International Journal of Sports Science 2014, 4(4): 136-141 DOI: 10.5923/j.sports.20140404.03 A Primary School-based Educational Program to Improve Fall Skills; Process Evaluation Alongside a Cluster Randomized Controlled Trial Joske Nauta 1 , Lize Adriaensens 2 , Karin Klein Wolt 2 , Willem Van Mechelen 1 , Evert Verhagen 1,* 1 Department of Public & Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, 1081 BT, The Netherlands 2 Consumer Safety Institute, Amsterdam, 1059 GK, The Netherlands Abstract In this study, the process evaluation of an educational program to improve fall skills in primary school age children was conducted alongside a cluster randomized controlled trial using the RE-AIM framework. Thirty-three schools participated in a cluster-randomized controlled trial. Seventeen schools were randomly allocated to the intervention group. Injuries were registered during a school year. Fall skills were assessed using self-reports and a fall skills test. And questionnaires were used to evaluate experiences of both children and teachers with the educational program. All children participating in physical education lessons were reached. The program was effective in increasing self-perceived fall–skills and the score on a fall-skills test (0.94 points), but the change in fall-related injury rates did not reach significance. Fourteen percent of invited schools was willing to Adopt the educational program. And although participating teachers were positive about the educational program, 89% failed to implement the exercises as intended. Lastly, 54% of the teachers intended to maintain the educational program in their regular teaching routine. Given that many teachers failed to implement the intervention as intended, it is promising that fall skills in children did significantly improve after the intervention. The reason why this did not result in corresponding decrease in fall related injury risk remains unclear. Adjusting the educational program to better fit the needs of teachers potentially increases adoption of the program which could result in a more effective educational injury prevention program. Keywords Educational program, Fall-related injury prevention, Implementation, Primary school-based, Process evaluation 1. Introduction Primary schools are considered a key intervention context through which Physical Activity (PA) levels can be increased in order to prevent childhood obesity and sedentary behavior related diseases [1]. Through sports, Physical Education (PE) and play, children of all ages are encouraged to participate in PA. Yet the risk of related injury is often neglected in these efforts to promote daily PA. In children, PA promotion is usually focused on leisure time PA. Although the number of injuries expressed per 1,000 hours of physical activity associated with these activities is lower than for organized PA (i.e. PE and sports), absolute numbers as well as costs associated with these injuries are significantly higher [2, 3]. Also, leisure time PA is related to a relatively large number of forearm fractures * Corresponding author: e.verhagen@vumc.nl (Evert Verhagen) Published online at http://journal.sapub.org/sports Copyright © 2014 Scientific & Academic Publishing. All Rights Reserved [3]. Overall forearm fractures account for up to one third of childhood fractures [4], and about 40% to 50% of children sustain at least one fracture during childhood5. Also given a steady increase in the incidence of forearm fractures over the last 30 years [4], it is evident that preventive measures are warranted. Currently, little is known about the mechanisms underlying the observed increase in forearm fractures. Regarding the injury mechanism, it has been described that 80% of forearm fractures occur after a fall [6]. Since falling is an inescapable part of a child’s daily play and PA, it is unlikely that falls can be completely avoided. The injury resulting from a fall could, however, be reduced when children are trained to properly react when falling. Martial arts falling techniques have, for example, shown to decrease forearm ground reaction forces [7, 8] thereby potentially reducing the risk of sustaining a forearm fracture [7]. In the Netherlands, an educational program, consisting of exercises based on martial arts techniques, was developed to improve fall skills in children. In this study, the process of implementation was evaluated.