Implementing a national programme at local level: findings from a multiple-site case study

Abstract

In developed countries, unintentional injury is a leading cause of death and morbidity in childhood, with increased risk for those children living in deprived circumstances. Preschool children are at particular risk of injury in the home. Provision of free safety equipment for families least able to afford it offers a promising counter-measure to home injuries in children under 5 years. This study employed multiple-site case studies to identify barriers and facilitators in the local implementation of a national home safety equipment scheme. Retrospective case studies were conducted in 20 sites in England, all of which had higher than average hospital admission rates for injury to children under five. Methods of data collection included one-to-one interviews, group discussions, site visits and documentary analysis. The findings from cross-case thematic analysis indicated a high level of satisfaction with local schemes among parents and professionals. Partnership working and the flexibility to adapt to local circumstances were identified as key facilitators to scheme delivery. Barriers included the limited project timeframe, lack of support from landlords and organisational factors at both national and local level that impeded implementation. The study highlights the importance of seeking a balance between the expectations of a nationally coordinated public health initiative and the practicalities of implementation within local settings.