Study Design
Participants for this cross-sectional survey of 170 older adults (aged 65 years and above) were recruited via both convenient and snowballing sampling techniques. Those recruited through convenient sampling provided information that lead to the recruitment of other participants who did not get the information earlier. Also, the four participating communities were selected by convenient sampling technique in Nsukka Local Government Area, Enugu State, Nigeria.
Data collection procedure
The researchers approached the community, association, and religious leaders in the study population for an interactive session to explain the study to them. During the course of the interactive session, the purpose and the procedures of the study was explained to them, and opportunity was given to them to ask questions. Having understood the study and became convinced that the outcome of the study will be beneficial to their community they authorized the study to be conducted among their people. Following this approval by the critical stakeholders, an invitation was extended to would-be participants through the leaders of the communities and community associations, also by placing announcements and adverts in the community churches. The venues for data collection were the town or union halls and church halls in each community. The purpose of the study and the procedure for data collection was explained to each participant from whom informed consent was then obtained. Before giving their consent they were assured that all the information they would give would be confidential, and that the procedure would cause them no harm. The instrument had two versions, the original version (English) and the translated version (Native language). Those of them that were not literate to understand the content of the original version were given the translated version which was in the Igbo language. The instruments were administered to each participant by the researcher. It took an average of 20 minutes for the respondents to complete the questionnaires. The completed questionnaire was collated by the research assistants immediately or on a later time and date. It took about 17 days for the administration and the retrieval of the completed study instrument to be completed. The collated instrument was reviewed for missing data by the researchers, and inputted in an excel spreadsheet by the statistician for data analysis.
Description of the Study Instruments
Physical activity neighborhood environment scale in Nigeria (PANES-N)
An adapted version of the physical activity neighborhood environment scale in Nigeria (PANES-N) was used to assess the perception of neighborhood safety factors 19 [20]. The 17-item PANES was originally developed by the international physical activity prevalence study and contained four Indicators of Crime and Traffic Safety [20]. the higher the score (on a scale of 1 to 4) the more favorable the perception rating of the environment. Safety in the neighborhood will be categorized as high or low [21].
Physical Activity Scale for Elderly (PASE):
Physical activity level was assessed using the Physical Activity Scale for Elderly (PASE): Participation in leisure activities including walking outside the home, light, moderate, and strenuous sports, recreation activities and muscle strengthening were recorded as never, seldom (1-2 days/week), sometimes (3-4 days/week), and often (5-7 days/week) [22].
Oral Interview
Prevalence of falls was assessed by subjectively asking the participants for history and frequency of falls in the past six months. The groups were formed based on the participant’s responses in 2 different ways.
Modified Fall Efficacy Scale (MFES)
Fall efficacy was assessed using the Modified Fall Efficacy Scale (MFES). This is a 14- item questionnaire. Each item will be scored on the 10-point visual analogue scale. '0'= not confident or not sure at all, 5'= fairly confident or fairly sure, '10'= completely confident or completely sure. The ranking is totaled (possible range of 0 – 140) and divided by 14 to get each subject's MFES score. Scores less than 8 indicate less confidence and low efficacy (fear of falling), 8 or greater indicate more confidence and high efficacy (lack of fear).
Fall Risk Assessment Tool (FRAT)
The risk of falls was assessed using the Fall Risk Assessment Tool (FRAT). The FRAT has three sections: Part 1 - fall risk status; Part 2 – risk factor checklist; and Part 3 – action plan. Fall risk status is categorized as low (5-11), medium (12-15) or high risk (16-20). Risk factors to be assessed include vision, mobility, transfers, behaviors, activities of daily living, environment, nutrition and continence which can either be Y (yes) or N (No) [23].
Participation scale (PS)
Social participation restriction was assessed using the participation scale (PS): It assesses the restrictions in social participation. The participation scale is a test of 18 – items covering eight out of nine major life domains. The rating includes; no significant restriction (0 – 12), mild restriction (13 – 22), moderate restriction (23 – 32), severe restriction (33 – 52) and extreme restriction (53 – 90) [24].
Data Analysis
Obtained data were analyzed using IBM Statistical packages for the Social sciences (SPSS 23.0: SPSS Inc, Chicago, IL, USA). Descriptive statistics used were mean and standard deviations (for participants' age), frequency counts (for occupational categories and location), proportions and percentages (for fallers and individuals with FOF), and inferential statistics of Spearman rank order correlation used to determine the correlation and relationship among neighborhood safety, fall indices (fall risk and fall efficacy), physical activity level and social participation restriction. Alpha level was set at 0.05.