84 Chapter 3 variations in the interpretation of tailoring, in this study according to Powell et al. [17], opposed to VanderVelde et al. ‘matching the intervention or components to previously measured characteristics of the participants’ [80]. None of the studies reported all seven prerequisites for each individual strategy, which limits the possibility to replicate implementation strategies [81] and to assess which implementation strategy had a positive effect on the implementation outcomes [82]. The studies published after 2013 did not provide complete documentation on the level of operationalization, as assessed with the recommendations of Proctor et al.[13]. The actor was decerned in less than 50% of the implementation strategies, all other prerequisites, such as dose, temporality, and implementation outcome affected were reported even less. While most studies reported about their implementation outcomes, they did not hypothesize how each individual implementation strategy could have an effect on a specific implementation outcome. Previously published systematic reviews in community care and long-term care facilities also mentioned a lack of details in the operationalization of implementation strategies [77, 80]. Preferably, reporting on implementation strategies should be done systematically, for instance, by following the recommendations of Proctor et al.[13]. Overall, in most studies, implementation of FPIs was associated with a fall rate reduction. However, five study sites showed an increase in their fall rate. The latter could be the result of ineffective implementation; the five studies involved did not map existing barriers to guide their implementation strategies. Another reason might be the lack of effectiveness of the chosen FPI. Kwok et al. reported a slight increase in the fall rate after using a single implementation strategy. Another factor that should be taken into account when interpreting these results is the possibility of publication bias, as studies reporting negative results are less frequently published [83]. Another issue is underreporting of falls. In most studies, fall rate was determined from data collected through a fall incident reporting system. Accuracy of this data is dependent on health professionals’ reporting behavior. Worldwide, problems associated with incident reporting are remarkably consistent: studies have shown that reporting systems detect only 7-15% of adverse events. Underreporting of incidents primarily depends on the prevailing culture and whether incidents are considered opportunities to learn from [84]. Strengths and limitations Using the ERIC taxonomy strengthens the insights in which areas implementation strategies were deployed. Even though, we still encountered challenges in categorizing certain strategies. Most of these challenges stemmed from a lack of provided details.
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