An ethnography of low-income mothers' safeguarding efforts

Conducting a child injury prevention RCT in the wake of COVID-19: lessons learned for virtual human subjects research

Unintentional injury is the leading cause of death among children in the United States, and children living in low-income households are particularly at risk for sustaining unintentional injuries. Close parental supervision has been found to reduce young children's risk for injury; however, few studies have examined interventions to increase parental supervision. This paper discusses COVID-19 related modifications that were made to a federally funded randomized controlled trial to reduce low-income children's risk for unintentional injury. The study's procedures (data collection and intervention delivery) had to be transitioned from in-person to a fully virtual format. Modifications that were made to the study included use of: participant cell phones to conduct data collection and intervention sessions; virtual meeting software to conduct sessions with participants and; an online platform to collect questionnaire data. In addition, many modifications were required to complete the in-home observation virtually. In terms of feasibility, the investigators were able to collect all of the data that was originally proposed; however, recruitment and retention was more challenging than anticipated. Lessons learned during the modification process are included to provide guidance to researchers seeking to conduct virtual human subjects research in the future.

Pediatric trauma in the California-Mexico border region: Injury disparities by Area Deprivation Index

BACKGROUND

The California-Mexico border region is a high-volume trauma area with populations of widely disparate socioeconomic status. This work analyzed differences in demographics and mechanism of injury in children using the Area Deprivation Index (ADI), a composite measure of 17 markers of neighborhood socioeconomic disadvantage.

METHODS

A retrospective review was performed of pediatric patients evaluated at the regional Level I Pediatric Trauma Center between 2008 and 2018. Collected data included patient demographics and injury characteristics. Patient addresses were correlated to neighborhood disadvantage level using ADI quintiles, with a higher quintile representing greater socioeconomic disadvantage.

RESULTS

A total of 9,715 children were identified, of which 4,307 (44%) were Hispanic. Hispanic children were more likely to live in more disadvantaged neighborhoods than non-Hispanic children (p < 0.001). There were markedly different injury mechanisms in neighborhoods with greater socioeconomic disadvantage (higher ADI) compared with those with less socioeconomic disadvantage. Sports-related and nonmotorized vehicular trauma predominated in less disadvantaged neighborhoods, while higher ADI quintiles were strongly associated with pedestrian versus automobile, motorized vehicle accidents/collisions, and nonaccidental injuries (p < 0.001).

CONCLUSION

This analysis represents the first study to characterize pediatric traumatic injury patterns based upon the neighborhood ADI metric. Area Deprivation Index can be a useful resource in identifying disparities in pediatric trauma and children at increased risk for vehicular and abusive injury who may benefit from increased resource allocation, social support, and prevention programs.

LEVEL OF EVIDENCE

Prognostic and epidemiological, Level III.

Evaluation of the effectiveness, implementation and cost-effectiveness of the Stay One Step Ahead home safety promotion intervention for pre-school children: a study protocol

BACKGROUND

Unintentional injuries in children under the age of 5 years commonly occur in the home and disproportionately affect those living in disadvantaged circumstances. Targeted home safety promotion should be offered to families most at risk but there is a paucity of standardised evidence-based resources available for use across family-support practitioners.

OBJECTIVE

To assess the effectiveness, implementation and cost-effectiveness of a 2-year home safety programme (Stay One Step Ahead) developed by parents, practitioners and researchers, and delivered by a range of family support providers in inner-city localities, compared with usual care in matched control localities.

METHODS

Parents of children aged 0 to 7 months will be recruited to a controlled before and after observational study. The primary outcome is home safety assessed by the proportion of families with a fitted and working smoke alarm, safety gate on stairs (where applicable) and poisons stored out of reach, assessed using parent-administered questionnaires at baseline, 12 and 24 months.Secondary outcomes include: the impact on other parent-reported safety behaviours, medically-attended injuries, self-efficacy for home safety and knowledge of child development and injury risk using questionnaires and emergency department attendance data; implementation (reach, acceptability, barriers, facilitators) of home safety promotion assessed through interviews and observations; and cost-effectiveness using medically-attended injury costs ascertained from healthcare records.

CONCLUSION

If shown to be effective and cost-effective this study will provide a practical resource to underpin national guidance. The study could inform public health prevention strategies to reduce home injury in children most at risk, while delivering cost savings to health and care services.

TRIAL REGISTRATION NUMBER

ISRCTN31210493; Pre result.

The Difficulty of Prevention: A Behavioral Perspective

Behavioral medicine provides insight in to the problem of injury prevention. Society often views unintentional injuries as only an accident when in reality many accident-related injuries are preventable. However, barriers to behavioral change in injury prevention exist for both patients (eg, inconvenience, perceived risk-benefit ratio) and health care providers (eg, feeling of badgering nonadherent patients, patient misinformation). To overcome barriers, the article discusses strategies for health care providers to address injury prevention such as choosing active over passive strategies, informing patients of predictable injury-prone circumstances, and individualizing patient risks.

Low-Income Mothers' Descriptions of Children's Injury-Related Events: A Discourse Analysis

The purpose of this study was to examine how mothers with young children who were living in low-income households used discursive strategies to explain their children's injury and near-miss events. In-person interviews were conducted with 17 mothers and a discourse analytic approach was used to analyze the data. Mothers used a variety of discursive strategies to explain injury events including minimizing the nature of events and expressing tensions between responsibility and resistance. Mothers also described challenges related to predicting children's behavior and dealing with competing demands. These discursive strategies reflected how societal expectations that mothers are held to in terms of keeping children safe conflicted at times with the constraints experienced by mothers living in economically challenging situations. The findings can be used to inform the design of injury prevention strategies that are sensitive to experiences of mothers of young children who are living with economic challenges.

Dwelling within political violence: Palestinian women's narratives of home, mental health, and resilience

Political violence is increasingly played out within everyday civilian environments, particularly family homes. Yet, within the literature on political violence and mental health, the role of threats to home remains under-explored. Using focus group data from 32 Palestinian women, this paper explores the implications of violations to the home within political violence. Threats to the privacy, control, and constancy of the family home - key dimensions of ontological security (Giddens, 1990) emerged as central themes in women's narratives. Surveillance, home invasions, and actual or threatened destruction of women's home environments provoked fear, anxiety, grief, humiliation, and helplessness, particularly as women struggled to protect their children. Women also described how they mobilized the home for economic, familial and cultural survival. Study findings illuminate the impact of threats to intimate environments on the well-being of women and their families living with chronic political violence, and underscore the importance of attention to violations of place and home in research on civilian experiences of and responses to political violence.

Maternal perceptions of supervision in pre-school-aged children: a qualitative approach to understanding differences between families living in affluent and disadvantaged areas

AIM

To explore maternal perceptions of supervision and childhood unintentional injury in order to develop understanding and explanation for differences in unintentional injury rates between an advantaged and disadvantaged area.

BACKGROUND

Unintentional injury is the second cause of mortality and a significant cause of morbidity in the zero to four year age group. Children living in socio-economic disadvantage are at a greater risk of unintentional injury than their more affluent counter-parts.

METHODS

Qualitative study using semi-structured interviews; content data analysis was undertaken. Participants included 37 mothers with a child aged less than five years; 16 living in an area of disadvantage (and high rate of childhood unintentional injury) and 21 living in an advantaged area (and low rate of childhood unintentional injury).

FINDINGS

Parents in both areas described the importance of parental supervision in reducing child unintentional injury risks. Parents in both areas used listening as a supervision strategy. Parents in both areas described how 'when the child goes quiet' that is a cue for them to make a visual check on the child. Listening was used more for boys than girls in both areas, but parents in the advantaged area used listening as a supervision strategy more frequently than those in the disadvantaged area. Parents described supervision strategies as being shaped by child character and age rather than child gender. Parents in both areas described similar strategies for managing distractions. An important difference was found with regard to older siblings; parents living in the advantaged area described older siblings as an injury risk to younger children. Parents in the disadvantaged area described older siblings as providing some supervision for younger children. Parents living in disadvantaged circumstances may face greater challenges with regard to supervision than parents living in advantaged circumstances and this may partly explain differences in injury risk.

Barriers to, and facilitators of, the prevention of unintentional injury in children in the home: a systematic review and synthesis of qualitative research

Background

This review considers barriers to, and facilitators of, success for interventions to reduce unintentional injury to children in the home through supply and/or installation of home safety equipment, and looks at risk assessments.

Methods

A systematic review of qualitative research. Bibliographic databases were searched for studies on interventions to reduce unintentional child injury in the home, or on related attitudes and behaviours. Studies were quality appraised, findings extracted, and a conceptual framework was developed to assess factors affecting the success of interventions.

Results

Nine peer-reviewed journal articles were included. Barriers and facilitators were highlighted at organisational, environmental and personal levels. Effective provision of safety equipment involves ongoing support with installation and maintenance. Take up and success of interventions depends on adjusting interventions according to practical limitations and parents' cultural expectations. A particular barrier was parents' inability to modify rented or shared accommodation.

Conclusions

The review highlights ways in which health inequalities affect the take up and success of home safety interventions, and how health workers can use this knowledge to facilitate future interventions.