Background Falls are the leading cause of injury morbidity and mortality in older adults. Exercise, including balance and strength training, decreases fall risk, but few older adults exercise as recommended. We examined factors associated with older adults’ participation in balance classes.

Methods This case-control study was nested in a controlled trial in which churches were randomly assigned to a social marketing program to encourage older adults to attend N’Balance classes or to no intervention. Eligible subjects were study church congregants aged ≥60 who completed a study survey. Cases included all eligible subjects who attended an N’Balance class during the study period; controls were congregants randomly selected to receive a survey who did not attend a balance class in this period. Study church leaders provided information about themselves and their church. Individual and church level characteristics were examined using logistic regression to determine the independent effect of social marketing and identify additional predictors of balance class participation.

Results After accounting for individual and church level differences, cases (n = 173 N’Balance participants) were much more likely than controls (n = 270) to attend churches that received the social marketing program (adjusted OR [aOR]: 20.62 [95% CI: 9.55, 44.54]). Cases were older (aOR per year of age: 1.06 [1.03, 1.10]), more likely to be female (aOR: 3.07 [1.74, 5.42]), and more frequently experienced ‘near falls’ (aOR: 1.98 [1.44, 2.72]). Cases were also more likely to attend a church with an older religious leader (aOR per year of age: 1.04 [1.01, 1.07]), located in a rural area (aOR: 1.89 [1.11, 3.22]).

Conclusions Church-based social marketing was strongly associated with increased uptake of balance classes for reducing fall risk, particularly among certain high-risk groups. Church-based marketing may need to be tailored to target others at risk, including men and urban and suburban congregants.