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Table 1 Comparison between Pisando Fuerte and Stepping On

From: Pisando Fuerte”: an evidence-based falls prevention program for Hispanic/Latinos older adults: results of an implementation trial

  Stepping On Pisando Fuerte Rationale for adaptation
Language English Spanish Hispanic/Latino older adults preferred Spanish.
Reading level of program 8th Grade Leader’s manual: 8th Grade
Handouts: 3rd Grade
Hispanic/Latino older adults in the study had low educational attainment.
Requirements to be a leader (1) Background as an allied health professional (RN, PT, PTA, OT, social worker) or fitness expert;
(2) Experience facilitating an adult self-management program;
(3) Professional experience working with older adults [21].
(1) Professional experience working with Hispanic/Latino older adults
(2) Background as allied health professional, fitness expert, community health worker, health educator, promotor(a), or equivalent experience.
Recruiting for leaders was difficult, few active health professionals are from a Hispanic/Latino background AND fluent in Spanish.
Community organizations did not have staff with the required characteristics, and they could not assure sustainability of the program without the changes.
Number of sessions 7 session (2 h each) 8 sessions (2.5 h each) During pilot, sessions lasted longer than expected.
Sessionsa  - Strength and balance exercises
 - Use of assistive devices
 - Preventing falls indoor/outdoor
 - Vision & footwear
 - Medications & sleep habits
 - Bone Health
 - Strength and balance exercises
 - Use of assisted devices
 - Preventing falls indoor/outdoor
 - Vision & footwear
 - Medications & sleep habits
 - Bone Health
 - How to talk to your doctor? – Modified
The session about “how to talk to your doctor” was modified per stakeholder input to add more emphasis on the importance to voice concerns to health professionals; and how to address barriers.
Use of weights for exercise Mandatory Optional Cost of the weights is prohibitive to the organizations and participants, and cultural barriers would reduce use.
Guest Experts In person visits from guest experts. If guest experts are not fluent in Spanish, leaders could use any of the following:
 - Invite an English speaker guest expert and use an interpreter to deliver the information
 - Use pre-recorded videos with Spanish-speaking guest experts, and bring an English speaker for questions & answers, with an interpreter to facilitate discussion.
It was a challenge to identify and bring bilingual guest experts to participate in the sessions. These modifications assure that the key elements of the program are maintained.
Other    - Inclusion of Hispanic/Latinos cultural values
 - Created a resource book for leaders on how to find resources in your community.
 - Supporting materials (e.g. Presentations, Handouts) included more pictures, and stories were adapted to be culturally appropriate
 - Participants were asked to share information with family members and family members were invited to the last session
These changes assured acceptability of the program by increasing fun, build trust in leaders, increase involvement of family members, and facilitated participation during sessions.
  1. aThe order of the sessions is not described in this table. For Pisando Fuerte the order was modified to fit the additional session and extra time