“The ‘yay’ feeling never faded, especially because I felt the improvement”: understanding adherence to a foot strengthening training in older adults through thematic analysis of interviews

Introduction: Falls among older adults are an increasing concern. Foot exercise programs may reduce fall risk, but adherence is low to moderate. This study aimed to acquire an in-depth insight into how adherence to a foot strengthening program is influenced. Methods: Twelve older adults (7 women, 5 men, aged 69–91 years) assigned to a 12-week supervised foot strengthening program, as part of a randomized controlled trial, were interviewed to explore their perspectives on and experiences with the program. Reflexive thematic analysis was used with an experiential and inductive orientation to collect and approach the data. The semi-structured interviews were guided by open-ended questions based on behavior change theory. Coding was done iteratively and driven by the data. Themes were developed as the analytic output. Results: The final themes were: “Getting started,” “Hanging in,” “Settled into the rhythm” and “Perceiving health benefits is the ultimate.” These central themes were additional to the positive evaluation of intervention features: clear instructions from the trainer, supportive materials, and flexibility in timing and content of the training program. Conclusion: Adherence to a foot strengthening program is influenced by factors that change over the course of the intervention. These factors are linked to typical phases encountered consecutively by the participants. The last phase involves the exercises becoming habitual practice, which is, like the second-to-last phase, not reached by every participant. This timeline and the influencing factors offer professionals a tool to approach individuals appropriately to maximize adherence to a foot strengthening program. It also guides the development of similar interventions.