Evaluating implementation of a fire-prevention injury prevention briefing in children's centres: Cluster randomised controlled trial

Cost-effectiveness of England's national 'Safe At Home' scheme for reducing hospital admissions for unintentional injury in children aged under 5

BACKGROUND

Injuries in children aged under 5 years most commonly occur in the home and disproportionately affect those living in the most disadvantaged communities. The 'Safe at Home' (SAH) national home safety equipment scheme, which ran in England between 2009 and 2011, has been shown to reduce injury-related hospital admissions, but there is little evidence of cost-effectiveness.

MATERIALS AND METHODS

Cost-effectiveness analysis from a health and local government perspective. Measures were the incremental cost-effectiveness ratio per hospital admission averted (ICER) and cost-offset ratio (COR), comparing SAH expenditure to savings in admission expenditure. The study period was split into three periods: T1 (years 0-2, implementation); T2 (years 3-4) and T3 (years 5-6). Analyses were conducted for T2 versus T1 and T3 versus T1.

RESULTS

Total cost of SAH was £9 518 066. 202 223 hospital admissions in the children occurred during T1-3, costing £3 320 000. Comparing T3 to T1 SAH reduced admission expenditure by £924 per month per local authority and monthly admission rates by 0.5 per local authority per month compared with control areas. ICER per admission averted was £4209 for T3 versus T1, with a COR of £0.29, suggesting that 29p was returned in savings on admission expenditure for every pound spent on SAH.

CONCLUSION

SAH was effective at reducing hospital admissions due to injury and did result in some cost recovery when taking into admissions only. Further analysis of its cost-effectiveness, including emergency healthcare, primary care attendances and wider societal costs, is likely to improve the return on investment further.

A cluster RCT and process evaluation of an implementation optimisation intervention to promote parental engagement enrolment and attendance in a childhood obesity prevention programme: results of the Optimising Family Engagement in HENRY (OFTEN) trial

Background

Poor and variable implementation of childhood obesity prevention programmes reduces their population impact and sustainability. We drew upon ethnographic work to develop a multi-level, theory-based implementation optimisation intervention. This intervention aimed to promote parental enrolment and attendance at HENRY (Health Exercise Nutrition for the Really Young), a UK community obesity prevention programme, by changing behaviours of children’s centre and local authority stakeholders.

Methods

We evaluated the effectiveness of the implementation optimisation intervention on HENRY programme enrolment and attendance over a 12-month implementation period in a cluster randomised controlled trial. We randomised 20 local government authorities (with 126 children’s centres) to HENRY plus the implementation optimisation intervention or to HENRY alone. Primary outcomes were (1) the proportion of centres enrolling at least eight parents per programme and (2) the proportion of centres with a minimum of 75% of parents attending at least five of eight sessions per programme. Trial analyses adjusted for stratification factors (pre-randomisation implementation of HENRY, local authority size, deprivation) and allowed for cluster design. A parallel mixed-methods process evaluation used qualitative interviews and routine monitoring to explain trial results.

Results

Neither primary outcome differed significantly between groups; 17.8% of intervention centres and 18.0% of control centres achieved the parent enrolment target (adjusted difference − 1.2%; 95% CI − 19.5%, 17.1%); 17.1% of intervention centres and 13.9% of control centres achieved the attendance target (adjusted difference 1.2%; 95% CI − 15.7%, 18.1%). Unexpectedly, the trial coincided with substantial national service restructuring, including centre closures and reduced funds. Some commissioning and management teams stopped or reduced delivery of both HENRY and the implementation optimisation intervention due to competing demands. Thus, at follow-up, HENRY programmes were delivered to approximately half the number of parents compared to baseline (n = 433 vs. 881).

Conclusions

During a period in which services were reduced by external policies, this first definitive trial found no evidence of effectiveness for an implementation optimisation intervention promoting parent enrolment to and attendance at an obesity prevention programme.

Trial registration

ClinicalTrials.govNCT02675699. Registered on 4 February 2016

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05757-w.

Effectiveness of home fire safety interventions. A systematic review and meta-analysis

PURPOSE

To assess the effectiveness of Home Fire Safety (HFS) interventions versus other interventions/no interventions/controls on HFS knowledge and behaviour at short-, intermediate- and long-term follow ups.

DESIGN

Systematic review and meta-analysis of randomized controlled trials.

DATA SOURCES

MEDLINE, EMBASE and PubMed databases were searched from January 1998 to July 2018, and studies retrieved.

PARTICIPANTS

Toddlers, children (primary or secondary school), teenagers or adults.

INTERVENTIONS/COMPARISON

HFS interventions compared to other interventions / no interventions / controls.

OUTCOMES

HFS knowledge and behaviour.

RESULTS

10 studies were identified (8 RCTs and 2 prospective cohort). Two studies assessed the effects of HFS interventions vs no interventions on HFS knowledge at up to 4 months follow up in school children and demonstrated significant difference between groups (very low quality, 2 RCTs, 535 participants, SMD 0.38, 95% CI: 0.21 to 0.55, p < 0.001). One study examined the effects of different modes of HFS interventions (computer-based vs instructor-led) on HFS knowledge and behaviour immediately post-intervention in adults and displayed no significant difference between groups (HFS knowledge; very low quality, 1 RCT, 68 participants, SMD -0.02, 95% CI: -0.50 to 0.45, p = 0.92) and (HFS behaviour; very low quality, 1 RCT, 68 participants, SMD 0.06, 95% CI: -0.41 to 0.54, p = 0.79) respectively.

CONCLUSION

The limited evidence supports the use of HFS interventions to improve HFS knowledge and behaviour in children, families with children and adults.