Developing the evidence-base for Safe Communities: a multi-level, partly randomised, controlled trial

Evaluating the Effectiveness of Complex, Multi-component, Dynamic, Community-Based Injury Prevention Interventions: A Statistical Framework

Dynamic violence and injury prevention interventions located within community settings raise evaluation challenges by virtue of their complex structure, focus, and aims. They try to address many risk factors simultaneously, are often overlapped in their implementation, and their implementation may be phased over time. This article proposes a statistical and analytic framework for evaluating the effectiveness of multilevel, multisystem, multi-component, community-driven, dynamic interventions. The proposed framework builds on meta regression methodology and recently proposed approaches for pooling results from multi-component intervention studies. The methodology is applied to the evaluation of the effectiveness of South African community-centered injury prevention and safety promotion interventions. The proposed framework allows for complex interventions to be disaggregated into their constituent parts in order to extract their specific effects. The potential utility of the framework is successfully illustrated using contact crime data from select police stations in Johannesburg. The proposed framework and statistical guidelines proved to be useful to study the effectiveness of complex, dynamic, community-based interventions as a whole and of their components. The framework may help researchers and policy makers to adopt and study a specific methodology for evaluating the effectiveness of complex intervention programs.

Application and Developmental Strategies for Community-Based Injury Prevention Programs of the International Safe Communities Movement in Korea

PURPOSE

Safety of humans is an important factor that affects health overall, and injuries are one of the major public-health problems in the world. The purposes of this study were to describe the International safe Community movement which contributes to the injury prevention and safety promotion all over the world, and to identify out the application and developmental strategies for Korea.

METHODS

A review was done of previous research, reviews, and reports on the history, concepts, basic principles, and recommendations for actions of the Safe Community.

RESULTS

For this study, the application strategies of the International Safe Community movement in Korea were examined to deduce the strengths of the safe Community program. Community-based injury prevention work according to the International Safe Community model is a successful and cost-effective way of reducing injuries in the community.

CONCLUSION

Through the International Safe Community program, communities are able to realize a healthy community and achieve improved quality of lives for the people, which is the ultimate objective of the Safe Community model. In addition, it will contribute to the economic vitalization and gain through energy and enhancement of productivity of people.

Community, intervention and provider support influences on implementation: reflections from a South African illustration of safety, peace and health promotion

Background

The development, implementation and evaluation of community interventions are important for reducing child violence and injuries in low- to middle-income contexts, with successful implementation critical to effective intervention outcomes. The assessment of implementation processes is required to identify the factors that influence effective implementation. This article draws on a child safety, peace and health initiative to examine key factors that enabled or hindered its implementation, in a context characterised by limited resources.

Methods

A case study approach was employed. The research team was made up of six researchers and intervention coordinators, who led the development and implementation of the Ukuphepha Child Study in South Africa, and who are also the authors of this article. The study used author observations, reflections and discussions of the factors perceived to influence the implementation of the intervention. The authors engaged in an in-depth and iterative dialogic process aimed at abstracting the experiences of the intervention, with a recursive cycle of reflection and dialogue. Data were analysed utilising inductive content analysis, and categorised using classification frameworks for understanding implementation.

Results

The study highlights key factors that enabled or hindered implementation. These included the community context and concomitant community engagement processes; intervention compatibility and adaptability issues; community service provider perceptions of intervention relevance and expectations; and the intervention support system, characterised by training and mentorship support.

Conclusions

This evaluation illustrated the complexity of intervention implementation. The study approach sought to support intervention fidelity by fostering and maintaining community endorsement and support, a prerequisite for the unfolding implementation of the intervention.

Barriers to caregiver involvement in a child safety intervention in South Africa

Injuries are a global threat to children’s health and are disproportionately prevalent in Sub-Saharan Africa. Despite the rates of childhood injuries, research into prevention and the community and family conditions required for such interventions have been largely under-researched. This article reviews international work highlighting caregiver involvement in the implementation of interventions in a number of sectors, including the health, education, and safety domains. This work, based largely on experiences in high-income countries, indicates that there are considerable challenges inhibiting caregiver involvement in such interventions. This article explores caregiver understandings of the personal, familial, and contextual barriers to their participation in child safety initiatives. It highlights the obstacles to involvement in a community-centred child safety promotion intervention that was implemented in a low-income setting in the Western Cape. A narrative approach was employed with study data captured in individual interviews and analysed using guidelines for conducting narrative analysis. In total, 11 caregivers were interviewed. Caregiver understandings of the impediments to greater involvement in safety interventions included the multifaceted nature of their personal and social difficulties. These included the prioritisation of work opportunities; conflict and estrangement from partners, family, and the community; and adverse living conditions. In such situations, many reported constrained personal choices and disengagement from many aspects of community relationships. Despite this stance, caregivers recognised the community connectedness, belonging, and responsibility needed to achieve a safer and healthier community.