Degree Name
DrPH (Doctor of Public Health)
Program
Public Health
Date of Award
8-2026
Committee Chair or Co-Chairs
Jodi Southerland
Committee Members
Karen Carver, Stephanie M. Mathis, Brian Johnston, Shimin Zheng
Abstract
Background. Falls are the leading cause of injury-related morbidity and mortality among older adults and represent a growing public health challenge as the population ages. Fear of falling (FOF) contributes to this burden by promoting activity restriction, functional decline, and increased fall risk, independent of prior falls. Although community-based fall prevention programs are effective, limited research has examined which older adults benefit most and what factors predict improvement in FOF. This gap is particularly evident within Cooperative Extension, a nationwide community-based delivery system for evidence-based health education programs.
Objective. This study aimed to (1) evaluate pre- to post-program changes in FOF among older adults completing A Matter of Balance/Volunteer Lay Leader (AMOB/VLL) through University of Tennessee Extension and (2) identify predictors of FOF improvement following program completion.
Methods. A secondary analysis was conducted using Healthy Aging Programs Integrated Database data from 1,399 adults aged 60 years and older who completed UT Extension-delivered AMOB/VLL between 2021 and 2024. A paired-samples t-test assessed changes in FOF. Multivariable binary logistic regression identified predictors of FOF improvement, and a repeated-measures ordinal logistic regression (GENLIN) served as a sensitivity analysis.
Results. AMOB/VLL participation was associated with a significant reduction in FOF (t(1,398) = 8.066, p < .001, d = 0.22). Approximately 40% of participants reported improvement in FOF following program completion. Older age and FOF-related social activity interference predicted greater odds of improvement, whereas loneliness and multimorbidity demonstrated a dose-response pattern of reduced odds (Nagelkerke R² = .227). The GENLIN sensitivity analysis confirmed the intervention effect and identified female sex and physical inactivity as factors associated with higher FOF levels across time points.
Conclusion. AMOB/VLL significantly reduced FOF in a real-world statewide Extension setting. Findings suggest that older adults reporting FOF-related social activity limitations may derive the greatest benefit from participation. In contrast, individuals experiencing loneliness, physical inactivity, or greater multimorbidity may require additional clinical, social, and behavioral supports to maximize outcomes. These findings can inform targeted recruitment and program tailoring within community-based healthy aging and age-friendly initiatives.
Document Type
Dissertation - embargo
Recommended Citation
Hoskins, Lydia, "Identifying Who Benefits Most: Predictors of Reduced Fear of Falling in a Statewide Community-Based Fall Prevention Program" (2026). Electronic Theses and Dissertations. Paper 4729. https://dc.etsu.edu/etd/4729
Copyright
Copyright by the authors.
