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Abraham J, Alva J, Vinish V. Assessment of knowledge, readiness, and barriers hindering the performance of first aid measures in emergency situations among non-healthcare professionals of selected organizations of Udupi Taluk. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:359. [PMID: 38144004 PMCID: PMC10743846 DOI: 10.4103/jehp.jehp_1860_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/28/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND A medical emergency is an unexpected event that poses a threat to one's health and safety. An individual who has received adequate first aid training is prepared to administer first aid promptly and effectively to a person in need until the arrival of medical assistance to prevent future problems that could result in disability or death. This study aims to assess the knowledge, readiness, and barriers to perform first aid measures. MATERIALS AND METHODS A descriptive survey was used to collect data from 384 non-healthcare professionals of selected organizations of Udupi Taluk with the help of a structured questionnaire from January 21, 2022 to April 13, 2022. The self-structured tool was validated with experts from the subject areas and reliability was obtained by using the Split half method (0.78) for the knowledge questionnaire, readiness scale by using Cronbach's alpha and the reliability coefficient was 0.80, and barrier checklist was accomplished by a test-retest method and reliability coefficient of 0.76. Data was organized, and frequency, percentage, and Chi-square analysis were performed using SPSS 16.0 version (IBM Corporation Business analytics software portfolio). RESULTS The results revealed that out of 384 samples, 261 (68%) non-healthcare professionals had average first aid knowledge, and 359 (93.4%) of the samples were found to be willing to administer first aid in an emergency. The six hurdles identified to performing first aid were language 365 (95.1%), lack of information 344 (89.6%), lack of training 341 (88.8%), legal concerns 274 (71.4%), fear 230 (59.9%), and lack of confidence 68 (17.7%). CONCLUSION The first aid knowledge among non-healthcare workers is generally average. Thus, the readiness of the non-healthcare professionals can be enhanced by improving their knowledge and reducing the barriers perceived by the non-healthcare professionals to provide first aid during a medical emergency with the help of first aid training and reading materials.
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Affiliation(s)
- Julliet Abraham
- Department of Medical-Surgical Nursing, Manipal College of Nursing Manipal, MAHE, Karnataka, India
| | - Janet Alva
- Department of Medical-Surgical Nursing, Manipal College of Nursing Manipal, MAHE, Karnataka, India
| | - V Vinish
- Department of Community Health Nursing, Manipal College of Nursing Manipal, MAHE, Karnataka, India
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Grêaux KM, van Assema P, Bessems KMHH, de Vries NK, Harting J. Patterns in bottlenecks for implementation of health promotion interventions: a cross-sectional observational study on intervention-context interactions in the Netherlands. Arch Public Health 2023; 81:183. [PMID: 37848963 PMCID: PMC10580618 DOI: 10.1186/s13690-023-01196-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND From a complex systems perspective, implementation should be understood as the introduction of an intervention in a context with which it needs to interact in order to achieve its function in terms of improved health. The presence of intervention-context interactions could mean that during implementation particular patterns of crucial interaction points might arise. We examined the presence of - and regularities in - such 'bottlenecks for implementation', as this could create opportunities to predict and intervene in potential implementation problems. METHODS We conducted a cross-sectional observational study against the background of municipal intersectoral policymaking in the Netherlands. We asked implementers of health promotion interventions to identify bottlenecks by rating the presence and importance of conditions for implementation in a range of intervention systems. We used descriptive statistics to characterize these systems (by their behaviour change method, health theme and implementation setting) and the conditions that acted as bottlenecks. After stratifying bottlenecks by intervention system and the system's characteristics, we tested our hypotheses by comparing the number and nature of the bottlenecks that emerged. RESULTS More than half of the possible conditions were identified as a bottleneck for implementation. Bottlenecks occurred in all categories of conditions, e.g., relating to the implementer, the intervention, and political and administrative support, and often connected with intersectoral policymaking, e.g., relating to the co-implementer and the co-implementer's organization. Both our hypotheses were supported: (1) Each intervention system came across a unique set of - a limited number of - conditions hampering implementation; (2) Most bottlenecks were associated with the characteristics of the system in which they occurred, but bottlenecks also appeared in the absence of such an association, or remained absent in the presence thereof. CONCLUSIONS We conclude that intervention-context interactions in integrated health policymaking may lead to both regularities and variations in bottlenecks for implementation. Regularities may partly be predicted by the function of an intervention system, and may serve as the basis for building the capacity needed for the structural changes that can bring about long-lasting health improvements. Variations may point at the need for flexibility in further tailoring the implementation approach to the - mostly unpredictable - problems at individual sites.
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Affiliation(s)
- K M Grêaux
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, PO Box 616, 6200 MD, Maastricht, the Netherlands.
| | - P van Assema
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, PO Box 616, 6200 MD, Maastricht, the Netherlands
- Caphri School of Public Health and Primary Care, Department of Health Promotion, Maastricht University Medical Centre+, PO Box 616, Maastricht, 6200 MD, the Netherlands
| | - K M H H Bessems
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - N K de Vries
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, PO Box 616, 6200 MD, Maastricht, the Netherlands
- Caphri School of Public Health and Primary Care, Department of Health Promotion, Maastricht University Medical Centre+, PO Box 616, Maastricht, 6200 MD, the Netherlands
| | - J Harting
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases Research Programme, Amsterdam, the Netherlands
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Bhatta S, Mytton J, Deave T. Home environmental change for child injury prevention in Nepal: A qualitative study. J Child Health Care 2023; 27:323-335. [PMID: 34839755 PMCID: PMC10472719 DOI: 10.1177/13674935211052156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Nepal, unintentional home injury is a leading reason for death and disability among pre-school children. However, there is a lack of evidence to inform culturally appropriate interventions to reduce home injuries. This study explored the potential for home environmental change at a community level to prevent unintentional home injury in children and identified the barriers to, and facilitators of, such changes. Focus groups were conducted in the Nepali language with mothers, fathers, teachers, school students and community health volunteers in rural areas of Makwanpur district in Nepal. The discussions were audio-recorded, transcribed, translated into English and analysed thematically. NVivo software was used to support coding and identification of themes. Five focus groups, involving forty-seven participants, were completed leading to the development of four themes. Overall, the findings highlight that community people perceive injuries to be a normal part of childhood and, therefore, few prevention measures were considered. Parents were, however, able to identify ways to change their environment that made it safer. Changes included removing hazards or adding safety equipment, adapting the home or restricting access to potential hazards. Barriers to implementation included limited awareness about injury hazards and risk management, poor quality housing and financial constraint. Facilitators included raising community awareness, acquiring resources and financial support and involving the family and community. Development of interventions to prevent injuries at home in pre-school children should reflect local context and culture; this is best achieved through engagement with parents.
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Affiliation(s)
- Santosh Bhatta
- Research Associate, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Julie Mytton
- Professor of Child Health, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Toity Deave
- Associate Professor for Family & Child Health, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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Stewart S, Kendrick D, Watson MC, Hayes M, Orton E. Implementation fidelity of the 'Stay One Step Ahead' home safety intervention: a mixed-methods analysis. Inj Prev 2023; 29:340-346. [PMID: 37137688 PMCID: PMC10423503 DOI: 10.1136/ip-2023-044855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/26/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To assess implementation fidelity of the Stay One Step Ahead (SOSA), a complex intervention which was delivered by health visiting teams, children's centres, and family mentors and was aimed at preventing unintentional home injuries in children under 5 in disadvantaged communities. STUDY DESIGN A mixed-methods evaluation of the implementation fidelity of the SOSA intervention. METHODS A conceptual framework for implementation fidelity was used to triangulate data from questionnaires and semistructured interviews with parents and practitioners, observations of parent and practitioner contacts, and meeting documents. Quantitative data were analysed using logistic regression and descriptive statistics. Thematic analysis was used for qualitative data. RESULTS Parents in intervention wards were more likely to receive home safety advice from a practitioner than those living in matched control wards. Monthly safety messages and family mentor home safety activities were delivered with greater fidelity than other intervention components. Content most frequently adapted included the home safety checklist used by health visiting teams, and safety weeks delivered at children's centres. CONCLUSION Consistent with similarly complex interventions, SOSA was delivered with variable fidelity in a challenging environment. The findings add to the body of evidence on implementation fidelity of home injury prevention programmes, providing important information for future intervention development and delivery.
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Affiliation(s)
- Sabrina Stewart
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Mike Hayes
- Child Accident Prevention Trust, London, UK
| | - Elizabeth Orton
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
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Furman L, Strotmeyer S, Vitale C, Gaines BA. Evaluation of a mobile safety center's impact on pediatric home safety knowledge and device use. Inj Epidemiol 2020; 7:27. [PMID: 32532361 PMCID: PMC7291631 DOI: 10.1186/s40621-020-00254-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background A Mobile Safety Center (MSC) is designed to remove financial accessibility barriers to home safety by providing education and safety devices within local communities. The objective of this study was to evaluate the impact of an MSC on pediatric home safety knowledge and device use. Methods We conducted a prospective home safety interventional study. Parents and grandparents with children at home were recruited at community events attended by the MSC. Participants completed a pre-test survey assessing demographics and current home safety knowledge, practices, and device use. Participants then attended the MSC’s short home safety educational program. Afterwards, participants completed a knowledge reassessment post-test and were offered free safety devices: a smoke detector, a gun lock, and a childproofing kit comprising outlet covers, doorknob covers, and cabinet latches. We administered two follow-up surveys four weeks and six months after visiting the MSC. Descriptive statistics, Friedman tests, Wilcoxon Sum-Rank tests, and Pearson Chi-Square were used to assess respondent demographic characteristics and changes in home safety knowledge, practices, and device use. Results We recruited 50 participants, of whom 29 (58%) completed follow-up 1, 30 (60%) completed follow-up 2, and 26 (52%) completed both. Participants who completed both follow-ups increased total correct answers to safety knowledge questions between the pre-test and post-test (p = 0.005), pre-test and follow-up 1 (p = 0.003), and pre-test and follow-up 2 (p = 0.012) with no significant changes between the post-test, follow-up 1, and follow-up 2. Of the respondents who reported accepting safety products, outlet covers were used most frequently, followed by the smoke detector, doorknob covers, cabinet latches, and the gun lock. Conclusions The MSC may be an effective means of increasing home safety among families with children, as participation in the MSC’s home safety educational program significantly increased home safety knowledge and spurred home safety device use. Implementation of MSCs could potentially reduce childhood injury rates within communities through promotion of home safety.
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Affiliation(s)
- Leah Furman
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Stephen Strotmeyer
- Department of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Christine Vitale
- Department of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Barbara A Gaines
- Department of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Brunton G, Oliver S, Thomas J. Innovations in framework synthesis as a systematic review method. Res Synth Methods 2020; 11:316-330. [PMID: 32090479 DOI: 10.1002/jrsm.1399] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 01/25/2020] [Accepted: 02/04/2020] [Indexed: 01/09/2023]
Abstract
Framework synthesis is one systematic review method employed to address health care practice and policy. Adapted from framework analysis methods, it has been used increasingly, using both qualitative and mixed-method systematic review methods. This article demonstrates a spectrum of approaches to framework synthesis that are dependent on the extent to which theory is tentative, emergent, refined, or established; and that stakeholder involvement may help to understand the topic's complexity where theory is more nascent. The choice of approach depends on the degree of match with existing theories and, in the absence of existing theory, the scale and heterogeneity of the literature to be managed.
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Affiliation(s)
- Ginny Brunton
- OntarioTech University, Faculty of Health Sciences, School of Nursing, Oshawa, ON, Canada
- University College London Institute of Education, EPPI-Centre, London, UK
- McMaster University, McMaster Midwifery Research Centre, Hamilton, ON, Canada
| | - Sandy Oliver
- University College London Institute of Education, EPPI-Centre, London, UK
- University of Johannesburg Faculty of Humanities, Africa Centre for Evidence, Johannesburg, South Africa
| | - James Thomas
- University College London Institute of Education, EPPI-Centre, London, UK
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Dorney K, Dodington JM, Rees CA, Farrell CA, Hanson HR, Lyons TW, Lee LK. Preventing injuries must be a priority to prevent disease in the twenty-first century. Pediatr Res 2020; 87:282-292. [PMID: 31466080 DOI: 10.1038/s41390-019-0549-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/03/2019] [Accepted: 08/13/2019] [Indexed: 02/08/2023]
Abstract
Injuries continue to be the leading cause of morbidity and mortality for children, adolescents, and young adults aged 1-24 years in industrialized countries in the twenty-first century. In this age group, injuries cause more fatalities than all other causes combined in the United States (U.S.). Importantly, many of these injuries are preventable. Annually in the U.S. there are >9 million emergency department visits for injuries and >16,000 deaths in children and adolescents aged 0-19 years. Among injury mechanisms, motor vehicle crashes, firearm suicide, and firearm homicide remain the leading mechanisms of injury-related death. More recently, poisoning has become a rapidly rising cause of both intentional and unintentional death in teenagers and young adults aged 15-24 years. For young children aged 1-5 years, water submersion injuries are the leading cause of death. Sports and home-related injuries are important mechanisms of nonfatal injuries. Preventing injuries, which potentially cause lifelong morbidity, as well as preventing injury deaths, must be a priority. A multi-pronged approach using legislation, advancing safety technology, improving the built environment, anticipatory guidance by clinical providers, and education of caregivers will be necessary to decrease and prevent injuries in the twenty-first century.
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Affiliation(s)
- Kate Dorney
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - James M Dodington
- Department of Pediatrics, Yale-New Haven Hospital, New Haven, CT, USA
| | - Chris A Rees
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Caitlin A Farrell
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Holly R Hanson
- Division of Pediatric Emergency Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Todd W Lyons
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
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Machin AI, Ngamsuoy A, Pearson P. Collaborative child home injury prevention in Thailand: An action research study. Nurs Health Sci 2018; 20:206-213. [PMID: 29349899 DOI: 10.1111/nhs.12403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 09/20/2017] [Accepted: 10/25/2017] [Indexed: 11/29/2022]
Abstract
Child home accidental injury is a global health issue, and promoting child safety is a pediatric nursing challenge worldwide. Planning child home accidental injury prevention requires understanding of factors influencing parents' behavior. Evidence suggests that participatory health promotion positively influences behavior; however, research on Thai parents is limited. This qualitative, action research study aimed to understand Thai parents' experiences of participating in a collaborative child home accidental injury prevention program and its influence on their behavior. Eight parental mother/father couples from one Thai province consented to participate, providing a wide range of data via in-depth individual interviews and self-assessment questionnaires. Thematic analysis of interview transcripts yielded three themes: collaborative learning, parental behavior change, and reflective learning extends beyond families. Participants reported that workshop participation improved their child home accidental injury-prevention behavior. The present study can inform pediatric nursing, child health-care practice, and child health policy in Thailand and beyond.
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Affiliation(s)
- Alison I Machin
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Amornrat Ngamsuoy
- Department of Paediatric Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Pauline Pearson
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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Scholtes B, Schröder-Bäck P. Ethical considerations for the design and implementation of child injury prevention interventions: the example of delivering and installing safety equipment into the home. Inj Prev 2017; 25:217-221. [PMID: 29229774 DOI: 10.1136/injuryprev-2017-042542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/10/2017] [Accepted: 11/13/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Public health ethics is a growing field of academic interest but ethical discussion of injury prevention seems to have received limited attention. Interventions that promise to be effective are not necessarily-without explicit justification-'good' and 'right' interventions in every sense. This paper explores public health ethics in the context of child injury prevention with the objective to initiate interdisciplinary dialogue on the ethics of child safety interventions. METHOD A framework of seven public health ethics principles (non-maleficence, health maximisation, beneficence, respect for autonomy, justice, efficiency and proportionality) were applied to an intervention to promote child safety in the home. RESULTS Preventing child injury in the home is ethically challenging due to the requirement for the state to intervene in the private sphere. Non-maleficence and beneficence are difficult to judge within this intervention as these are likely to be highly dependent on the nature of intervention delivery, in particular, the quality of communication. Respect for autonomy is challenged by an intervention occurring in the home. The socioeconomic gradient in child injury risk is an important factor but a nuanced approach could help to avoid exacerbating inequalities or stigmatisation. Equally, a nuanced approach may be necessary to accommodate the principles of proportionality and efficiency within the local context. CONCLUSION We conclude that this intervention is justifiable from an ethical perspective but that this type of reflection loop is helpful to identify the impact of interventions beyond effectiveness.
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Affiliation(s)
- Beatrice Scholtes
- Department of International Health, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
- Department of Public Health, University of Liège, Liège, Belgium
| | - Peter Schröder-Bäck
- Department of International Health, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
- Faculty for Human Sciences & Health Sciences, University of Bremen, Bremen, Germany
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Denehy M, Leavy JE, Jancey J, Nimmo L, Crawford G. This Much Water: a qualitative study using behavioural theory to develop a community service video to prevent child drowning in Western Australia. BMJ Open 2017; 7:e017005. [PMID: 28760802 PMCID: PMC5642767 DOI: 10.1136/bmjopen-2017-017005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Drowning in children under the age of 5 is a frequently occurring, yet preventable event. This research used behavioural theory to test the suitability and appropriateness of a drowning prevention message in a community service video. DESIGN This qualitative study used content analysis of focus groups. Constructs from the Health Belief Model guided the data analysis. SETTING Community organisations and playgrounds in Perth, Western Australia. PARTICIPANTS Participants were parents or carers of at least one child under 5 years residing in Western Australia. Seven focus groups (n=57) were conducted with eight participants in each group. Most participants were parents (96%), female (95%), aged between 25 and 34 years (63%) and were born in Australia (68%). RESULTS Participants indicated the community service video was credible in communicating the message that young children were susceptible to drowning in shallow water and that various water hazards existed in and around the home. However, a range of external factors, such as the child's age, type of water hazard, presence of siblings and other environmental factors, influenced risk perceptions. Child drowning was seen as a serious issue. Controlling access to water and the role of supervision were understood to be important factors in preventing drowning. CONCLUSIONS The lack of published drowning prevention interventions shaped by behavioural theory limits the understanding of best practice. Using constructs from the Health Belief Model, this research confirmed the perceived seriousness, devastating and unforgettable consequence of drowning; however, findings were mixed regarding cues to action. Future development of drowning prevention media messages should test strategies to increase susceptibility and self-efficacy among the target group and explore the impact of different message senders. The findings provide a valuable understanding of possible messages and their execution for use in media campaigns, as one component of an effective public health intervention to prevent child drowning underpinned by behavioural theory.
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Affiliation(s)
- Mel Denehy
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth, Australia
| | - Justine E Leavy
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth, Australia
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth, Australia
| | - Lauren Nimmo
- Royal Life Saving Society Western Australia Inc., Perth, Australia
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Perth, Australia
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Kendrick D, Ablewhite J, Achana F, Benford P, Clacy R, Coffey F, Cooper N, Coupland C, Deave T, Goodenough T, Hawkins A, Hayes M, Hindmarch P, Hubbard S, Kay B, Kumar A, Majsak-Newman G, McColl E, McDaid L, Miller P, Mulvaney C, Peel I, Pitchforth E, Reading R, Saramago P, Stewart J, Sutton A, Timblin C, Towner E, Watson MC, Wynn P, Young B, Zou K. Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundUnintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.AimTo increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.MethodsSix work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.ResultsModifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.LimitationsOur case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.ConclusionsOur studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.Future workFurther randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.Trial registrationCurrent Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Joanne Ablewhite
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Felix Achana
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Penny Benford
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Rose Clacy
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Frank Coffey
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Carol Coupland
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Trudy Goodenough
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Adrian Hawkins
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mike Hayes
- Child Accident Prevention Trust, London, UK
| | - Paul Hindmarch
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephanie Hubbard
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Bryony Kay
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Arun Kumar
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - Elaine McColl
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Lisa McDaid
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Phil Miller
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Isabel Peel
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Richard Reading
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norfolk Community Health and Care NHS Trust, Norwich, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - Jane Stewart
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Clare Timblin
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Elizabeth Towner
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Michael C Watson
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Persephone Wynn
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Kun Zou
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Abstract
BACKGROUND The London Health Sciences Centre Home Safety Program (HSP) provides safety devices, education, a safety video, and home safety checklist to all first-time parents for the reduction of childhood home injuries. The objective of this study was to evaluate the HSP for the prevention of home injuries in children up to 2 years of age. METHODS A program evaluation was performed with follow-up survey, along with an interrupted time series analysis of emergency department (ED) visits for home injuries 5 years before (2007-2013) and 2 years after (2013-2015) implementation. Spatial analysis of ED visits was undertaken to assess differences in home injury rates by dissemination areas controlling differences in socioeconomic status (i.e., income, education, and lone-parent status) at the neighborhood level. RESULTS A total of 3,458 first-time parents participated in the HSP (a 74% compliance rate). Of these, 20% (n = 696) of parents responded to our questionnaire, with 94% reporting the program to be useful (median, 6; interquartile range, 2 on a 7-point Likert scale) and 81% learning new strategies for preventing home injuries. The median age of the respondent's babies were 12 months (interquartile range, 1). The home safety check list was used by 87% of respondents to identify hazards in their home, with 95% taking action to minimize the risk. The time series analysis demonstrated a significant decline in ED visits for home injuries in toddlers younger than2 years of age after HSP implementation. The declines in ED visits for home injuries remained significant over and above each socioeconomic status covariate. CONCLUSION Removing hazards, supervision, and installing safety devices are key facilitators in the reduction of home injuries. Parents found the HSP useful to identify hazards, learn new strategies, build confidence, and provide safety products. Initial finding suggests that the program is effective in reducing home injuries in children up to 2 years of age. LEVEL OF EVIDENCE Therapeutic/care management study, level V.
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Tancred T, Manzi F, Schellenberg J, Marchant T. Facilitators and Barriers of Community-Level Quality Improvement for Maternal and Newborn Health in Tanzania. QUALITATIVE HEALTH RESEARCH 2017; 27:738-749. [PMID: 27022034 DOI: 10.1177/1049732316638831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
A quality improvement intervention for maternal and newborn health was carried out in southern Tanzania at the community level. It sought to improve health-seeking behaviors and uptake of community-level maternal and newborn health practices. A process evaluation populated using data primarily from in-depth interviews and focus group discussions with the intervention's implementers was undertaken in four villages receiving the intervention to evaluate the intervention's implementation, uncover facilitators and barriers of quality improvement, and highlight contextual factors that might have influenced implementation. Performance implementation scores were used to rank the villages. Identifying higher- and lower-performing villages highlighted key facilitators and barriers of community-level quality improvement related to support from local leaders, motivation through use of local quality improvement data, and regular education around quality improvement and maternal and newborn health. These findings can be taken formatively in the design of similar interventions in the future.
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Affiliation(s)
- Tara Tancred
- 1 London School of Hygiene & Tropical Medicine, London, UK
| | - Fatuma Manzi
- 2 Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Tanya Marchant
- 1 London School of Hygiene & Tropical Medicine, London, UK
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14
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Deave T, Hawkins A, Kumar A, Hayes M, Cooper N, Watson M, Ablewhite J, Coupland C, Sutton A, Majsak-Newman G, McDaid L, Goodenough T, Beckett K, McColl E, Reading R, Kendrick D. Evaluating implementation of a fire-prevention injury prevention briefing in children's centres: Cluster randomised controlled trial. PLoS One 2017; 12:e0172584. [PMID: 28339460 PMCID: PMC5365108 DOI: 10.1371/journal.pone.0172584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/05/2017] [Indexed: 11/22/2022] Open
Abstract
Background Many developed countries have high mortality rates for fire-related deaths in children aged 0–14 years with steep social gradients. Evidence-based interventions to promote fire safety practices exist, but the impact of implementing a range of these interventions in children’s services has not been assessed. We developed an Injury Prevention Briefing (IPB), which brought together evidence about effective fire safety interventions and good practice in delivering interventions; plus training and facilitation to support its use and evaluated its implementation. Methods We conducted a cluster randomised controlled trial, with integrated qualitative and cost-effectiveness nested studies, across four study sites in England involving children’s centres in disadvantaged areas; participants were staff and families attending those centres. Centres were stratified by study site and randomised within strata to one of three arms: IPB plus facilitation (IPB+), IPB only, usual care. IPB+ centres received initial training and facilitation at months 1, 3, and 8. Baseline data from children’s centres were collected between August 2011 and January 2012 and follow-up data were collected between June 2012 and June 2013. Parent baseline data were collected between January 2012 and May 2012 and follow-up data between May 2013 and September 2013. Data comprised baseline and 12 month parent- and staff-completed questionnaires, facilitation contact data, activity logs and staff interviews. The primary outcome was whether families had a plan for escaping from a house fire. Treatment arms were compared using multilevel models to account for clustering by children’s centre. Results 1112 parents at 36 children’s centres participated. There was no significant effect of the intervention on families’ possession of plans for escaping from a house fire (adjusted odds ratio (AOR) IPB only vs. usual care: 0.93, 95%CI 0.58, 1.49; AOR IPB+ vs. usual care 1.41, 95%CI 0.91, 2.20). However, significantly more families in the intervention arms reported more behaviours for escaping from house fires (AOR IPB only vs. usual care: 2.56, 95%CI 01.38, 4.76; AOR IPB+ vs. usual care 1.78, 95%CI 1.01, 3.15). Conclusion Our study demonstrated that children’s centres can deliver an injury prevention intervention to families in disadvantaged communities and achieve changes in home safety behaviours.
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Affiliation(s)
- Toity Deave
- Centre for Child & Adolescent Health, Health & Applied Sciences, University of the West of England Bristol, Bristol, United Kingdom
| | - Adrian Hawkins
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Arun Kumar
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Mike Hayes
- Child Accident Prevention Trust, Barnet, London, United Kingdom
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Michael Watson
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Joanne Ablewhite
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Carol Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Gosia Majsak-Newman
- Norfolk and Suffolk Primary and Community Care Research Office, Hosted by South Norfolk CCG, Norwich, United Kingdom
| | - Lisa McDaid
- Norfolk and Norwich University Hospital, NHS Clinical Research and Trials Unit, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Trudy Goodenough
- Centre for Child & Adolescent Health, Health & Applied Sciences, University of the West of England Bristol, Bristol, United Kingdom
| | - Kate Beckett
- University of the West of England, Research and Innovation, University Hospitals Bristol NHS Foundation Trust, Education Centre, Bristol, United Kingdom
| | - Elaine McColl
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard Reading
- Jenny Lind Paediatric Department, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
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15
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Möller H, Falster K, Ivers R, Falster MO, Clapham K, Jorm L. Closing the Aboriginal child injury gap: targets for injury prevention. Aust N Z J Public Health 2016; 41:8-14. [DOI: 10.1111/1753-6405.12591] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/01/2016] [Accepted: 06/01/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Holger Möller
- Centre for Big Data Research in Health; UNSW Kensington Campus; New South Wales
| | - Kathleen Falster
- Centre for Big Data Research in Health; UNSW Kensington Campus; New South Wales
- National Centre for Epidemiology and Population Health; The Australian National University; Australian Capital Territory
- The Sax Institute; New South Wales
| | - Rebecca Ivers
- The George Institute for Global Health; New South Wales
| | - Michael O. Falster
- Centre for Big Data Research in Health; UNSW Kensington Campus; New South Wales
| | - Kathleen Clapham
- The Australian Health Services Research Institute; University of Wollongong; New South Wales
| | - Louisa Jorm
- Centre for Big Data Research in Health; UNSW Kensington Campus; New South Wales
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16
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Achana F, Sutton AJ, Kendrick D, Hayes M, Jones DR, Hubbard SJ, Cooper NJ. A decision analytic model to investigate the cost-effectiveness of poisoning prevention practices in households with young children. BMC Public Health 2016; 15:705. [PMID: 27488449 PMCID: PMC4973049 DOI: 10.1186/s12889-016-3334-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic reviews and a network meta-analysis show home safety education with or without the provision of safety equipment is effective in promoting poison prevention behaviours in households with children. This paper compares the cost-effectiveness of home safety interventions to promote poison prevention practices. METHODS A probabilistic decision-analytic model simulates healthcare costs and benefits for a hypothetical cohort of under 5 year olds. The model compares the cost-effectiveness of home safety education, home safety inspections, provision of free or low cost safety equipment and fitting of equipment. Analyses are conducted from a UK National Health Service and Personal Social Services perspective and expressed in 2012 prices. RESULTS Education without safety inspection, provision or fitting of equipment was the most cost-effective strategy for promoting safe storage of medicines with an incremental cost-effectiveness ratio of £2888 (95 % credible interval (CrI) £1990-£5774) per poison case avoided or £41,330 (95%CrI £20,007-£91,534) per QALY gained compared with usual care. Compared to usual care, home safety interventions were not cost-effective in promoting safe storage of other household products. CONCLUSION Education offers better value for money than more intensive but expensive strategies for preventing medicinal poisonings, but is only likely to be cost-effective at £30,000 per QALY gained for families in disadvantaged areas and for those with more than one child. There was considerable uncertainty in cost-effectiveness estimates due to paucity of evidence on model parameters. Policy makers should consider both costs and effectiveness of competing interventions to ensure efficient use of resources.
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Affiliation(s)
- Felix Achana
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Alex J Sutton
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Mike Hayes
- Child Accident Prevention Trust, London, SE16 4DG, UK
| | - David R Jones
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Stephanie J Hubbard
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Nicola J Cooper
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
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17
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Falcone RA, Edmunds P, Lee E, Gardner D, Price K, Gittelman M, Pomerantz W, Besl J, Madhavan G, Phelan KJ. Volunteer driven home safety intervention results in significant reduction in pediatric injuries: A model for community based injury reduction. J Pediatr Surg 2016; 51:1162-9. [PMID: 26792663 DOI: 10.1016/j.jpedsurg.2015.11.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Home based injuries account for a significant number of injuries to children between 1 and 5years old. Evidence-based safety interventions delivered in the home with installation of safety equipment have been demonstrated to reduce injury rates. The aim of this study was to evaluate the impact of a community based volunteer implemented home safety intervention. METHODS In partnership with a community with high injury rates for children between 1 and 5years old, a home safety bundle was developed and implemented by volunteers. The safety bundle included installing evidence based safety equipment. Monthly community emergency room attended injury rates as well as emergency room attended injuries occurring in intervention and nonintervention homes was tracked throughout the study. RESULTS Between May 2012 and May 2014 a total of 207 homes with children 1-5years old received the home safety bundle. The baseline monthly emergency room attended injury rate for children aged 1-5years within our target community was 11.3/1000 and that within our county was 8.7/1000. Following the intervention current rates are now 10.3/1000 and 9.2/1000 respectively. Within intervention homes the injury rate decreased to 4.2/1000 while the rate in the homes not receiving the intervention experienced an increase in injury rate to 12/1000 (p<0.05). When observed vs. expected injuries were examined the intervention group demonstrated 59% fewer injuries while the nonintervention group demonstrated a 6% increase (p<0.05). CONCLUSION Children in homes that received a volunteer-provided, free home safety bundle experienced 59% fewer injuries than would have been expected. By partnering with community leaders and organizing volunteers, proven home safety interventions were successfully provided to 207 homes during a two-year period, and a decline in community injury rates for children younger than 5years was observed compared to county wide injury rates.
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Affiliation(s)
- Richard A Falcone
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Patrick Edmunds
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Emily Lee
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Dawne Gardner
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Kimberly Price
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Michael Gittelman
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Wendy Pomerantz
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - John Besl
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Gowri Madhavan
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Kieran J Phelan
- Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
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Ablewhite J, Kendrick D, Watson M, Shaw I. The other side of the story - maternal perceptions of safety advice and information: a qualitative approach. Child Care Health Dev 2015; 41:1106-13. [PMID: 25605523 PMCID: PMC4964917 DOI: 10.1111/cch.12224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND A qualitative study of maternal perceptions of home safety advice. The aim was to gain an understanding of maternal perceptions of and possible barriers to the implementation of home safety advice. METHODS Semi-structured interviews with 37 mothers with a child aged less than 5 years of age; 16 were mothers living in an area of socio-economic disadvantage (with a high rate of childhood unintentional injury), 21 were mothers living in an area of relative affluence (with a low rate of childhood unintentional injury). Thematic analysis was used to analyse the data. RESULTS Although some mothers living in both areas found talking to a health professional about child home safety was helpful, mothers in both areas tended to find talking to other mothers as being more helpful and they preferred this to talking to a professional. Barriers to obtaining safety advice from professionals exist for mothers living in both areas. Mothers living in the advantaged area describe 'feeling silly' and that they should 'know it already' when talking to professionals. Mothers living in the disadvantaged area are less likely to access home safety advice due to fear of being perceived as an incompetent mother and the fear of social service involvement. CONCLUSIONS Mothers find home safety advice from other parents more useful and prefer this to advice from professionals. This suggests greater use could be made of appropriately trained parents to deliver safety advice and education. Fear and mistrust can limit access to child safety advice in parents living in disadvantaged areas and this may be a potential explanation for differential unintentional injury rates as those who need the advice and support most may be least likely to access it. Further research should explore how professionals can build trust, gain parents' confidence and provide child safety advice and education that is targeted appropriately to parents living circumstances and their child safety needs.
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Affiliation(s)
- J. Ablewhite
- School of MedicineUniversity of NottinghamNottinghamUK
| | - D. Kendrick
- School of MedicineUniversity of NottinghamNottinghamUK
| | - M. Watson
- Faculty of Medicine and Health SciencesQueens Medical CentreUniversity of NottinghamNottinghamUK
| | - I. Shaw
- School of Sociology and Social PolicyUniversity of NottinghamNottinghamUK
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19
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Ablewhite J, McDaid L, Hawkins A, Peel I, Goodenough T, Deave T, Stewart J, Watson M, Kendrick D. Approaches used by parents to keep their children safe at home: a qualitative study to explore the perspectives of parents with children aged under five years. BMC Public Health 2015; 15:983. [PMID: 26419449 PMCID: PMC4588674 DOI: 10.1186/s12889-015-2252-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 09/08/2015] [Indexed: 12/03/2022] Open
Abstract
Background Childhood unintentional injury represents an important global health problem. Many unintentional injuries experienced by children aged under 5 years occur within the home and are preventable. The aim of this study was to explore the approaches used by parents of children under five in order to help prevent unintentional injuries in the home and the factors which influence their use. Understanding how parents approach risk-management in the home has important implications for injury practitioners. Methods A multi-centre qualitative study using semi-structured interviews. A thematic approach was used to analyse the data. Sixty five parents of children aged under 5 years, from four study areas were interviewed: Bristol, Newcastle, Norwich and Nottingham. Results Three main injury prevention strategies used by parents were: a) Environmental such as removal of hazards, and use of safety equipment; b) parental supervision; and c) teaching, for example, teaching children about safety and use of rules and routine. Strategies were often used in combination due to their individual limitations. Parental assessment of injury risk, use of strategy and perceived effectiveness were fluid processes dependent on a child’s character, developmental age and the prior experiences of both parent and child. Some parents were more proactive in their approach to home safety while others only reacted if their child demonstrated an interest in a particular object or activity perceived as being an injury risk. Conclusion Parents’ injury prevention practices encompass a range of strategies that are fluid in line with the child’s age and stage of development; however, parents report that they still find it challenging to decide which strategy to use and when.
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Affiliation(s)
- Joanne Ablewhite
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Lisa McDaid
- Clinical Research & Trials Unit, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, NR4 7UY, UK.
| | - Adrian Hawkins
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - Isabel Peel
- Clinical Research & Trials Unit, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, NR4 7UY, UK.
| | - Trudy Goodenough
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK.
| | - Toity Deave
- School of Health Sciences, University of Nottingham, Nottingham, NG7 2HA, UK.
| | - Jane Stewart
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Michael Watson
- School of Health Sciences, University of Nottingham, Nottingham, NG7 2HA, UK.
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK.
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20
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Ablewhite J, Peel I, McDaid L, Hawkins A, Goodenough T, Deave T, Stewart J, Kendrick D. Parental perceptions of barriers and facilitators to preventing child unintentional injuries within the home: a qualitative study. BMC Public Health 2015; 15:280. [PMID: 25885179 PMCID: PMC4392794 DOI: 10.1186/s12889-015-1547-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/16/2015] [Indexed: 11/25/2022] Open
Abstract
Background Childhood unintentional injury represents an important global health problem. Most of these injuries occur at home, and many are preventable. The main aim of this study was to identify key facilitators and barriers for parents in keeping their children safe from unintentional injury within their homes. A further aim was to develop an understanding of parents’ perceptions of what might help them to implement injury prevention activities. Methods Semi-structured interviews were conducted with sixty-four parents with a child aged less than five years at parent’s homes. Interview data was transcribed verbatim, and thematic analysis was undertaken. This was a Multi-centre qualitative study conducted in four study centres in England (Nottingham, Bristol, Norwich and Newcastle). Results Barriers to injury prevention included parents’ not anticipating injury risks nor the consequences of some risk-taking behaviours, a perception that some injuries were an inevitable part of child development, interrupted supervision due to distractions, maternal fatigue and the presence of older siblings, difficulties in adapting homes, unreliability and cost of safety equipment and provision of safety information later than needed in relation to child age and development. Facilitators for injury prevention included parental supervision and teaching children about injury risks. This included parents’ allowing children to learn about injury risks through controlled risk taking, using “safety rules” and supervising children to ensure that safety rules were adhered to. Adapting the home by installing safety equipment or removing hazards were also key facilitators. Some parents felt that learning about injury events through other parents’ experiences may help parents anticipate injury risks. Conclusions There are a range of barriers to, and facilitators for parents undertaking injury prevention that would be addressable during the design of home safety interventions. Addressing these in future studies may increase the effectiveness of interventions.
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Affiliation(s)
- Joanne Ablewhite
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Isabel Peel
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - Lisa McDaid
- Clinical Research & Trials Unit, Norfolk and Norwich University Hospital NHS, Foundation Trust, Norwich, NR4 7UY, UK.
| | - Adrian Hawkins
- The Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK.
| | - Trudy Goodenough
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK.
| | - Toity Deave
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK.
| | - Jane Stewart
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK.
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21
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Beckett K, Goodenough T, Deave T, Jaeckle S, McDaid L, Benford P, Hayes M, Towner E, Kendrick D. Implementing an Injury Prevention Briefing to aid delivery of key fire safety messages in UK children's centres: qualitative study nested within a multi-centre randomised controlled trial. BMC Public Health 2014; 14:1256. [PMID: 25492496 PMCID: PMC4295482 DOI: 10.1186/1471-2458-14-1256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/19/2014] [Indexed: 11/24/2022] Open
Abstract
Background To improve the translation of public health evidence into practice, there is a need to increase practitioner involvement in initiative development, to place greater emphasis on contextual knowledge, and to address intervention processes and outcomes. Evidence that demonstrates the need to reduce childhood fire-related injuries is compelling but its translation into practice is inconsistent and limited. With this knowledge the Keeping Children Safe programme developed an "Injury Prevention Briefing (IPB)" using a 7 step process to combine scientific evidence with practitioner contextual knowledge. The IPB was designed specifically for children’s centres (CCs) to support delivery of key fire safety messages to parents. This paper reports the findings of a nested qualitative study within a clustered randomised controlled trial of the IPB, in which staff described their experiences of IPB implementation to aid understanding of why or how the intervention worked. Methods Interviews were conducted with key staff at 24 CCs participating in the two intervention arms: 1) IPB supplemented by initial training and regular facilitation; 2) IPB sent by post with no facilitation. Framework Analysis was applied to these interview data to explore intervention adherence including; exposure or dose; quality of delivery; participant responsiveness; programme differentiation; and staff experience of IPB implementation. This included barriers, facilitators and suggested improvements. Results 83% of CCs regarded the IPB as a simple, accessible tool which raised awareness, and stimulated discussion and behaviour change. 15 CCs suggested minor modifications to format and content. Four levels of implementation were identified according to content, frequency, duration and coverage. Most CCs (75%) achieved ‘extended’ or ‘essential’ IPB implementation. Three universal factors affected all CCs: organisational change and resourcing; working with hard to engage groups; additional demands of participating in a research study. Six specific factors were associated with the implementation level achieved: staff engagement and training; staff continuity; adaptability and flexibility; other agency support; conflicting priorities; facilitation. CCs achieving high implementation levels increased from 58% (no facilitation) to 92% with facilitation. Conclusion Incorporating service provider perspectives and scientific evidence into health education initiatives enhances potential for successful implementation, particularly when supplemented by ongoing training and facilitation. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1256) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Denise Kendrick
- School of Medicine, Division of Primary Care, University of Nottingham, University Park, Nottingham, UK.
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Deave T, Towner E, McColl E, Reading R, Sutton A, Coupland C, Cooper N, Stewart J, Hayes M, Pitchforth E, Watson M, Kendrick D. Multicentre cluster randomised controlled trial evaluating implementation of a fire prevention Injury Prevention Briefing in children's centres: study protocol. BMC Public Health 2014; 14:69. [PMID: 24450931 PMCID: PMC3913957 DOI: 10.1186/1471-2458-14-69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 01/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The UK has one of the highest fatality rates for deaths from fire-related injuries in children aged 0-14 years; these injuries have the steepest social gradient of all injuries in the UK. Children's centres provide children under five years old and their families with a range of services and information, including home safety, but their effectiveness in promoting injury prevention has yet to be evaluated. We developed a fire prevention intervention for use in children's centres comprising an Injury Prevention Briefing (IPB) which provides evidence on what works and best practice from those running injury prevention programmes, and a facilitation package to support implementation of the IPB. This protocol describes the design and methods of a trial evaluating the effectiveness and cost-effectiveness of the IPB and facilitation package in promoting fire prevention. METHODS/DESIGN Pragmatic, multicentre cluster randomised controlled trial, with a nested qualitative study, in four study centres in England. Children's centres in the most disadvantaged areas will be eligible to participate and will be randomised to one of three treatment arms comprising: IPB with facilitation package; IPB with no facilitation package; usual care (control). The primary outcome measure will be the proportion of families who have a fire escape plan at follow-up. Eleven children's centres per arm are required to detect an absolute difference in the percentage of families with a fire escape plan of 20% in either of the two intervention arms compared with the control arm, with 80% power and a 5% significance level (2-sided), an intraclass correlation coefficient of 0.05 and assuming outcomes are assessed on 20 families per children's centre. Secondary outcomes include the assessment of the cost-effectiveness of the intervention, other fire safety behaviours and factors associated with degree of implementation of the IPB. DISCUSSION This will be the first trial to develop and evaluate a fire prevention intervention for use in children's centres in the UK. Its findings will be generalisable to children's centres in the most disadvantaged areas of the UK and may also be generalisable to similar interventions to prevent other types of injury. TRIAL REGISTRATION http://NCT01452191 (date of registration: 13/10/2011).
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Affiliation(s)
- Toity Deave
- Centre for Child & Adolescent Health, Health & Life Sciences, University of the West of England Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Elizabeth Towner
- Centre for Child & Adolescent Health, Health & Life Sciences, University of the West of England Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Elaine McColl
- Newcastle Clinical Trials Unit, 4th Floor, William Leech Building, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - Richard Reading
- Jenny Lind Paediatric Department, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Carol Coupland
- Division of Primary Care, School of Medicine, Tower Building, University Park, Nottingham NG7 2RD, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Jane Stewart
- Division of Primary Care, School of Medicine, Tower Building, University Park, Nottingham NG7 2RD, UK
| | - Mike Hayes
- Child Accident Prevention Trust, Canterbury Court (1.09), 1 - 3 Brixton Road, London SW9 6DE, UK
| | - Emma Pitchforth
- London School of Economics Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Michael Watson
- School of Health Sciences, D86, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2HA, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, Tower Building, University Park, Nottingham NG7 2RD, UK
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Mytton J, Ingram J, Manns S, Thomas J. Facilitators and barriers to engagement in parenting programs: a qualitative systematic review. HEALTH EDUCATION & BEHAVIOR 2013; 41:127-37. [PMID: 23640123 DOI: 10.1177/1090198113485755] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Parenting programs have the potential to improve the health and well-being of parents and children. A challenge for providers is to recruit and retain parents in programs. Studies researching engagement with programs have largely focused on providers', policy makers', or researchers' reflections of their experience of parents' participation. We conducted a systematic review of qualitative studies where parents had been asked why they did or did not choose to commence, or complete programs, and compared these perceptions with those of researchers and those delivering programs. We used data-mining techniques to identify relevant studies and summarized findings using framework synthesis methods. Six facilitator and five barrier themes were identified as important influences on participation, with a total of 33 subthemes. Participants focused on the opportunity to learn new skills, working with trusted people, in a setting that was convenient in time and place. Researchers and deliverers focused on tailoring the program to individuals and on the training of staff. Participants and researchers/deliverers therefore differ in their opinions of the most important features of programs that act as facilitators and barriers to engagement and retention. Program developers need to seek the views of both participants and deliverers when evaluating programs.
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Williams J, Nansel TR, Weaver NL, Tse J. Safe n' sound: an evidence-based tool to prioritize injury messages for pediatric health care. FAMILY & COMMUNITY HEALTH 2012; 35:212-224. [PMID: 22617412 PMCID: PMC3648218 DOI: 10.1097/fch.0b013e318250bcc3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Safe N' Sound is a computer-based tool that prioritizes key injury risks for toddlers and infants and provides tailored feedback. The program was implemented in 5 pediatric sites. Caregiver risk behaviors were analyzed and compared with corresponding national and state morbidity and mortality data. The priority risks identified were generally consistent with the incidence of injury. Frequencies of several risk behaviors varied across sites and differences were observed across ages. Use of a prioritization scheme may facilitate risk behavior counseling and reasonably result in a decrease in injury mortality or morbidity.
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Affiliation(s)
- Janice Williams
- Carolinas Center for Injury Prevention, Carolinas Medical Center, Charlotte, North Carolina 28232, USA.
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