u003e\u0026bull; Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStaff do not receive training on how to assess vision.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreferred training modes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThere are opportunities to train staff in existing departmental weekly/monthly teaching sessions.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssessing vision in cognitively impaired patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStaff felt it would be difficult to assess vision in cognitively impaired patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Physical and Information Technology Infrastructure\u003c/p\u003e\n \u003cp\u003e\u0026bull; Capability\u003c/p\u003e\n \u003cp\u003e\u0026bull; Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA physical aid, such as an (electronic) vision screening tool would help guide staff vision assessments.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAcute pressures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eWorking pressures in acute settings affected the opportunity of staff to assess vision in older adults who attend hospital following a fall.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEquipment and space availability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Physical infrastructure\u003c/p\u003e\n \u003cp\u003e\u0026bull; Available resources\u003c/p\u003e\n \u003cp\u003e\u0026bull; Opportunity\u003c/p\u003e\n \u003cp\u003e\u0026bull; Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot having readily available vision assessment equipment would deter staff from assessing vision.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTime and staffing burden\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Available resources\u003c/p\u003e\n \u003cp\u003e\u0026bull; Compatibility\u003c/p\u003e\n \u003cp\u003e\u0026bull; Opportunity\u003c/p\u003e\n \u003cp\u003e\u0026bull; Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA lengthy vision assessment would be difficult to integrate into already busy job plans.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCurrent practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHCPs described their current practice in relation to the assessment of vision in older adults who attend hospital following a fall.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClinical impact of formal assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Innovation complexity\u003c/p\u003e\n \u003cp\u003e\u0026bull; Access to knowledge and information\u003c/p\u003e\n \u003cp\u003e\u0026bull; Recipient-centeredness\u003c/p\u003e\n \u003cp\u003e\u0026bull; Capability\u003c/p\u003e\n \u003cp\u003e\u0026bull; Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCurrent assessments have low clinical impact as they are not thorough enough.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInformal observational assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Mission alignment\u003c/p\u003e\n \u003cp\u003e\u0026bull; Recipient-centeredness\u003c/p\u003e\n \u003cp\u003e\u0026bull; Capability\u003c/p\u003e\n \u003cp\u003e\u0026bull; Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStaff detect impaired vision through observational assessments.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eRoles and responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003ePerceptions of the roles responsibilities of HCPs in the falls MDT related to vision screening in older adults who attend hospital following a fall.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eRoles of falls MDT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Work infrastructure\u003c/p\u003e\n \u003cp\u003e\u0026bull; Opportunity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo clear responsibility for assessing vision.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Work infrastructure\u003c/p\u003e\n \u003cp\u003e\u0026bull; Mission alignment\u003c/p\u003e\n \u003cp\u003e\u0026bull; Compatibility\u003c/p\u003e\n \u003cp\u003e\u0026bull; Opportunity\u003c/p\u003e\n \u003cp\u003e\u0026bull; Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShared responsibility would improve screening coverage.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient knowledge and engagement in self-care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026bull; Local attitudes\u003c/p\u003e\n \u003cp\u003e\u0026bull; Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatients don\u0026rsquo;t adhere to advice regarding vision.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003eKey: B-Barrier, F-Facilitator, MDT-Multi Disciplinary Team, ECP-Eye Care Professional, HCP-Health Care Professional\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eNetworks and pathways\u003c/h3\u003e\n\u003cp\u003eThis theme related to lack of networking and communication between the falls MDT and ECPs. Despite support for multidisciplinary falls management and collaboration with ECPs, participants often lacked understanding of different ECP roles. Communication between ward-based staff and ECPs, who were predominantly outpatient-based, was limited.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e[FG5 Physiotherapist1] \u0026ldquo;You tend to see like, the similar people, like you see people like therapies and then like SALT and dietetics. And it is. It is literally just if you see someone more often, you\u0026apos;re gonna remember,\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThis theme crosscut the Outer setting, Inner setting and Individual CFIR domains, as participants were unsure about when and how to refer patients to hospital or community eye services. It was largely seen as the medical team\u0026rsquo;s role to liaise with ECPs if needed. Lack of clear referral criteria and management pathways for impaired vision were viewed as significant deterrents to assessing vision, rendering assessments \u0026lsquo;tokenistic\u0026rsquo; without clear routes for forward referral. Clear referral criteria and a recognized point of contact were seen as facilitators to vision screening.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e[FG1 Physiotherapist1] \u0026ldquo;\u0026hellip;a lot of the time people aren\u0026rsquo;t comfortable with doing certain assessments because, ok if you find out there\u0026rsquo;s a deficit, now what?...when we ask questions it\u0026rsquo;s really important that that\u0026rsquo;s then relevant and followed-up and we\u0026rsquo;re not just asking questions for questions sake.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThis theme mapped to multiple CFIR constructs, including: \u0026lsquo;Partnerships and Connections\u0026rsquo;, \u0026lsquo;Relational Connections\u0026rsquo; and \u0026lsquo;Communications\u0026rsquo;. These constructs relate to internal and external networks, relationships and information sharing practices between the hospital falls MDT, and hospital and community eye services.[\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e] This theme also mapped to the \u0026lsquo;Access to Knowledge and Information\u0026rsquo; construct, which refers to accessing guidance and training to implement practices,[\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e] including guidance on referral criteria and management pathways for impaired vision.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003ePriorities in acute care\u003c/h2\u003e\n \u003cp\u003eParticipants from all professional backgrounds believed vision to be an important falls risk factor, but one that did not receive enough attention in acute care. This mapped to the \u0026lsquo;Relative Priority\u0026rsquo; and \u0026lsquo;Mission Alignment\u0026rsquo; CFIR constructs. \u0026lsquo;Relative Priority\u0026rsquo; relates to the importance given to assessing vision compared to other initiatives[\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e].\u0026rsquo;Mission Alignment\u0026rsquo; refers to the degree to which assessing vision aligns with the perceived purpose, or goals, of the hospital falls MDT.[\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e] The relative priority of assessing vision in acute falls care was low compared with other assessments, such as blood pressure or medication reviews. This was said to be because impaired vision was infrequently considered to be the reason for admission or the fall, an acute condition, or one that affected hospital discharge. Managing these other conditions was considered to be more aligned with the mission of the falls MDT in an acute hospital than vision assessment.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e[FG5 Healthcare Assistant1] \u0026ldquo;I\u0026apos;m just thinking about lots of different other aspects that might affect a patient. For example, like I said, pressure sores and things like pain or\u0026hellip; the condition of why they\u0026apos;re there. So, I guess vision, even though it does come in briefly. I\u0026apos;m thinking about lots of other things that must be done for the patient\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eGlasses were often said to be used as a visible cue prompting staff to investigate impaired vision, or remind patients to wear their own glasses. To prompt staff to complete vision assessments, participants suggested adding vision assessments to existing mandatory falls assessment checklists.\u003c/p\u003e\n \u003cp\u003eParticipants felt corrected vision could aid inpatient rehabilitation, diagnosing multifactorial causes for falls and considering unexplained deficits in other areas, such as mobility. The patient\u0026rsquo;s functional independence and quality of hospital stay could also be impacted by impaired vision. \u0026ldquo;Knock-on\u0026rdquo; effects of impaired vision included: effects on eating, drinking, taking medication, mobility and causing anxiety, which could potentially lead to malnutrition, dehydration and deconditioning.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e[FG1 Healthcare Assistant 1] \u0026ldquo;Cos if the vision isn\u0026rsquo;t all that great, it all has a knock on effect, in the sense of like not being able to take the medication or malnutrition because they\u0026rsquo;re not eating or\u0026hellip;dehydration because they\u0026rsquo;re not seeing their drink to drink it\u0026hellip;.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eThis theme also mapped to the \u0026lsquo;Recipient Centeredness\u0026rsquo; construct, relating to the shared values, beliefs and norms of the falls MDT to support and care for patients.[\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e] Staff adapted the ward environment to protect and support patients. They ensured that objects patients needed and mobility aids were within reach and closely supervised patients when mobilising. Staff felt more inclined to do things for patients than to give them independence, in order to keep patients safe or save time. This was also thought to be expected by the patients. Participants appreciated that this culture might make it difficult to determine which patients were struggling with impaired vision without a routine vision assessment.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e[FG2 Physiotherapist 1] \u0026ldquo;It\u0026apos;s (vision) probably not like the first thing that comes to mind for me when I think of like\u0026hellip; What\u0026apos;s going to cause someone to fall? Especially like on a ward environment when people are maybe overprotected a little bit and are always walking around with someone\u0026hellip;.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e[FG2 Healthcare Assistant 1]\u003c/em\u003e \u0026ldquo;\u0026hellip;we are making sure that all the things near their bed like the water, food, everything\u0026hellip;\u0026rdquo;\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eKnowledge gap and confidence\u003c/h3\u003e\n\u003cp\u003eRegardless of the number of years of experience or level of seniority, participants described limited training about vision. Individuals spoke of not feeling capable or confident to adequately assess vision, or manage impairments appropriately, particularly in patients with impaired cognition, who make up a significant proportion of their work. This theme mapped to CFIR\u0026rsquo;s \u0026lsquo;Access to \u0026lsquo;Knowledge and Information\u0026rsquo; construct.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e[FG3 Physiotherapy assistant 1] \u0026ldquo;I\u0026apos;ve been HCOP, with HCOP for 11 years now. I\u0026apos;ve never really had specific teaching on eyesight\u0026hellip;\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e[FG2 Physiotherapist 1] \u0026ldquo;Especially like lots of cognitive(ly impaired) patients. I don\u0026apos;t know how I\u0026apos;d possibly try and do like a mini eye test.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eParticipants were keen to learn and confident that training needs could be accommodated by protected teaching time. Participants recommended resources such as information posters for staff and patients, patient information leaflets and an electronic vision assessment tool to help guide assessments, incorporated into existing falls checklists. The \u0026lsquo;Physical and Information Technology Infrastructure\u0026rsquo; constructs mapped here, as they capture material components or technological systems that might support vision screening in the acute hospital setting.[\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e]\u003c/p\u003e\n\u003ch3\u003eAcute pressures\u003c/h3\u003e\n\u003cp\u003eThe lack of readily available vision assessment equipment, competing tasks, staff shortages and limited time were said to affect the opportunity of staff to assess vision. This mapped to the \u0026lsquo;Available Resources\u0026rsquo; and \u0026lsquo;Physical Infrastructure\u0026rsquo; CFIR constructs, which together relate to the availability of physical space, materials and equipment to support implementation of vision screening.[\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e]\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e[FG1 Occupational Therapist 1] \u0026ldquo;\u0026hellip;just getting you to do another, another thing in a list of a hundred jobs I\u0026rsquo;m tryna do\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThe \u0026lsquo;Compatibility\u0026rsquo; construct, which is concerned with the fit of vision screening with current \u0026ldquo;workflows, systems and processes\u0026rdquo;[\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e] was also mapped to this theme. Participants reflected on the current organisational climate i.e. the limited resources of their acute setting, to suggest that a brief bedside vision assessment that does not require specialist equipment, could aid compatibility with their current ways of working.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eCurrent practice\u003c/h2\u003e\n \u003cp\u003eWithin this theme, participants described current practice in relation to the assessment of vision in older adults attending hospital following a fall. Current nursing protocols and falls checklists used by participants in this study incorporate a basic vision assessment, e.g. presence or absence of glasses. These assessments are performed 2-hourly throughout the day. Therapist assessments are not repeated but ask broad questions about visual issues. Many participants felt assessments were unhelpful in understanding the patient\u0026rsquo;s true level of vision.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e[FG1 Healthcare Assistant 2] \u0026ldquo;You\u0026rsquo;re not really using that (assessment)... or actually know the truth about it (vision),\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eSome participants\u0026rsquo; displeasure was evident in their tone, facial expressions and language, describing the assessments as \u003cem\u003e\u0026ldquo;tokenistic\u0026rdquo;\u003c/em\u003e, a \u003cem\u003e\u0026ldquo;ritual\u0026rdquo;\u003c/em\u003e and \u003cem\u003e\u0026ldquo;ticking a box\u0026rdquo;\u003c/em\u003e. The assessments were described as \u0026ldquo;not person-centred\u0026rdquo;, which related to the \u0026lsquo;Mission Alignment\u0026rsquo; and \u0026lsquo;Recipient-Centeredness\u0026rsquo; constructs, as person-centred care is integral to how HCPs construct their worldview.[\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e] The lack of depth of assessments reduced the impact on clinical practice and their person-centredness. This mapped to the \u0026lsquo;Innovation Complexity\u0026rsquo; construct, which relates to scope and degree of complexity of the vision screening assessment. Participants suggested a more in-depth vision assessment, at critical time points, such as at admission, would have more clinical impact.\u003c/p\u003e\n \u003cp\u003eNurses, HCAs and therapists realised through discussion that they regularly performed observational assessments of functional vision and adapted the ward environment accordingly, as mentioned previously. Observations included: how steadily the patient mobilised, how accurately they reached for objects, their eye-contact and interactions with members of staff.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e[FG3 Physiotherapy assistant 1] \u0026ldquo;But it\u0026apos;s it\u0026apos;s just one of those things that you don\u0026apos;t actually think about. So, thinking about it. We actually do it on the every day, quite regularly. You don\u0026apos;t realise it\u0026apos;s, I don\u0026apos;t know.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eRoles and responsibilities\u003c/h2\u003e\n \u003cp\u003eWhen justifying responsibility for assessing vision in this patient group, Nurses, HCAs and therapists in this study compared compatibility of assessing vision within their job roles and how well vision assessments aligned with their professional goals. These discussions mapped to the \u0026lsquo;Compatibility\u0026rsquo; and \u0026lsquo;Mission Alignment\u0026rsquo; constructs. For example, physiotherapists believed that impaired vision affected safe mobilisation and was therefore their responsibility. Whilst nurses and HCAs felt many patients may be missed due to the limited working hours of therapists and that they may have greater opportunity to assess patients. Nursing staff also felt that they see patients more regularly and built closer relationships with them, allowing them to gain a better understanding of the patient\u0026rsquo;s level of vision.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e[FG2 Physiotherapist 1]: \u0026ldquo;I think if anything it could be more, \u0026hellip; like a therapy thing just because like in theory we\u0026apos;re the ones saying how someone should be mobilising. And if we think that they\u0026apos;re not safe to mobilise a certain way because of vision, maybe that should be on us to like assess and to hand that over to like nurses and HCAs.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e[FG2 Healthcare Assistant 2]: \u0026ldquo;\u0026hellip;as healthcare assistants you\u0026apos;re the first ones really because you guys might not get round to that patient until because you have a list don\u0026apos;t you go round to.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eParticipants concluded that vision assessments should be a shared responsibility between staff groups, as this would improve screening coverage, reduce burden on any single staff group and be more likely to detect and manage vision problems. A simple vision assessment that could be performed by any HCP in the falls MDT was therefore suggested as a facilitator for vision screening. This theme mapped directly to CFIR\u0026rsquo;s \u0026lsquo;Work Infrastructure\u0026rsquo; construct, which considers staffing levels, tasks and responsibilities of individuals and teams to support vision screening.[\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e] No participants mentioned the role of ECPs when discussing responsibility to vision screen.\u003c/p\u003e\n \u003cp\u003eParticipants also expressed that patients should take greater responsibility for having their eyes tested in the community, reminding themselves to wear glasses and communicating their visual needs to HCPs. However, they were also aware of potential barriers to doing this.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eMapping to COM-B constructs\u003c/h2\u003e\n \u003cp\u003eThree themes (Current practice, Networks and pathways, Knowledge gap and confidence) mapped to the \u0026lsquo;Capability\u0026rsquo; component of the COM-B model. This relates to \u0026ldquo;competence, knowledge and skills\u0026rdquo; staff need to implement vision screening.[\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e] The remaining three themes (Acute pressures, Priorities of acute care, Roles and responsibilities), mapped to \u0026lsquo;Opportunity\u0026rsquo;, reflecting whether staff have the \u0026ldquo;availability, scope and power\u0026rdquo; to implement vision screening.[\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e] The \u0026lsquo;Motivation\u0026rsquo; construct refers to the drive and commitment to implement vision screening.[\u003cspan class=\"CitationRef\"\u003e76\u003c/span\u003e] Barriers related to staff capability and opportunity, described above, affected commitment and implementation, therefore, all six themes mapped to \u0026lsquo;Motivation\u0026rsquo;.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to use CFIR to explore barriers and facilitators to vision screening in older adults attending hospital following a fall, from the perspectives of the falls MDT in an acute hospital. The themes and CFIR constructs identified in this study highlighted three overarching discourses related to factors affecting vision screening in older adults attending hospital following a fall. Firstly, lack of education and training on vision relevant to falls for non-ECPs. Secondly, the role of ECPs in the falls MDT, including lack of referral networks and integration in the team. Thirdly, prioritisation of task-focussed, rather than person-centred falls care in the acute setting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe most important barrier to assessing and managing impaired vision was a lack of knowledge and training resulting in lack of perceived capability and confidence. This is consistent with findings of a survey of ward-based geriatricians, occupational therapists, physiotherapists and nurses who identified vision impairment as the falls risk factor they felt least capable to assess and manage.[61] Nurses, physiotherapists and occupational therapists also identified the main individual-level barrier affecting implementation of the Competence, Rehabilitation of Sight after Stroke (KROSS) visual assessment tool in Norwegian stroke rehabilitation units as perceived capability and competence.[84] \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNon-medical members of the falls MDT rarely communicated with the ophthalmology department and did not consider ECPs as core members of the falls MDT. This led to reluctance to assess vision as HCPs did not know how to manage and refer patients with impaired vision to ECPs appropriately. Vision assessment tools and guidelines developed by ECPs have been successful in enabling vision screening and management by non-ECPs such as medical students, physicians, nurses, physiotherapists, occupational therapists and assistant nurses. This includes the Visual Impairment Screening Assessment (VISA) tool for patients following stroke and brain injuries[85, 86], National Institute for Health and Care Excellence NG236 Stroke Rehabilitation in Adults guideline[87, 88], and KROSS visual assessment tool.[89] The Look out! Bedside vision check[90] was also developed collaboratively with ECPs to prevent inpatient falls, but has not yet been validated. Where capacity permits, hospital ECPs such as orthoptists have also performed vision screening in older adults who attend hospital following a fall, specifically following neck of femur fracture.[91]\u003c/p\u003e\n\u003cp\u003eDespite not feeling capable of assessing and managing impaired vision, nursing staff and therapists in our study believed that vision screening in falls was their shared responsibility. This is in contrast to the study by Milisen et al, where participants of all professionals backgrounds felt that compared to other falls risk factors, they felt least responsible for assessing and managing impaired vision.[61] This may have been related to lack of perceived capability, however reasons for feeling least responsible were not given. Participants in our study expressed how detecting and managing impaired vision in falls patients aligned with individual and organisational goals, including: ensuring patient safety, rehabilitation, discharge preparation, improving health outcomes and quality of hospital stay.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVision screening was also considered more compatible with job plans when different staff groups worked together, as therapists may miss patients outside of their daytime working hours that nurses could capture. This echoes the findings of earlier work using the KROSS visual assessment tool in stroke units.[84], where unclear responsibilities, lack of interdisciplinary collaboration to share responsibility and workload and lack of integration of ECPs in the stroke MDT, were barriers to vision screening.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHCPs were motivated to implement vision screening in falls as they felt understanding the visual status of patients aligned with their person-centered priorities of patient safety, rehabilitation, improved health outcomes and quality of hospital stay for the patient. Participants relied on observational assessments of vision and expressed dissatisfaction with formal assessments of vision that lacked depth for detecting and managing impaired vision. Participants perceived formal vision assessments as a task they had to complete in line with local protocols but that had little if any clinical impact. They described a task-focussed organisational culture prioritising the management of acute conditions, the primary reason for admission, or those affecting discharge. This presented a barrier to implementation, as impaired vision did not fit these categories and created tension between commitment to person-centred care and feeling compelled to be task-focussed to meet organisational demands.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFindings from the current study can inform the development of interventions and implementation strategies for improving routine vision screening in older adults attending hospital following a fall. Thus improving acute hospital management of impaired vision contributing to falls. Lack of knowledge, perceived capability and confidence was related to the \u0026lsquo;Access to knowledge and information\u0026rsquo; and \u0026lsquo;Capability\u0026rsquo; constructs, suggesting the need for \u0026nbsp;effective training and access to relevant guidance and resources to increase staff competence, confidence and successful implementation.[92-95] Lack of referral networks, integration of ECPs into the falls MDT and undefined roles related to multiple CFIR constructs, including \u0026lsquo;Mission Alignment\u0026rsquo;, \u0026lsquo;Compatibility\u0026rsquo;, \u0026lsquo;Work infrastructure\u0026rsquo;, \u0026lsquo;Relational connections\u0026rsquo; and \u0026lsquo;Communication\u0026rsquo;. Successful implementation of innovations may be influenced by the innovation\u0026rsquo;s perceived alignment with organisational goals and a feeling of shared responsibility.[96] Implementation has also been found to be positively influenced by coordination and collaboration between specialities,[97] clearly defined roles[98, 99] and quality of communication within an organisation[95]. These reduce confusion and empower staff with guidance and support networks. \u0026nbsp;Finally, conflict between person-centred care and being task-focussed also related to multiple CFIR constructs, including \u0026lsquo;Mission Alignment\u0026rsquo;, \u0026lsquo;Compatibility\u0026rsquo;, \u0026lsquo;Recipient Centeredness\u0026rsquo;, \u0026lsquo;Motivation\u0026rsquo; and \u0026lsquo;Available Resources\u0026rsquo;. Patient-centred care[100] has been found to be a predictor of implementation success, as has perceived mission alignment,[101] as the innovation then receives buy in and commitment from staff.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFindings mapped to COM-B components could be used with the Behaviour Change Wheel to design interventions aimed at changing individual behaviours.[77] Whilst findings mapped to other CFIR constructs could be applied with compatible tools, such as the Expert Recommendations for Implementing Change for implementation strategy planning and design.[71, 102] The perspectives of the medical team and patients also need to be explored to ensure all relevant stakeholders are involved for successful implementation planning.[103]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe key strengths of this study related to the combined inductive and deductive coding using CFIR, which enabled a comprehensive approach to data analysis.[81]\u0026nbsp;A case-study approach, meanwhile, supported in-depth understanding of barriers in the acute hospital context,[104, 105]\u0026nbsp;making findings transferable to similar settings. Group heterogeneity and small group sizes were also a strength of this study. \u0026nbsp;Our participants were heterogenous in professional background, years of experience, age and ethnicity, reflecting the mix of HCPs involved in the care of older adults. This added richness to the data and allowed a more holistic approach to the subject. As with Dahlin-Ivanoff we found that small heterogenous groups were dynamic and easier to manage contributions of participants.[106, 107]\u003c/p\u003e\n\u003cp\u003eKey limitations of the study relate to the findings coming from a single hospital, which is likely to limit generalisability and the fact that we weren\u0026rsquo;t able to recruit from the full multidisciplinary team, particularly our inability to recruit any doctors to the study. While their perspectives would have been useful, as they take overall responsibility for patient care, medical staff may have introduced a power imbalance and influenced freedom of expression. Although nurses and allied health professionals may be more likely to perform vision screening, medical support or lack thereof, could influence uptake of this in practice.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFocus groups with HCPs identified barriers and facilitators to vision screening in older adults attending acute hospitals following a fall. HCPs were motivated to vision screen and felt it aligned with person-centred falls care, however individual and contextual barriers related to staff capability and opportunity in the acute setting affected implementation. There is a need for multi-component and multi-level interventions and implementation strategies to: integrate ECPs into the falls MDT, engage supportive leaders, develop an effective vision screening assessment with accompanying guidance, define roles, responsibilities and management pathways, organise individual training and time allocation for staff to perform screening.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Vivensa Foundation [ARHV23\\1]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approvals\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the the Health Research Authority (HRA),Health and Care Research Wales (HCRW) and the East Midlands - Nottingham 2 Research Ethics Committee [REC reference: 25/EM/0001, 06/12/2024]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm that the data supporting the findings of this study are available within the article and/or its appendices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Aishah Baig and Alison Cowley. The first draft of the manuscript was written by Aishah Baig and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Supervision was provided by authors Kate Radford, Alison Cowley, Jignasa Mehta and Adam Gordon.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBergen, G., M.R. Stevens, and E.R. Burns, \u003cem\u003eFalls and Fall Injuries Among Adults Aged \u0026ge;65 Years - United States, 2014.\u003c/em\u003e MMWR Morb Mortal Wkly Rep, 2016. \u003cstrong\u003e65\u003c/strong\u003e(37): p. 993-998.\u003c/li\u003e\n\u003cli\u003eSalari, N., et al., \u003cem\u003eGlobal prevalence of falls in the older adults: a comprehensive systematic review and meta-analysis.\u003c/em\u003e J Orthop Surg Res, 2022. \u003cstrong\u003e17\u003c/strong\u003e(1): p. 334.\u003c/li\u003e\n\u003cli\u003eAlqahtani, B.A., et al., \u003cem\u003ePrevalence of falls among older adults in the Gulf Cooperation Council countries: A systematic review and meta-analysis.\u003c/em\u003e Archives of Gerontology and Geriatrics, 2019. \u003cstrong\u003e83\u003c/strong\u003e: p. 169-174.\u003c/li\u003e\n\u003cli\u003eNICE. \u003cem\u003eFalls in older people: assessing risk and prevention. Clinical guideline [CG161]\u003c/em\u003e. 2013 01/07/2022]; Available from: https://www.nice.org.uk/Guidance/CG161.\u003c/li\u003e\n\u003cli\u003eMasud, T. and R.O. Morris, \u003cem\u003eEpidemiology of falls.\u003c/em\u003e Age Ageing, 2001. \u003cstrong\u003e30 Suppl 4\u003c/strong\u003e: p. 3-7.\u003c/li\u003e\n\u003cli\u003eCummings, S.R., et al., \u003cem\u003eEpidemiology of osteoporosis and osteoporotic fractures.\u003c/em\u003e Epidemiol Rev, 1985. \u003cstrong\u003e7\u003c/strong\u003e: p. 178-208.\u003c/li\u003e\n\u003cli\u003eKeene, G.S., M.J. Parker, and G.A. Pryor, \u003cem\u003eMortality and morbidity after hip fractures.\u003c/em\u003e Bmj, 1993. \u003cstrong\u003e307\u003c/strong\u003e(6914): p. 1248-50.\u003c/li\u003e\n\u003cli\u003eNICE, \u003cem\u003eNICE impact falls and fragility fractures\u003c/em\u003e. 2018.\u003c/li\u003e\n\u003cli\u003eSvedbom, A., et al., \u003cem\u003eOsteoporosis in the European Union: a compendium of country-specific reports.\u003c/em\u003e Arch Osteoporos, 2013. \u003cstrong\u003e8\u003c/strong\u003e(1): p. 137.\u003c/li\u003e\n\u003cli\u003eKanis, J.A., et al., \u003cem\u003eA meta-analysis of previous fracture and subsequent fracture risk.\u003c/em\u003e Bone, 2004. \u003cstrong\u003e35\u003c/strong\u003e(2): p. 375-82.\u003c/li\u003e\n\u003cli\u003eKlotzbuecher, C.M., et al., \u003cem\u003ePatients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis.\u003c/em\u003e J Bone Miner Res, 2000. \u003cstrong\u003e15\u003c/strong\u003e(4): p. 721-39.\u003c/li\u003e\n\u003cli\u003eRubenstein, L.Z., C.M. Powers, and C.H. MacLean, \u003cem\u003eQuality indicators for the management and prevention of falls and mobility problems in vulnerable elders.\u003c/em\u003e Ann Intern Med, 2001. \u003cstrong\u003e135\u003c/strong\u003e(8 Pt 2): p. 686-93.\u003c/li\u003e\n\u003cli\u003eLenze, E.J., et al., \u003cem\u003eAdverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture.\u003c/em\u003e Int J Geriatr Psychiatry, 2004. \u003cstrong\u003e19\u003c/strong\u003e(5): p. 472-8.\u003c/li\u003e\n\u003cli\u003eDelbaere, K., et al., \u003cem\u003eDeterminants of disparities between perceived and physiological risk of falling among elderly people: cohort study.\u003c/em\u003e Bmj, 2010. \u003cstrong\u003e341\u003c/strong\u003e: p. c4165.\u003c/li\u003e\n\u003cli\u003eFriedman, S.M., et al., \u003cem\u003eFalls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention.\u003c/em\u003e J Am Geriatr Soc, 2002. \u003cstrong\u003e50\u003c/strong\u003e(8): p. 1329-35.\u003c/li\u003e\n\u003cli\u003eGagnon, N., et al., \u003cem\u003eAffective correlates of fear of falling in elderly persons.\u003c/em\u003e Am J Geriatr Psychiatry, 2005. \u003cstrong\u003e13\u003c/strong\u003e(1): p. 7-14.\u003c/li\u003e\n\u003cli\u003eHajek, A. and H.-H. K\u0026ouml;nig, \u003cem\u003eThe association of falls with loneliness and social exclusion: evidence from the DEAS German Ageing Survey.\u003c/em\u003e BMC Geriatrics, 2017. \u003cstrong\u003e17\u003c/strong\u003e(1): p. 204.\u003c/li\u003e\n\u003cli\u003eHowland, J., et al., \u003cem\u003eFear of falling among the community-dwelling elderly.\u003c/em\u003e J Aging Health, 1993. \u003cstrong\u003e5\u003c/strong\u003e(2): p. 229-43.\u003c/li\u003e\n\u003cli\u003eHadjistavropoulos, T., K. Delbaere, and T.D. Fitzgerald, \u003cem\u003eReconceptualizing the role of fear of falling and balance confidence in fall risk.\u003c/em\u003e J Aging Health, 2011. \u003cstrong\u003e23\u003c/strong\u003e(1): p. 3-23.\u003c/li\u003e\n\u003cli\u003eHarding, S. and A. Gardner, \u003cem\u003eFear of falling.\u003c/em\u003e Australian Journal of Advanced Nursing, 2009. \u003cstrong\u003e27\u003c/strong\u003e: p. 94-100.\u003c/li\u003e\n\u003cli\u003eLegters, K., \u003cem\u003eFear of falling.\u003c/em\u003e Phys Ther, 2002. \u003cstrong\u003e82\u003c/strong\u003e(3): p. 264-72.\u003c/li\u003e\n\u003cli\u003eAlexiou, K.I., et al., \u003cem\u003eQuality of life and psychological consequences in elderly patients after a hip fracture: a review.\u003c/em\u003e Clin Interv Aging, 2018. \u003cstrong\u003e13\u003c/strong\u003e: p. 143-150.\u003c/li\u003e\n\u003cli\u003eDyer, S.M., et al., \u003cem\u003eA critical review of the long-term disability outcomes following hip fracture.\u003c/em\u003e BMC Geriatrics, 2016. \u003cstrong\u003e16\u003c/strong\u003e(1): p. 158.\u003c/li\u003e\n\u003cli\u003eEvitt, C.P. and P.A. Quigley, \u003cem\u003eFear of falling in older adults: a guide to its prevalence, risk factors, and consequences.\u003c/em\u003e Rehabil Nurs, 2004. \u003cstrong\u003e29\u003c/strong\u003e(6): p. 207-10.\u003c/li\u003e\n\u003cli\u003eKosorok, M.R., et al., \u003cem\u003eRestricted activity days among older adults.\u003c/em\u003e Am J Public Health, 1992. \u003cstrong\u003e82\u003c/strong\u003e(9): p. 1263-7.\u003c/li\u003e\n\u003cli\u003eSalkeld, G., et al., \u003cem\u003eQuality of life related to fear of falling and hip fracture in older women: a time trade off study.\u003c/em\u003e Bmj, 2000. \u003cstrong\u003e320\u003c/strong\u003e(7231): p. 341-6.\u003c/li\u003e\n\u003cli\u003eTinetti, M.E. and C.S. Williams, \u003cem\u003eThe effect of falls and fall injuries on functioning in community-dwelling older persons.\u003c/em\u003e J Gerontol A Biol Sci Med Sci, 1998. \u003cstrong\u003e53\u003c/strong\u003e(2): p. M112-9.\u003c/li\u003e\n\u003cli\u003eJames, S.L., et al., \u003cem\u003eThe global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017.\u003c/em\u003e Inj Prev, 2020. \u003cstrong\u003e26\u003c/strong\u003e(Supp 1): p. i3-i11.\u003c/li\u003e\n\u003cli\u003eKwan, M.M., et al., \u003cem\u003eFalls incidence, risk factors, and consequences in Chinese older people: a systematic review.\u003c/em\u003e J Am Geriatr Soc, 2011. \u003cstrong\u003e59\u003c/strong\u003e(3): p. 536-43.\u003c/li\u003e\n\u003cli\u003eGill, T.M., et al., \u003cem\u003eAssociation of injurious falls with disability outcomes and nursing home admissions in community-living older persons.\u003c/em\u003e Am J Epidemiol, 2013. \u003cstrong\u003e178\u003c/strong\u003e(3): p. 418-25.\u003c/li\u003e\n\u003cli\u003eHartholt, K.A., et al., \u003cem\u003eMortality From Falls Among US Adults Aged 75 Years or Older, 2000-2016.\u003c/em\u003e Jama, 2019. \u003cstrong\u003e321\u003c/strong\u003e(21): p. 2131-2133.\u003c/li\u003e\n\u003cli\u003eLuebbert, S., et al., \u003cem\u003eFalls in Senior Adults: Demographics, Cost, Risk Stratification, and Evaluation.\u003c/em\u003e Mo Med, 2022. \u003cstrong\u003e119\u003c/strong\u003e(2): p. 158-163.\u003c/li\u003e\n\u003cli\u003eBurns, E.R., J.A. Stevens, and R. Lee, \u003cem\u003eThe direct costs of fatal and non-fatal falls among older adults - United States.\u003c/em\u003e J Safety Res, 2016. \u003cstrong\u003e58\u003c/strong\u003e: p. 99-103.\u003c/li\u003e\n\u003cli\u003eHeinrich, S., et al., \u003cem\u003eCost of falls in old age: a systematic review.\u003c/em\u003e Osteoporos Int, 2010. \u003cstrong\u003e21\u003c/strong\u003e(6): p. 891-902.\u003c/li\u003e\n\u003cli\u003eOu, W., et al., \u003cem\u003eHospitalization costs of injury in elderly population in China: a quantile regression analysis.\u003c/em\u003e BMC Geriatr, 2023. \u003cstrong\u003e23\u003c/strong\u003e(1): p. 143.\u003c/li\u003e\n\u003cli\u003eGanz, D.A. and N.K. Latham, \u003cem\u003ePrevention of Falls in Community-Dwelling Older Adults.\u003c/em\u003e N Engl J Med, 2020. \u003cstrong\u003e382\u003c/strong\u003e(8): p. 734-743.\u003c/li\u003e\n\u003cli\u003eFlorence, C.S., et al., \u003cem\u003eMedical Costs of Fatal and Nonfatal Falls in Older Adults.\u003c/em\u003e J Am Geriatr Soc, 2018. \u003cstrong\u003e66\u003c/strong\u003e(4): p. 693-698.\u003c/li\u003e\n\u003cli\u003eCamp, K., S. Murphy, and B. Pate, \u003cem\u003eIntegrating Fall Prevention Strategies into EMS Services to Reduce Falls and Associated Healthcare Costs for Older Adults.\u003c/em\u003e Clin Interv Aging, 2024. \u003cstrong\u003e19\u003c/strong\u003e: p. 561-569.\u003c/li\u003e\n\u003cli\u003eHaddad, Y.K., et al., \u003cem\u003eHealthcare spending for non-fatal falls among older adults, USA.\u003c/em\u003e Inj Prev, 2024. \u003cstrong\u003e30\u003c/strong\u003e(4): p. 272-276.\u003c/li\u003e\n\u003cli\u003eMontero-Odasso, M.M., et al., \u003cem\u003eEvaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review.\u003c/em\u003e JAMA Netw Open, 2021. \u003cstrong\u003e4\u003c/strong\u003e(12): p. e2138911.\u003c/li\u003e\n\u003cli\u003eNICE, \u003cem\u003eSurveillance of Falls in Older People: Assessing Risk and Prevention (NICE Guideline CG161)\u003c/em\u003e. 2019, NICE: London.\u003c/li\u003e\n\u003cli\u003eMehta, J., \u003cem\u003eImpact of vision on falls and fear of falling in older adults\u003c/em\u003e. 2020, University of Liverpool: Liverpool.\u003c/li\u003e\n\u003cli\u003eLegood, R., P. Scuffham, and C. Cryer, \u003cem\u003eAre we blind to injuries in the visually impaired? A review of the literature.\u003c/em\u003e Inj Prev, 2002. \u003cstrong\u003e8\u003c/strong\u003e(2): p. 155-60.\u003c/li\u003e\n\u003cli\u003eDhital, A., T. Pey, and M.R. Stanford, \u003cem\u003eVisual loss and falls: a review.\u003c/em\u003e Eye, 2010. \u003cstrong\u003e24\u003c/strong\u003e(9): p. 1437-1446.\u003c/li\u003e\n\u003cli\u003eReed-Jones, R.J., et al., \u003cem\u003eVision and falls: a multidisciplinary review of the contributions of visual impairment to falls among older adults.\u003c/em\u003e Maturitas, 2013. \u003cstrong\u003e75\u003c/strong\u003e(1): p. 22-8.\u003c/li\u003e\n\u003cli\u003eBlack, A. and J. Wood, \u003cem\u003eVision and falls.\u003c/em\u003e Clin Exp Optom, 2005. \u003cstrong\u003e88\u003c/strong\u003e(4): p. 212-22.\u003c/li\u003e\n\u003cli\u003eSaftari, L.N. and O.-S. Kwon, \u003cem\u003eAgeing vision and falls: a review.\u003c/em\u003e Journal of Physiological Anthropology, 2018. \u003cstrong\u003e37\u003c/strong\u003e(1): p. 11.\u003c/li\u003e\n\u003cli\u003eGrisso, J.A., et al., \u003cem\u003eRISK-FACTORS FOR FALLS AS A CAUSE OF HIP FRACTURE IN WOMEN.\u003c/em\u003e New England Journal of Medicine, 1991. \u003cstrong\u003e324\u003c/strong\u003e(19): p. 1326-1331.\u003c/li\u003e\n\u003cli\u003eTran, T.H., et al., \u003cem\u003e[Visual impairment in elderly fallers].\u003c/em\u003e J Fr Ophtalmol, 2011. \u003cstrong\u003e34\u003c/strong\u003e(10): p. 723-8.\u003c/li\u003e\n\u003cli\u003eJack, C.I., et al., \u003cem\u003ePrevalence of low vision in elderly patients admitted to an acute geriatric unit in Liverpool: elderly people who fall are more likely to have low vision.\u003c/em\u003e Gerontology, 1995. \u003cstrong\u003e41\u003c/strong\u003e(5): p. 280-5.\u003c/li\u003e\n\u003cli\u003eArdaneh, M., M. Fararouei, and J. Hassanzadeh, \u003cem\u003eFactors Contributing to Falls Leading to Fracture among Older Adults.\u003c/em\u003e Journal of Population Ageing, 2023. \u003cstrong\u003e16\u003c/strong\u003e(1): p. 121-135.\u003c/li\u003e\n\u003cli\u003eChew, F.L.M., et al., \u003cem\u003eThe association between various visual function tests and low fragility hip fractures among the elderly: A Malaysian experience.\u003c/em\u003e Age and Ageing, 2010. \u003cstrong\u003e39\u003c/strong\u003e(2): p. 239-245.\u003c/li\u003e\n\u003cli\u003eHoffman, G.J., et al., \u003cem\u003ePosthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older.\u003c/em\u003e JAMA Netw Open, 2019. \u003cstrong\u003e2\u003c/strong\u003e(5): p. e194276.\u003c/li\u003e\n\u003cli\u003eHollinghurst, R., et al., \u003cem\u003eAnnual risk of falls resulting in emergency department and hospital attendances for older people: an observational study of 781,081 individuals living in Wales (United Kingdom) including deprivation, frailty and dementia diagnoses between 2010 and 2020.\u003c/em\u003e Age Ageing, 2022. \u003cstrong\u003e51\u003c/strong\u003e(8).\u003c/li\u003e\n\u003cli\u003eCurran-Groome, W., et al., \u003cem\u003eRisk Factors of Recurrent Falls Among Older Adults Admitted to the Trauma Surgery Department.\u003c/em\u003e Geriatr Orthop Surg Rehabil, 2020. \u003cstrong\u003e11\u003c/strong\u003e: p. 2151459320943165.\u003c/li\u003e\n\u003cli\u003eMontero-Odasso, M., et al., \u003cem\u003eWorld guidelines for falls prevention and management for older adults: a global initiative.\u003c/em\u003e Age and Ageing, 2022. \u003cstrong\u003e51\u003c/strong\u003e(9).\u003c/li\u003e\n\u003cli\u003eLamb, S.E., et al., \u003cem\u003eA national survey of services for the prevention and management of falls in the UK.\u003c/em\u003e BMC Health Services Research, 2008. \u003cstrong\u003e8\u003c/strong\u003e(1): p. 233.\u003c/li\u003e\n\u003cli\u003eRCP, \u003cem\u003eFalling standards, broken promises Report of the national audit of falls and bone health in older people\u003c/em\u003e. 2011, RCP: London.\u003c/li\u003e\n\u003cli\u003eRCP, \u003cem\u003eNational Audit of Inpatient Falls Annual Report Autumn 2022\u003c/em\u003e. 2022.\u003c/li\u003e\n\u003cli\u003eKoh, S.S., et al., \u003cem\u003eNurses\u0026apos; perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals.\u003c/em\u003e BMC Health Serv Res, 2008. \u003cstrong\u003e8\u003c/strong\u003e: p. 105.\u003c/li\u003e\n\u003cli\u003eMilisen, K., et al., \u003cem\u003eFeasibility of implementing a practice guideline for fall prevention on geriatric wards: A multicentre study.\u003c/em\u003e International Journal of Nursing Studies, 2013. \u003cstrong\u003e50\u003c/strong\u003e(4): p. 495-507.\u003c/li\u003e\n\u003cli\u003eDavenport, K., et al., \u003cem\u003eFall Prevention Knowledge, Attitudes, and Behaviors: A Survey of Emergency Providers.\u003c/em\u003e West J Emerg Med, 2020. \u003cstrong\u003e21\u003c/strong\u003e(4): p. 826-830.\u003c/li\u003e\n\u003cli\u003eParks, A., et al., \u003cem\u003eBarriers and enablers that influence guideline-based care of geriatric fall patients presenting to the emergency department.\u003c/em\u003e Emerg Med J, 2019. \u003cstrong\u003e36\u003c/strong\u003e(12): p. 741-747.\u003c/li\u003e\n\u003cli\u003eAyton, D.R., et al., \u003cem\u003eBarriers and enablers to the implementation of the 6-PACK falls prevention program: A pre-implementation study in hospitals participating in a cluster randomised controlled trial.\u003c/em\u003e PLoS One, 2017. \u003cstrong\u003e12\u003c/strong\u003e(2): p. e0171932.\u003c/li\u003e\n\u003cli\u003eBarmentloo, L.M., et al., \u003cem\u003eBarriers and Facilitators for Screening Older Adults on Fall Risk in a Hospital Setting: Perspectives from Patients and Healthcare Professionals.\u003c/em\u003e Int J Environ Res Public Health, 2020. \u003cstrong\u003e17\u003c/strong\u003e(5).\u003c/li\u003e\n\u003cli\u003eBauer, M.S. and J. Kirchner, \u003cem\u003eImplementation science: What is it and why should I care?\u003c/em\u003e Psychiatry Research, 2020. \u003cstrong\u003e283\u003c/strong\u003e: p. 112376.\u003c/li\u003e\n\u003cli\u003eEccles, M.P. and B.S. Mittman, \u003cem\u003eWelcome to Implementation Science.\u003c/em\u003e Implementation Science, 2006. \u003cstrong\u003e1\u003c/strong\u003e(1): p. 1.\u003c/li\u003e\n\u003cli\u003eBauer, M.S., et al., \u003cem\u003eAn introduction to implementation science for the non-specialist.\u003c/em\u003e BMC Psychology, 2015. \u003cstrong\u003e3\u003c/strong\u003e(1): p. 32.\u003c/li\u003e\n\u003cli\u003eBreimaier, H.E., et al., \u003cem\u003eThe Consolidated Framework for Implementation Research (CFIR): a useful theoretical framework for guiding and evaluating a guideline implementation process in a hospital-based nursing practice.\u003c/em\u003e BMC Nurs, 2015. \u003cstrong\u003e14\u003c/strong\u003e: p. 43.\u003c/li\u003e\n\u003cli\u003eRangachari, P., S.S. Mushiana, and K. Herbert, \u003cem\u003eA scoping review of applications of the Consolidated Framework for Implementation Research (CFIR) to telehealth service implementation initiatives.\u003c/em\u003e BMC Health Serv Res, 2022. \u003cstrong\u003e22\u003c/strong\u003e(1): p. 1450.\u003c/li\u003e\n\u003cli\u003eKirk, M.A., et al., \u003cem\u003eA systematic review of the use of the Consolidated Framework for Implementation Research.\u003c/em\u003e Implementation Science, 2016. \u003cstrong\u003e11\u003c/strong\u003e(1): p. 72.\u003c/li\u003e\n\u003cli\u003eLyu, J., et al., \u003cem\u003eFacilitators and barriers to implementing patient-reported outcomes in clinical oncology practice: a systematic review based on the consolidated framework for implementation research.\u003c/em\u003e Implement Sci Commun, 2024. \u003cstrong\u003e5\u003c/strong\u003e(1): p. 120.\u003c/li\u003e\n\u003cli\u003eLam, H., et al., \u003cem\u003eIdentifying actionable strategies: using Consolidated Framework for Implementation Research (CFIR)-informed interviews to evaluate the implementation of a multilevel intervention to improve colorectal cancer screening.\u003c/em\u003e Implement Sci Commun, 2021. \u003cstrong\u003e2\u003c/strong\u003e(1): p. 57.\u003c/li\u003e\n\u003cli\u003eDias, E.M., et al., \u003cem\u003eBarriers to and facilitators of implementing colorectal cancer screening evidence-based interventions in federally qualified health centers: a qualitative study.\u003c/em\u003e BMC Health Serv Res, 2024. \u003cstrong\u003e24\u003c/strong\u003e(1): p. 797.\u003c/li\u003e\n\u003cli\u003eBirken, S.A., et al., \u003cem\u003eCriteria for selecting implementation science theories and frameworks: results from an international survey.\u003c/em\u003e Implement Sci, 2017. \u003cstrong\u003e12\u003c/strong\u003e(1): p. 124.\u003c/li\u003e\n\u003cli\u003eDamschroder, L.J., et al., \u003cem\u003eThe updated Consolidated Framework for Implementation Research based on user feedback.\u003c/em\u003e Implement Sci, 2022. \u003cstrong\u003e17\u003c/strong\u003e(1): p. 75.\u003c/li\u003e\n\u003cli\u003eMichie, S., M.M. van Stralen, and R. West, \u003cem\u003eThe behaviour change wheel: A new method for characterising and designing behaviour change interventions.\u003c/em\u003e Implementation Science, 2011. \u003cstrong\u003e6\u003c/strong\u003e(1): p. 42.\u003c/li\u003e\n\u003cli\u003eHennink, M.M., B.N. Kaiser, and V.C. Marconi, \u003cem\u003eCode Saturation Versus Meaning Saturation: How Many Interviews Are Enough?\u003c/em\u003e Qual Health Res, 2017. \u003cstrong\u003e27\u003c/strong\u003e(4): p. 591-608.\u003c/li\u003e\n\u003cli\u003eGreenebaum, J.B., \u003cem\u003eManaging Impressions: \u0026ldquo;Face-Saving\u0026rdquo; Strategies of Vegetarians and Vegans.\u003c/em\u003e Humanity \u0026amp; society, 2012. \u003cstrong\u003e36\u003c/strong\u003e(4): p. 309-325.\u003c/li\u003e\n\u003cli\u003eAllen, L., \u003cem\u003eManaging masculinity: Young men\u0026apos;s identity work in focus groups.\u003c/em\u003e Qualitative research, 2005. \u003cstrong\u003e5\u003c/strong\u003e(1): p. 35-57.\u003c/li\u003e\n\u003cli\u003eCraven, K., et al., \u003cem\u003eEmbedding mentoring to support trial processes and implementation fidelity in a randomised controlled trial of vocational rehabilitation for stroke survivors.\u003c/em\u003e BMC Medical Research Methodology, 2021. \u003cstrong\u003e21\u003c/strong\u003e(1): p. 203.\u003c/li\u003e\n\u003cli\u003eGale, N.K., et al., \u003cem\u003eUsing the framework method for the analysis of qualitative data in multi-disciplinary health research.\u003c/em\u003e BMC Medical Research Methodology, 2013. \u003cstrong\u003e13\u003c/strong\u003e(1): p. 117.\u003c/li\u003e\n\u003cli\u003eTong, A., P. Sainsbury, and J. Craig, \u003cem\u003eConsolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.\u003c/em\u003e International Journal for Quality in Health Care, 2007. \u003cstrong\u003e19\u003c/strong\u003e(6): p. 349-357.\u003c/li\u003e\n\u003cli\u003eMathisen, T.S., et al., \u003cem\u003eBarriers and facilitators to the implementation of a structured visual assessment after stroke in municipal health care services.\u003c/em\u003e BMC Health Serv Res, 2021. \u003cstrong\u003e21\u003c/strong\u003e(1): p. 497.\u003c/li\u003e\n\u003cli\u003eRowe, F.J., et al., \u003cem\u003eVision Screening Assessment (VISA) tool: diagnostic accuracy validation of a novel screening tool in detecting visual impairment among stroke survivors.\u003c/em\u003e BMJ Open, 2020. \u003cstrong\u003e10\u003c/strong\u003e(6): p. e033639.\u003c/li\u003e\n\u003cli\u003eRowe, F.J., et al., \u003cem\u003eVisual Impairment Screening Assessment (VISA) tool: pilot validation.\u003c/em\u003e BMJ Open, 2018. \u003cstrong\u003e8\u003c/strong\u003e(3): p. e020562.\u003c/li\u003e\n\u003cli\u003eNICE. \u003cem\u003eNG236: Stroke rehabilitation in adults\u003c/em\u003e. 2023 02/10/2025]; Available from: https://www.nice.org.uk/guidance/ng236.\u003c/li\u003e\n\u003cli\u003eNICE, \u003cem\u003eStroke rehabilitation in adults (update) [C] Evidence reviews for the clinical and costeffectiveness of routine specialist orthoptist assessment \u003c/em\u003e2023. p. 1-48.\u003c/li\u003e\n\u003cli\u003eFalkenberg, H., et al., \u003cem\u003eValidation of the interdisciplinary Norwegian vision assessment tool KROSS in stroke patients admitted to hospital or rehabilitation services.\u003c/em\u003e Discover Health Systems, 2024. \u003cstrong\u003e3\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eRCP, \u003cem\u003eLook Out! Bedside vision check for falls prevention: assessment tool.\u003c/em\u003e, RCP, Editor. 2017.\u003c/li\u003e\n\u003cli\u003eBaig, A., et al., \u003cem\u003eVision Screening in Older Adults Admitted with a Fragility Hip Fracture: A Healthcare Quality Improvement Report.\u003c/em\u003e Br Ir Orthopt J, 2023. \u003cstrong\u003e19\u003c/strong\u003e(1): p. 96-107.\u003c/li\u003e\n\u003cli\u003eGrol, R.P., et al., \u003cem\u003ePlanning and studying improvement in patient care: the use of theoretical perspectives.\u003c/em\u003e Milbank Q, 2007. \u003cstrong\u003e85\u003c/strong\u003e(1): p. 93-138.\u003c/li\u003e\n\u003cli\u003eDy, S.M., et al., \u003cem\u003eA framework to guide implementation research for care transitions interventions.\u003c/em\u003e J Healthc Qual, 2015. \u003cstrong\u003e37\u003c/strong\u003e(1): p. 41-54.\u003c/li\u003e\n\u003cli\u003eAshok, M., et al., \u003cem\u003eFramework for Research on Implementation of Process Redesigns.\u003c/em\u003e Qual Manag Health Care, 2018. \u003cstrong\u003e27\u003c/strong\u003e(1): p. 17-23.\u003c/li\u003e\n\u003cli\u003eGreenhalgh, T., et al., \u003cem\u003eDiffusion of innovations in service organizations: systematic review and recommendations.\u003c/em\u003e Milbank Q, 2004. \u003cstrong\u003e82\u003c/strong\u003e(4): p. 581-629.\u003c/li\u003e\n\u003cli\u003eSimpson, D.D. and D.F. Dansereau, \u003cem\u003eAssessing organizational functioning as a step toward innovation.\u003c/em\u003e Sci Pract Perspect, 2007. \u003cstrong\u003e3\u003c/strong\u003e(2): p. 20-8.\u003c/li\u003e\n\u003cli\u003eFeldstein, A.C. and R.E. Glasgow, \u003cem\u003eA practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice.\u003c/em\u003e Jt Comm J Qual Patient Saf, 2008. \u003cstrong\u003e34\u003c/strong\u003e(4): p. 228-43.\u003c/li\u003e\n\u003cli\u003eBodenheimer, T. and C. Sinsky, \u003cem\u003eFrom triple to quadruple aim: care of the patient requires care of the provider.\u003c/em\u003e Ann Fam Med, 2014. \u003cstrong\u003e12\u003c/strong\u003e(6): p. 573-6.\u003c/li\u003e\n\u003cli\u003eBodenheimer, T., E.H. Wagner, and K. Grumbach, \u003cem\u003eImproving primary care for patients with chronic illness.\u003c/em\u003e Jama, 2002. \u003cstrong\u003e288\u003c/strong\u003e(14): p. 1775-9.\u003c/li\u003e\n\u003cli\u003eOswald, J.M., et al., \u003cem\u003ePractice-research integration in the residential treatment of patients with severe eating and comorbid disorders.\u003c/em\u003e Psychotherapy (Chic), 2019. \u003cstrong\u003e56\u003c/strong\u003e(1): p. 134-148.\u003c/li\u003e\n\u003cli\u003eHelfrich, C.D., et al., \u003cem\u003eDeterminants of Implementation Effectiveness: Adapting a Framework for Complex Innovations.\u003c/em\u003e Medical Care Research and Review, 2007. \u003cstrong\u003e64\u003c/strong\u003e(3): p. 279-303.\u003c/li\u003e\n\u003cli\u003eWaltz, T.J., et al., \u003cem\u003eChoosing implementation strategies to address contextual barriers: diversity in recommendations and future directions.\u003c/em\u003e Implement Sci, 2019. \u003cstrong\u003e14\u003c/strong\u003e(1): p. 42.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Cathain, A., et al., \u003cem\u003eGuidance on how to develop complex interventions to improve health and healthcare.\u003c/em\u003e BMJ Open, 2019. \u003cstrong\u003e9\u003c/strong\u003e(8): p. e029954.\u003c/li\u003e\n\u003cli\u003eCrowe, S., et al., \u003cem\u003eThe case study approach.\u003c/em\u003e BMC Medical Research Methodology, 2011. \u003cstrong\u003e11\u003c/strong\u003e(1): p. 100.\u003c/li\u003e\n\u003cli\u003eYin, R.K., \u003cem\u003eCase study research, design and method\u003c/em\u003e. 4th edition ed. 2009, London: Sage.\u003c/li\u003e\n\u003cli\u003eDahlin-Ivanoff, S., et al., \u003cem\u003eResearch collaboration with older people as a matter of scientific quality and ethics: a focus group study with researchers in ageing and health.\u003c/em\u003e Research Involvement and Engagement, 2024. \u003cstrong\u003e10\u003c/strong\u003e(1): p. 6.\u003c/li\u003e\n\u003cli\u003eIvanoff, S.D. and J. Hultberg, \u003cem\u003eUnderstanding the multiple realities of everyday life: basic assumptions in focus-group methodology.\u003c/em\u003e Scand J Occup Ther, 2006. \u003cstrong\u003e13\u003c/strong\u003e(2): p. 125-32. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Falls, Vision screening, Vision, Ageing","lastPublishedDoi":"10.21203/rs.3.rs-8425555/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8425555/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe assessment and management of impaired vision is included in falls prevention guidance, however implementation is inconsistent. We conducted focus groups to explore the perspectives of Health Care Professionals (HCP) on vision screening in older adults attending acute hospitals following a fall.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA focus group study was undertaken with HCPs from a single acute hospital trust. Semi-structured topic guides were informed by the Consolidated Framework for Implementation Research (CFIR). Transcripts were first inductively then deductively coded using CFIR constructs. Demographic data was collected and summarised.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFive focus groups were conducted with 19 HCPs overall. Six interconnecting themes were identified, mapped to 14 CFIR constructs, relating to barriers and facilitators to vision screening. Barriers encompassed: lack of training, referral networks to manage impaired vision and prioritisation of task-focussed, rather than person-centred, care in the acute setting. Facilitators included: perceived mission alignment, adequate training, tools, guidance on roles, responsibilities and management pathways, integration of eye care professionals in multidisciplinary falls care and time in job plans.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eHCPs were motivated to vision screen and felt it aligned with person-centred falls care, however there were individual and contextual barriers related to staff capability and opportunity to implement vision screening in the acute setting. Multi-component and multi-level interventions and implementation strategies are needed to integrate eye care professionals into the falls MDT, engage supportive leaders, develop an effective vision screening assessment, define roles, responsibilities and management pathways, organise individual training and time allocation for staff to perform screening.\u003c/p\u003e","manuscriptTitle":"Health professional perspectives on vision screening in older adults who attend hospital following a fall: a focus group study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-31 10:39:21","doi":"10.21203/rs.3.rs-8425555/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revisions","date":"2026-02-12T07:02:37+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2026-01-05T15:53:20+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-29T10:44:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-27T00:49:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Geriatric Medicine","date":"2025-12-22T08:42:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"823088d7-6a6a-4cfd-93b1-99340965fb80","owner":[],"postedDate":"December 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-15T15:34:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-31 10:39:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8425555","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8425555","identity":"rs-8425555","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}