The context of falls and falls prevention among older people in Kuwait
: a mixed methods exploration

  • Hadeel Alsaleh

Student thesis: Doctoral Thesis


Background: Falls constitute a serious threat to the health and well-being of older populations worldwide, making them an area of significant research focus. It is important to consider the cultural contexts in which falls occur. As such, this thesis aims to determine the prevalence and perceptions of falls in Kuwait, which are currently unknown.
Methods: This mixed-methods thesis comprises three studies: (1) a population-based retrospective cross-sectional study of the prevalence of injurious falls among older people (aged 50+ years) attending the Accident and Emergency (A&E) Department of Al-Razi Orthopaedic Hospital (involving 573 patient admissions over a three month period); (2) qualitative interviews exploring the perceptions of falls and fall prevention among older people (50+ years) and their caregivers (N=16); and (3) focus groups with 10 healthcare professionals (HCPs – doctors and physiotherapists).
Findings: A&E documented fall rates were 3.78 per 1,000 of the population. Rates were higher for Kuwaitis (7.55 per 1,000 population) than non-Kuwaitis (2.01 per 1,000). Only ‘age’ was significantly associated with injury type.
The interview findings revealed that culture, social life, and the provision of care, underpinned the context for falls and fall prevention in Kuwait (Theme 1: ‘context and life’). Among older Kuwaiti participants, falls prevention was an unfamiliar issue; their knowledge of falls (Theme 2: ‘knowledge’) came from their experiences and those of others, which motivated them to eliminate what they perceived as risk factors. Older age was stigmatised (Theme 3: ‘beliefs’), and independence was valued. Health responsibility beliefs and fatalism beliefs were identified. Older people were found to have positive attitudes (Theme 4: ‘attitudes’), which participants generally considered beneficial for fall prevention behaviour. Yet, a reliance on environmental familiarity to appeared potentially thwart actions to reduce environmental hazards. Social networks were important in older people’s lives (Theme 5: ‘significance of others’), and five potentially valuable sources of social support and influence were identified: spouses, children, paid caregivers, peers, and HCPs. A new concept of ‘circular care benefits’ emerged, providing a development to the Theory of Planned Behaviour, by contributing understanding that caring for others helps build subjective norms.
The HCPs’ focus groups revealed three main themes: (a) Knowledge, (b) Attitudes, and (c) Practice, following the KAP-Gap framework. HCPs lacked falls-related knowledge but held positive attitudes towards fall preventability, understanding older people, and cross-generational reform. Negative attitudes existed, such as professional dominance, ageism, stereotyping and enhancing dependence. The HCPs were interested in preventing falls, yet, challenged by the ambiguity of their roles in fall prevention.
Discussion: Fall prevention practices in Kuwait are still in their infancy; formal knowledge and governmental initiatives are lacking. Yet, the fall rates were lower than rates elsewhere. The interview findings support the Theory of Planned Behaviour in the context of falls prevention, with further contribution to the understanding of ‘subjective norms’. The interpretation of HCPs’ perceptions enabled the identification of clinical gaps and implications.
Future research should explore: the concept of ‘circular care benefits’ as a contributing factor to the Theory of Planned Behaviour; community-based falls prevalence in Kuwait; and perspectives from other populations (e.g. residing non-Kuwaiti nationals, and other types of HCPs). Practice implications include improving falls reporting systems, embedding falls prevention into the curriculum for HCPs, addressing the ambiguity of an HCP’s role in fall prevention, and establishing new falls prevention healthcare services.
Date of AwardAug 2019
Original languageEnglish
Awarding Institution
  • University of Portsmouth
SupervisorSasee Pallikadavath (Supervisor), Julie Udell (Supervisor) & Amy Drahota-Towns (Supervisor)

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