Relationships between Health Literacy, Self-Efficacy, and Re-Falling Preventive Behavior in Older Adults Undergoing Hip Surgery
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Abstract
Falls in older adults are a significant issue that impacts their quality of life, particularly among those who have experienced a fall resulting in a hip fracture and have undergone hip surgery. Hip fracture is one of the most serious consequences of falls in older adults and is associated with increased disability, functional decline, and healthcare utilization. After undergoing hip surgery, older adults with fractures usually experience loss of mobility, limited ability to perform activities of daily living, increased healthcare utilization, including hospitalization, rehabilitation, continuous follow-up care, and higher healthcare expenditure. The initial 2-week postoperative period is a critical stage due to high limitations on mobility and heightened risk of recurrent falls, which adversely affect physical health, self-confidence, independence, and the ability to perform daily activities safely. During this period, tissue and bone healing remain incomplete, resulting in substantial physical limitations. Older adults often require assistance from caregivers in performing daily activities and adapting to temporary functional limitations. Effective fall prevention requires a multifaceted approach, in which health literacy in fall prevention and self-efficacy in fall prevention are essential factors influencing re-fall preventive behaviors.Health literacy enables older adults to access, understand, evaluate, and appropriately use health information for making decisions related to fall prevention. However, these factors have not been adequately examined in the early postoperative period, when postoperative recovery remains unstable, and the risk of recurrent falls is high. Therefore, investigating these factors during the early recovery phase may contribute to the development of appropriate nursing interventions for older adults after hip surgery.
This descriptive correlational study aimed to examine the relationships between health literacy in fall prevention, self-efficacy in fall prevention, and re-fall preventive behaviors in 76 older adults with hip fractures who underwent hip surgery and were discharged from the hospital during the early recovery phase, when they are particularly vulnerable to recurrent falls.The findings are expected to provide empirical data to develop nursing care plans that promote re-fall preventive behaviors among older adults with hip fractures before hospital discharge.A descriptive correlational research design was used in this study. The participants were selected using purposive sampling based on inclusion criteria, including: (a) aged 60 years and older, (b) having a hip fracture caused by a fall, (c) ability to communicate and understand the Thai language, and (d) no cognitive impairment. Participants were recruited during their scheduled follow-up visit after hospital discharge during the early recovery period. The research instruments consisted of the demographic and health status questionnaire, the Health Literacy in Fall Prevention Questionnaire, the Activities-Specific Balance Confidence (ABC) Scale, and the Fall Preventive Behaviors Questionnaire, developed based on relevant literature. Data were analyzed using descriptive statistics to summarize participant characteristics and key variables, and Spearman’s rank correlation coefficient to examine the relationships among health literacy, self-efficacy, and re-fall preventive behaviors.
The majority of participants were female, with a mean age of 78.63 years. Most had experienced their first hip fracture and had no history of previous falls beyond the incident leading to their current hospitalization. At the two-week postoperative follow-up, many participants continued to experience functional limitations and required assistance with mobility and activities of daily living. The mean score of re-falling preventive behaviors was higher than the midpoint of the scale, indicating a moderate to high level of engagement in preventive practices. This finding suggests that most participants were able to adopt recommended fall prevention measures despite their physical limitations during the early recovery period. Health literacy in fall prevention had a significant positive correlation with self-efficacy in fall prevention (r = .31, p < .05) and re-falling preventive behaviors (r = .34, p < .05), respectively. However, self-efficacy in fall prevention was not significantly correlated with re-falling preventive behaviors (r = .20, p >.05). These findings further underscore the critical role of health literacy in fall prevention in promoting re-falling preventive behaviors among older adults during the recovery phase following hip surgery. The findings indicated that older adults with higher levels of health literacy in fall prevention tended to have greater self-efficacy in fall prevention and were more likely to engage in re-falling preventive behaviors. Nurses and multidisciplinary healthcare professionals should develop intervention programs to enhance health literacy in fall prevention and strengthen re-falling preventive behaviors in older adults during the early postoperative period, thereby reducing
the risk of re-falling.
Keywords : Falls, Health literacy, Hip surgery, Older adults, Re–falling prevention behaviors,Self-efficacy
Author’s contributions:
SN: Conceptualization, Method and design, Instrument validation, Data collection, Data analysis,Manuscript drafting, Revised manuscript
PY: Conceptualization, Method and design, Data interpretation, Revised manuscript,Corresponding with the editor-in-chief
SC: Conceptualization, Method and Design, Data interpretation, Revised manuscript
Article Details
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บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในรามาธิบดีพยาบาลสาร ถือเป็นลิขสิทธิ์ของวารสาร หากบุคคลหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่หรือเพื่อกระทำการใด ใด จะต้องได้รับอนุญาตเป็นลายลักษณ์อักษรจากรามาธิบดีพยาบาลสารก่อนเท่านั้น
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