Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives
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Published:2017-07
Issue:14
Volume:5
Page:1-834
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ISSN:2050-4322
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Container-title:Programme Grants for Applied Research
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language:en
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Short-container-title:Programme Grants Appl Res
Author:
Kendrick Denise1, Ablewhite Joanne1, Achana Felix2, Benford Penny1, Clacy Rose1, Coffey Frank3, Cooper Nicola2, Coupland Carol1, Deave Toity4, Goodenough Trudy4, Hawkins Adrian5, Hayes Mike6, Hindmarch Paul5, Hubbard Stephanie2, Kay Bryony7, Kumar Arun1, Majsak-Newman Gosia8, McColl Elaine9, McDaid Lisa8, Miller Phil3, Mulvaney Caroline1, Peel Isabel3, Pitchforth Emma10, Reading Richard811, Saramago Pedro12, Stewart Jane1, Sutton Alex2, Timblin Clare1, Towner Elizabeth4, Watson Michael C1, Wynn Persephone1, Young Ben1, Zou Kun1
Affiliation:
1. Division of Primary Care, University of Nottingham, Nottingham, UK 2. Department of Health Sciences, University of Leicester, Leicester, UK 3. Nottingham University Hospitals NHS Trust, Nottingham, UK 4. Centre for Child and Adolescent Health, University of the West of England, Bristol, UK 5. Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK 6. Child Accident Prevention Trust, London, UK 7. University Hospitals Bristol NHS Foundation Trust, Bristol, UK 8. Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK 9. Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK 10. RAND (Europe), Westbrook Centre, Cambridge, UK 11. Norfolk Community Health and Care NHS Trust, Norwich, UK 12. Centre for Health Economics, University of York, York, UK
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.
Funder
National Institute for Health Research
Publisher
National Institute for Health Research
Subject
Automotive Engineering
Cited by
9 articles.
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