Summary

Introduction: Falls and fall-related injuries in community-dwelling older adults are a
growing global health concern. Despite effective exercise-based fall prevention programs (FPPs),
low enrollment rates persist due to negative connotations associated with falls and aging. This
study aimed to investigate whether positive framing in communication leads to a higher intention
to participate in an FPP among community-dwelling older adults. Methods: We conducted a twosequence
randomized crossover study. We designed two flyers, a standard flyer containing standard
terminology regarding FPPs for older adults, and a reframed flyer highlighting fitness and activity
by reframing ‘fall prevention’ as an ‘exercise program’ and ‘old’ as ‘over 65 years’. With a Mann–
Whitney U test, we investigated group differences regarding the intention to participate between
the flyers. A sensitivity analysis and subgroup analyses were performed. We conducted qualitative
thematic analysis on open-ended answers to gain a deeper understanding of participants’ intention
to participate. Results: In total, we included 133 participants. Findings indicated a significantly
higher intention to participate in the reframed flyer (median = 4; interquartile range = 1–6) compared
to the standard flyer (median = 2; interquartile range = 1–4) (p = 0.038). Participants favored more
general terms such as ‘over 65 years’ over ‘older adults’. Older adults who were female, not at
high fall risk, perceived themselves as not at fall risk, and maintained a positive attitude to aging
showed greater receptivity to positively-framed communications in the reframed flyer. Additionally,
already being engaged in physical activities and a lack of practical information about the FPP
appeared to discourage participation intentions. Discussion: The results in favor of the reframed
flyer provide practical insights for designing and implementing effective (mass-)media campaigns on
both (inter)national and local levels, as well as for interacting with this population on an individual
basis. Aging-related terminology in promotional materials hinders engagement, underscoring the
need for more positive messaging and leaving out terms such as ‘older’. Tailored positively framed
messages and involving diverse older adults in message development are essential for promoting
participation in FPPs across various population subgroups to promote participation in FPPs among
community-dwelling older adults.