Abstract
BACKGROUND: The Falls Management Exercise (FaME) Programme has been shown in clinical trials to reduce falls amongst the over 65s. FaME was implemented in one large, rural county in England. The current study is a formative process evaluation measuring the impact on those completing the FaME intervention, and examines service reach, fidelity, acceptability, and maintenance of outcomes. METHODS: Anonymised routine data was collected from 110 participants at baseline, the end of the programme and at three-months follow-up. Median and IQR at baseline and end of FaME for self-reported falls, fear of falling, physical activity, quality of life, loneliness, Timed-up-and-go, Turn 180(0) and Functional Reach were calculated, and differences were compared using a Wilcoxon signed-rank test. Qualitative data were collected through interviews with intervention commissioners (N = 5), delivery staff (N = 9) and participants (N = 32) and their carers (N = 8) and eight structured observations of FaME classes, and analysed using the Framework method. RESULTS: Of the 110 participants who started the programme and consented to routine data being collected for the study, 90% remained on programme and completed the final 24th session; 75% completed at least 75% or more of the 24-week course. Median levels of Timed-up-and-go, Functional Reach and the Turn 180(o) test improved across the 110 participants between baseline and the end of the FaME intervention (P < 0.001). Fear of falling and self-reported falls decreased on average by the end of the intervention (P < 0.001). Participants were highly motivated to attend, with completers reporting a range of benefits attributed to the intervention. DISCUSSION: The primary aim of reducing falls amongst the over-65s participating in FaME was met and the service was acceptable to participants. There remain concerns around service reach, and the potential to widen health inequalities. The main risk to the maintenance of the FaME intervention across the county is the recruitment and retention of programme staff. CONCLUSION: This study finds evidence that despite the anticipated challenges of implementation in a rural county with poor infrastructure, the intervention achieved improved outcomes for participants. STUDY REGISTRATION: Researchregistry9560. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-23737-6.