"It's part of getting old": ageing perceptions and cultural beliefs underpin hip recovery and refracture prevention experiences: a qualitative study.

Normalisation of pathological ageing shaped older adults' expectations and engagement with preventive care after hip fracture.

• Participants commonly attributed hip fracture and associated decline to normal ageing rather than a preventable or treatable condition.
• This 'normalisation of pathological ageing' was identified as one of three interconnected themes across individual, social and health system levels.
• Such beliefs reduced perceived need for engagement with secondary prevention strategies and refracture prevention clinics.
• The theme was identified across the 20 participants (mean age 74 years, 60% women, 75% culturally diverse).

Cultural orientations shaped motivations, expectations and family roles in hip fracture recovery and refracture prevention.

• Cultural orientations constituted one of three major themes emerging from thematic analysis.
• Family roles were a significant culturally-shaped factor influencing recovery trajectories.
• Interviews were conducted in multiple languages including English, Arabic, Assyrian, and Vietnamese to capture culturally diverse experiences.
• 75% of the 20 participants were identified as culturally diverse, enabling cross-cultural comparison within a multicultural Australian setting.

Refracture prevention clinics were valued by participants but access was hampered by logistical and system barriers.

• Care continuity was identified as the third major interconnected theme.
• Despite participants valuing refracture prevention clinics, engagement was undermined by logistical and health system-level barriers.
• The study was embedded within a prospective cohort at a metropolitan Australian trauma hospital.
• Participants included both older adults with recent low-trauma hip fracture and their caregivers, purposively sampled for cultural diversity.

A qualitative study design using semi-structured interviews and two-step inductive-deductive thematic analysis was used to explore cultural and individual factors in hip fracture recovery.

• Twenty participants were interviewed: mean age 74 years, 60% women, 75% culturally diverse.
• Semi-structured interviews were conducted in English, Arabic, Assyrian, or Vietnamese.
• Data were thematically analysed using a two-step inductive-deductive approach, mapping codes to Andersen's Behavioural Model before theme development.
• Participants were purposively sampled for cultural diversity from a metropolitan Australian trauma hospital cohort.
• Participants included both older adults with recent low-trauma hip fracture and their caregivers.

Three interconnected themes interacted across individual, social and health system levels to shape recovery trajectories and refracture prevention engagement.

• The three themes were: (i) normalisation of pathological ageing, (ii) cultural orientations, and (iii) care continuity.
• Themes were identified as interconnected rather than discrete, operating simultaneously across multiple levels.
• The analytical framework mapped findings to Andersen's Behavioural Model to organise individual, social and system-level factors.
• Limited prior understanding existed of how individual, social and cultural factors influence engagement with recovery and secondary prevention in multicultural health systems.