Background on Supportive Relationships
What are supportive relationship strategies?
- Interventions are programs or activities designed to increase social support to prevent injuries from falls through involvement with individuals, organizations and communities.
- These interventions may focus on increasing the information individuals have about injury from falls (e.g., risk factors and prevention) [informational support], provide a venue for sharing experiences and feelings [emotional and appraisal support], or provide tangible support (e.g., install window guards or hand rails, change floor surfaces). In addition, such interventions provide opportunities to identify and address challenges collectively (e.g., collective problem solving or advocacy) rather than individually.
- This support may be provided through involvement from a variety of individuals or individuals as part of groups, organizations, or communities including:
- school nurses
- community health advisors
How do supportive relationships impact injury from falls?
- Supportive relationships interventions may help to change behaviors in order to prevent an injury from occurring (primary prevention) or work with those who have already had an injury from falling and reduce the likelihood of a subsequent injury by changing behavior or environmental conditions secondary prevention). In some cases, individuals may be asked to wear protective equipment to prevent serious injuries when falls occur (e.g., hip protectors for older adults, personal protective equipment for employees).
- Supportive relationships interventions are successful for many reasons: individuals can ask questions or clarify what they have been told, those providing support can also provide referrals and resources to assist the individual, and longer-term relationships can help to sustain behavior change over time, among others.
How can I use supportive relationship strategies in an injury from falls intervention?
- Supportive relationship intervention strategies may be designed to discuss challenges, benefits and advice for preventing injury from falls. Supportive Relationships may be provided in the form of face-to-face interactions, telephone calls, or through interactive web-based systems. These interventions may include specific information as part of each call or face-to-face session, or may be more open ended and responsive to the specific needs of the individual.
Why is it important to considering tailoring in supportive relationship strategies?
- These interventions can be very successful when the support is tailored to the individual’s needs. For example, if the individual is susceptible to falls, the support can be around how to incorporate strength building and activity into a daily routine.
- In order to provide tailored advice to the individual, the person providing the support has to determine the specific challenges the individual is facing. Supportive relationships interventions may include an assessment of existing behaviors (e.g., physical activity) or the environment (e.g., windows, floors, stairs) as well as a discussion of challenges, benefits and advice for creating and maintaining change over time.
- Supportive relationship interventions work best when the advice also takes into account the person’s gender, age, language, race or ethnicity, and other cultural factors.
What is “readiness to change” and how does it relate to supportive relationships?
- Supportive relationships interventions can be very successful when the support is tailored to individuals’ readiness to change. The concept of readiness to change (drawn from the Transtheoretical Model or Stages of Change) suggests that individuals may need different kinds of interventions to help them change their behavior or environment depending on how ready they are to change. For example, individuals who are not really thinking about changing their behaviors (e.g., get more physical activity) or environments (e.g., install window guards) may need information on the harmful effects of injury from falls (e.g., number of deaths, types of serious injuries). Yet, individuals who are ready to make these changes may need access to resources to make the changes (e.g., physical activity classes to build their strength, balance, and coordination; free window guards). Supportive relationships may be particularly important when people are ready to change their behaviors (i.e., supportive relationships can help to reinforce these decisions).
How do supportive relationship strategies deal with relapse?
- Often, individuals change their behaviors and then relapse, or go back to previous behaviors. Likewise, they may change certain parts of the environment (e.g., handrail on the stairs) and don’t recognize the need to regularly assess and change other parts of the environment as needed (e.g., handrail in the shower). Supportive relationships interventions, therefore, include information to help individuals increase their awareness, work with individuals to develop strategies to help prevent relapse in the future, and encourage individuals to regularly reassess their behaviors and environments. (See Relapse Prevention Theory)
- It can be helpful to recognize that changes in behaviors and environments may happen in small steps. For example, efforts to prevent injuries from falls may happen first in response to certain conditions (e.g., a fall in the bathroom encourages the placement of non-slip mats) and slowly generalize to other areas of the home (e.g., placing handrails by the bed, better lighting in the kitchen). Every individual will have preferences for what steps make be the easiest to take first, and these preferences may depend to a large extent on the support of others for these changes (e.g., family, co-workers, roommates, friends).
How have supportive relationships been used in past injury from falls interventions?
- Increase support for changing behaviors and modifying the environment to reduce injury from falls among infants and children. Health care providers, teachers, or lay health advisors can help families or new parents learn about the risks of injury from falls among infants and children. Changes in behaviors such as supervising children when playing on playground equipment or discontinuing use of infant walkers can help to minimize falls. In addition, parents can install window guards and safety gates around stairs. This support may be offered through face-to-face interactions, letters, home visits or telephone calls. Supportive interventions may be initiated by the health care provider or the family (e.g., counseling during an office visit).
- Increase support for changing behaviors and modifying the environment to reduce injury from falls among the elderly. Health care providers, lay health advisors or certified exercise instructors can provide support to older adults in their homes, residential care facilities, health care settings, or over the phone. The support may include encouragement to improve home safety as well as assistance in making specific modifications (e.g., installing handrails or non-slip floor surfaces, moving furniture, or improving lighting). These interventions may also encourage older adults to use safer footwear or increase their physical activity.
- Increase worksite support for using personal protective equipment to reduce injury from falls. Health care providers, lay health advisors, or worksite representatives may provide support to employees to prevent injuries from falls (e.g., construction workers, firefighters, mail carriers).