Academic Journal
Decoding why patients follow-or do not follow-fall-prevention instructions using the revised protection motivation theory: A cross-sectional study employing partial least squares structural equation modelling.
| Τίτλος: | Decoding why patients follow-or do not follow-fall-prevention instructions using the revised protection motivation theory: A cross-sectional study employing partial least squares structural equation modelling. |
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| Συγγραφείς: | Takase M; School of Nursing, Yasuda Women's University, Hiroshima, Japan. Electronic address: takase@yasuda-u.ac.jp. |
| Πηγή: | International journal of nursing studies [Int J Nurs Stud] 2026 Jul; Vol. 179, pp. 105535. Date of Electronic Publication: 2026 Apr 17. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Pergamon Press Country of Publication: England NLM ID: 0400675 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-491X (Electronic) Linking ISSN: 00207489 NLM ISO Abbreviation: Int J Nurs Stud Subsets: MEDLINE |
| Imprint Name(s): | Publication: Oxford ; New York : Pergamon Press Original Publication: Oxford. |
| Ιατρικοί όροι (MeSH): | Accidental Falls*/prevention & control , Motivation* , Patient Compliance*, Humans ; Cross-Sectional Studies ; Female ; Male ; Aged ; Middle Aged ; Japan ; Aged, 80 and over |
| Περίληψη: | Background: Patient falls remain a persistent problem in healthcare settings, requiring numerous preventive interventions. However, existing systematic reviews have not demonstrated the effectiveness of these interventions in reducing fall rates and the number of fallers. Successful fall-prevention requires not only healthcare providers' efforts but also patients' active cooperation and engagement. Yet the mechanisms through which patients become motivated to follow nurses' fall-prevention instructions, and the factors influencing their adherence, remain unclear. Objective: This study examined factors associated with patients' motivation and adherence to nurses' fall-prevention instructions in hospital settings, drawing on the revised Protection Motivation Theory. Design: A cross-sectional design. Setting(s): Hospitals nationwide in Japan. Participants: A total of 304 patients recruited nationwide in Japan, aged ≥60 years, hospitalised on general wards for at least 24 h, and who had received nurse-provided fall-prevention instructions, participated in the study. Methods: Participants were invited to complete an online survey containing a newly developed protection motivation scale. Data were analysed using partial least squares structural equation modelling. Results: The revised Protection Motivation Theory showed greater predictive power than the original theory in explaining patients' fall-prevention motivation. Perceived severity of falls (β = 0.185, 95% CI[0.059, 0.307]), perceived effectiveness of the instructions (response efficacy) (β = 0.299, 95% CI[0.113, 0.492]), self-efficacy in performing the recommended actions (β = 0.311, 95% CI[0.124, 0.484]), and a supportive nurse-patient relationship (β = 0.199, 95% CI[0.069, 0.342]) were all significantly and positively associated with patients' motivation to follow nurses' instructions. Among these, self-efficacy (f2 = 0.128) and response efficacy (f2 = 0.084) showed the largest and second-largest effect sizes, respectively. Adherence to fall-prevention instructions was positively predicted by motivation (β = 0.376, 95% CI[0.208, 0.532]) and self-efficacy (β = 0.270, 95% CI[0.094, 0.443])-again with the largest (f2 = 0.148) and second-largest (f2 = 0.070) effect sizes-and negatively predicted by perceived response costs (β = -0.114, 95% CI[-0.224, -0.014]) and sex (β = -0.119, 95% CI[-0.211, -0.023]). Conclusions: To enhance patients' motivation to engage in fall-prevention strategies, nurses should emphasise the potential consequences and seriousness of falls rather than focusing solely on patients' vulnerability. More importantly, strengthening patients' confidence in both the effectiveness of preventive measures and in their own ability to apply them-supported by a positive nurse-patient relationship-may be particularly effective. As patients move into the active implementation stage, nurses should continue to reinforce response efficacy and self-efficacy. Of particular note is that bolstering self-efficacy appears critical, as it may help patients overcome challenges encountered during implementation. Registration: Not registered. (Copyright © 2026 Elsevier Ltd. All rights reserved.) |
| Competing Interests: | Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Miyuki Takase reports financial support was provided by Japan Society for the Promotion of Science. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Falls; Hospitals; Motivation; Patient adherence; Patient education; Protection motivation theory; Self-efficacy |
| Entry Date(s): | Date Created: 20260418 Date Completed: 20260715 Latest Revision: 20260715 |
| Update Code: | 20260715 |
| DOI: | 10.1016/j.ijnurstu.2026.105535 |
| PMID: | 42000646 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1873-491X |
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| DOI: | 10.1016/j.ijnurstu.2026.105535 |