From information to action- a phase-based analysis of patient engagement in inpatient fall prevention: A scoping review.

BACKGROUND

Inpatient falls are a major patient safety concern worldwide. Although patient engagement has been increasingly emphasised in fall prevention, its distribution and depth across the prevention process remain poorly understood.

OBJECTIVE

This scoping review examined how patient engagement is structured across the phases of inpatient fall prevention worldwide, focusing on decisional ownership and the contextual and structural factors influencing its implementation.

DESIGN

A scoping review was conducted in accordance with the Joanna Briggs Institute methodology.

METHODS

PubMed, Web of Science, and CINAHL were searched for English-language studies published between January 2015 and July 2026. The final search was conducted on 16 July 2026. Patient engagement was conceptualised as decisional ownership and classified into Level 1 (passive engagement), Level 2 (shared decision-making), and Level 3 (autonomous decision-making). The inpatient fall prevention process was organised into four phases: risk awareness, co-planning, goal setting, and self-management. Data were synthesised descriptively, incorporating cognitive requirements, family involvement, and information-sharing approaches.

RESULTS

Patient engagement varied across the four phases of inpatient fall prevention and was unevenly distributed throughout the prevention process. Engagement was concentrated in the risk awareness and co-planning phases, where Level 2 (shared decision-making) was occasionally achieved. In contrast, goal setting was often implicit or absent, and patient involvement in self-management remained limited. The extent of engagement was influenced by patients' cognitive capacity, with family involvement serving as a proxy in some interventions, although this role was inconsistently translated into active participation or behavioural change.

CONCLUSION

Patient engagement in inpatient fall prevention does not extend uniformly across the care process. Current interventions primarily support shared decision-making but rarely facilitate autonomous patient involvement. Future interventions should incorporate explicit goal setting, strengthen self-management, integrate proxy engagement for patients with cognitive impairment, and align information sharing with decision-making support. This review reconceptualises patient engagement as a phase-dependent, structurally mediated process and identifies important gaps in the design of current interventions.