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Health Promot Pract. 2016 Mar;17(2):244-53. doi: 10.1177/1524839915610317. Epub 2015 Oct 23.

State Fall Prevention Coalitions as Systems Change Agents: An Emphasis on Policy.

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University of North Carolina at Chapel Hill, NC, USA.
The University of Georgia, College of Public Health, Athens, GA, USA Texas A&M Health Science Center, School of Public Health, College Station, TX, USA
Texas A&M Health Science Center, School of Public Health, College Station, TX, USA.
Falls Free Initiative, National Council on Aging, Arlington, VA, USA.
Scheirer Consulting, Princeton, NJ, USA.



Falls among older adults are an escalating public health issue, which requires a multidisciplinary and multilevel approach to affect systems change to effectively address this problem. The National Council on Aging established the Falls Free® Initiative, enfolding and facilitating statewide Fall Prevention Coalitions. Fall Free® activities included developing the State Policy Toolkit for Advancing Falls Prevention to promote sustainable change by supporting the dissemination and adoption of evidence-based strategies.


To (1) determine if the policies being implemented were recommended and supported by the Toolkit, (2) identify the perceived barriers and facilitators to implementing policies, and (3) identify Coalitions' current and future fall prevention policy activities.


A 63-item online survey was distributed to State Coalition Leads. Descriptive statistics (frequencies and counts) were used to describe Coalition characteristics and activities.


Coalitions had several similarities, and varied greatly in their number of member organizations and members as well as meeting frequencies. Key activities included building partnerships, disseminating programs, and pursuing at least one of the eight National Council on Aging-recommended policy goals. The most commonly reported facilitator was active support from the Coalition Leads, whereas the lack of funding was the most cited barrier.


This study serves as the first national census of empirical evidence regarding Falls Coalitions' composition, goals, and activities. Results indicate that Coalitions are actively pursuing evidence-based policies but could benefit from additional technical assistance and resources. Findings support the value of Toolkit recommendations by documenting what is feasible and being implemented. Knowledge about facilitators and barriers will inform future efforts to foster sustainable systems change in states with active Coalitions and encourage Coalitions in other states.


aging and health; coalitions; fall prevention policy; older adult fall prevention; systems change

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