Evidence-based good practice
Transfer of knowledge can happen with both effective and ineffective practices and numerous ineffective strategies continue to be practised across Europe despite evidence that they are not the best use of resources. For example, bicycle skills fairs or 'rodeos' as an educational strategy to address bicycle-related injuries have not been shown to be effective and as a solitary strategy are not considered good practice (14). Despite this evidence, the activity continues to be offered, often as a stand-alone intervention.
In the current environment of scarce resources and competing issues the injury prevention community needs to ensure that existing efforts and resources are focussed on effective evidence-based good practice. It also needs to ensure that it systematically studies and understands why strategies work in one setting/context and not in others and it needs to learn to effectively transfer the good practice to other settings/contexts. If the injury prevention community does not make adopting evidence-based good practice a priority, policy makers will continue to invest resources in strategies that do not lead to reducing the burden of injury in children.
Why do we not implement good practice?
There are several reasons why as a field the injury prevention community fails to select and implement good practice.
Resistance to change
Resistance can come from government in the form of resistance to legislative or regulatory efforts, from the injury prevention community in terms of comfort with the way things are, personal investment in an existing unproven programme or lack of awareness of a need to change. It can also come from the programme developers and managers because producing an educational pamphlet as the sole intervention is easier, faster and more quantitative than advocating for legislation or environmental modifications. The public itself can also play a role. If an activity is perceived by the public to be of value, even if it is actually not effective, then politicians and decisions makers often hesitate to stop investing. Understanding where resistance is likely to come from and planning accordingly to address it is part of good practice in transferring strategies from one setting to another.
While the importance of keeping children alive and contributingto society seems inherently simple and essential, it also takesongoing commitment. This usually requires more time, money or potential inconvenience for adults and as a result the ongoing commitment is not made. For example, sometimes what is good for children is not perceived to be good for others. A product modification that is viewed as important to ensuringa reduced risk for child injury may be seen as being in conflict with what is best for industry. This is because industry tends to see the desired changes resulting in increased production costs, job losses, etc. This in turn can impact elected officials who attempt to balance perceived needs and may side with industry for fear of not being re-elected and loss of corporate support.
Selecting and following through with good practice requires real commitment for the long term and beyond a single election cycle. Because in injury prevention a given strategy can affect multiple sectors, ministries, industry and partners it is important to understand the many viewpoints and to build the strongest case for the child-benefiting change. It is therefore important that the injury prevention field continues to build the evidence of effective strategies, including cost effectiveness of strategies, so that data are available to support arguments for children’s lives as the priority over other issues.
Failure to plan solutions effectively
If too little time is spent on up front planning then the steps of looking for good practice from other settings may be missed. Furthermore, once good practice is identified, failure to assess adequately the potential for successful transfer and to plan concrete steps to increase its likelihood can result in unsuccessful transfer and implementation. And unsuccessful transfer and implementation can have a negative impact on the field as a whole if it is interpreted as a failure of the strategy rather than a failure of the transfer and implementation. The amount of time, work and practical research required to obtain the necessary information and do a good job on these planning steps can be daunting. As the injury prevention field learns more about what works and why, resources such as this guide can help by identifying good practice and providing guidance for the decision to attempt transfer and steps to increase likelihood of success.
Lack of capacity or expertise
In some cases the individuals making the decisions do not have the information necessary to make the correct decision and choose good practice. There is therefore a role for injury practitioners to educate decision makers and to advocate for commitment and resources for strategies that will work. There is also a role for lead organisations in the injury prevention and safety promotion field to support the efforts of injury practitioners to advocate for good practice and to address capacity building as a priority issue in the field.
Lack of time or resources
Often practices that are not evidence-based can be appealing because they are quick and easy and give the impression that something is being done (e.g. distributing a pamphlet). To truly address child safety it will be necessary to select evidencebased good practice strategies that may cost more and / or take longer to achieve but in the end will achieve greater results. In an environment of scarce resources and limited time frames for funding this will likely require collaboration between organisations and working smarter with government and industry to ensure they take up what works.
In summary, to implement good practice today the injury prevention community needs to take into account both the specific aspects of children as a target group and the seven broad approaches to child injury prevention and safety promotion that offer proven or promising strategies. It needs to keep in mind that these seven approaches are most effective when they work in combination, and to invest scarce resources into what is known to work. This will also require an understanding of the importance of using good practice and the reasons why it is not implemented more often. The next section provides more detail on the strategies based on the seven broad approaches that are considered current best investments.
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