Good practice approaches
What do we know about good practice approaches to preventing unintentional injuries in children?
Prior to examining the actual good practice approaches to preventing unintentional injuries in children, it is important to note that preventing injury in this age group is unique for a number of reasons. To plan and implement truly effective strategies, it is essential to take these factors into account when selecting and transferring good practice. The uniqueness stems from:
Children as the focus of the work
When talking about child injury prevention and safety promotion, children and their parents / caregivers are the primary target groups of interventions. Although a specific intervention might involve advocating for policy change with decision makers, the main focus for child injury prevention and safety promotion is the children themselves and the adults who are their main caregivers (3-9).
The importance of children's developmental stage
The types of injuries that children experience are closely linked with their age and stage of development which involves physical, psychological and behavioural characteristics (10). This needs to be taken into account when examining potential strategies and transferring them to new settings.
The fact that injuries disproportionately affect the most vulnerable children in society
The likelihood of a child being killed or injured is associated with a variety of factors including single parenthood, low education among mothers, very young mothers, poor housing, large family size and parental drug or alcohol abuse (11). This uniqueness of children mandates the importance of knowing your target audience well and involving your target group early on in the project.(12,13) Failing to involve your target group is likely to reduce the success of an intervention. Particularly when transferring a good practice from one setting to another, it is important to know your target group as rigorous evaluations, such as those used to support best evidence recommendations, typically have limited generalisability because of the specificity of their participants. When broad approaches to child injury prevention and safety promotion are examined, there are seven that offer proven or promising strategies (6). These seven approaches are described below but it is important to note that although they have been proposed as offering proven or promising strategies, actual strategies based on these approaches have not been evaluated in all areas of child injury prevention. Nonetheless, they provide a useful framework to consider for any type of childhood injury.
1. Environmental modification
Children are particularly vulnerable to injury because they live in a world over which they have little control and which is built around the needs of adults.10 modification of the environment to make that world more 'child- or parent- friendly' is an accepted approach to reducing risk. These strategies are most effective when used in combination with legislation and educational activities.6 Examples of this type of strategy in the 'at-a-glance' section include playground equipment design and installation and area-wide measures to reduce pedestrian and cyclist risk (e.g. traffic calming).
2. Product modification
Similar to the issues in environmental modification, many products pose an added risk to children because they are designed around the needs of adults. Product modification is a more passive means than active adult supervision of reducing the risk around certain products.14 These strategies also become more effective when used in conjunction with legislation and educational activities. Examples of this type of strategy in the 'at-a-glance' section include child resistant closures, factory set temperatures on water heaters and child resistant lighters.
3. Legislation, regulation and enforcement
Legislation has proven to be the most powerful tool in the prevention of injury.6 Legislation is most effective when enforced and when used in combination with product or environmental modification and educational activities. Examples of this type of strategy in the 'at-a-glance' section include legislation around the use of child passenger restraints, bicycle helmets and child resistant packaging.
4. Promoting the use of safety devices
Safety devices are promoted to reduce the risk of injury occurrence or minimize the impact in the event of an injury event (6). Examples of this type of strategy in the 'at-a-glance' section include smoke detectors, bicycle helmets and child passenger restraints.
5. Supportive home visits to families of young children
Although more evaluation is required of supportive home visits, early studies have found generally positive results for this approach. Supportive home visits are particularly effective if the information provided is age appropriate and visits are combined with provision of free safety equipment and broader promotional campaigns (6,2).
6. Community-based interventions
These interventions, which focus on changing community values and behaviours and altering the physical environment of communities to reduce the risk of injury, may have particular relevance for children as interventions often target the safety awareness, attitudes, and behaviours of children and parents. 15 Community-based interventions employ a broad array of strategies that include education/behaviour change, product and environmental modification and legislation/enforcement, with the key difference that the strategy focuses on the community, not the individual. Examples of this type of strategy in the 'at-a-glance' section include community-based bicycle helmet and child passenger restraint promotional campaigns.
7. Education and skills development
The effectiveness of educational and skill development programmes on their own is controversial and evidence is often lacking. However if they are well designed and take into account the target population, or if they are used in combination with other strategies, such as legislation or environmental or product modification, educational and skills development programmes can be effective (6). An example of this type of strategy in the 'at-a-glance' section includes pedestrian skills training.
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