Home Injury Prevention Research Articles

Home Injury Prevention in Children: Attitude & Awareness of the Caregivers at King Abdul-Aziz Medical City - Pediatric Emergency, Riyadh, KSA

Home Injury Prevention in Children: Attitude & Awareness of the Caregivers at King Abdul-Aziz Medical City - Pediatric Emergency, Riyadh, KSA

Preventing unintentional injuries in the home using the Health Impact Pyramid.

Injuries continue to be the leading cause of death for the first four decades of life. These injuries result from a confluence of behavioral, physical, structural, environmental, and social factors. Taken together, these illustrate the importance of taking a broad and multileveled approach to injury prevention. Using examples from fall, fire, scald, and poisoning-related injuries, this article illustrates the utility of an approach that incorporates a social-environmental perspective in identifying and selecting interventions to improve the health and safety of individuals. Injury prevention efforts to prevent home injuries benefit from multilevel modifications of behavior, public policy, laws and enforcement, the environment, consumer products and engineering standards, as demonstrated with Frieden's Health Impact Pyramid. A greater understanding, however, is needed to explain the associations between tiers. While interventions that include modifications of the social environment are being field-tested, much more work needs to be done in measuring social-environmental change and in evaluating these programs to disentangle what works best.

Validity of parent's self-reported responses to home safety questions

The aim of the study was to describe the validity of parent's self-reported responses to questions on home safety practices for children of 2–4 years. A cross-sectional validation study compared parent's self-administered responses to items in the Home Injury Prevention Survey with home observations undertaken by trained researchers. The relationship between the questionnaire and observation results was assessed using percentage agreement, sensitivity, specificity, positive predictive value, negative predictive value and intraclass correlation coefficients. Percentage agreements ranged from 44% to 100% with 40 of the total 45 items scoring higher than 70%. Sensitivities ranged from 0% to 100%, with 27 items scoring at least 70%. Specificities also ranged from 0% to 100%, with 33 items scoring at least 70%. As such, the study identified a series of self-administered home safety questions that have sensitivities, specificities and predictive values sufficiently high to allow the information to be useful in research and injury prevention practice.

Home modifications to reduce injuries from falls in the Home Injury Prevention Intervention (HIPI) study: a cluster-randomised controlled trial

Despite the considerable injury burden attributable to falls at home among the general population, few effective safety interventions have been identified. We tested the safety benefits of home modifications, including handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, edging for outside steps, and slip-resistant surfacing for outside areas such as decks and porches. We did a single-blind, cluster-randomised controlled trial of households from the Taranaki region of New Zealand. To be eligible, participants had to live in an owner-occupied dwelling constructed before 1980 and at least one member of every household had to be in receipt of state benefits or subsidies. We randomly assigned households by electronic coin toss to either immediate home modifications (treatment group) or a 3-year wait before modifications (control group). Household members in the treatment group could not be masked to their assigned status because modifications were made to their homes. The primary outcome was the rate of falls at home per person per year that needed medical treatment, which we derived from administrative data for insurance claims. Coders who were unaware of the random allocation analysed text descriptions of injuries and coded injuries as all falls and injuries most likely to be affected by the home modifications tested. To account for clustering at the household level, we analysed all injuries from falls at home per person-year with a negative binomial generalised linear model with generalised estimating equations. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000779279. Of 842 households recruited, 436 (n=950 individual occupants) were randomly assigned to the treatment group and 406 (n=898 occupants) were allocated to the control group. After a median observation period of 1148 days (IQR 1085-1263), the crude rate of fall injuries per person per year was 0.061 in the treatment group and 0.072 in the control group (relative rate 0.86, 95% CI 0.66-1.12). The crude rate of injuries specific to the intervention per person per year was 0.018 in the treatment group and 0.028 in the control group (0.66, 0.43-1.00). A 26% reduction in the rate of injuries caused by falls at home per year exposed to the intervention was estimated in people allocated to the treatment group compared with those assigned to the control group, after adjustment for age, previous falls, sex, and ethnic origin (relative rate 0.74, 95% CI 0.58-0.94). Injuries specific to the home-modification intervention were cut by 39% per year exposed (0.61, 0.41-0.91). Our findings suggest that low-cost home modifications and repairs can be a means to reduce injury in the general population. Further research is needed to identify the effectiveness of particular modifications from the package tested. Health Research Council of New Zealand.

Home Injuries among Young Children in Malaysia: A Population Based Study

Background: Home injury among children is a public health concern. This study aimed to assess the prevalence rate and risk factors of home injury among children less than seven years old in Malaysia. Methods:Secondary data from National Health and Morbidity Survey 2006 was used. It was a cross sectional study using a stratified two stage sampling technique. The data was analysed using SPSS version 19. Descriptive and multiple logistic regressions were used in the analysis. All tests were two tailed with significance as p<0.05. Odds ratio (OR) along with 95% confidence interval (C.I) were derived where appropriate. Results:Among 8017 children aged less than seven years, 994 (11.4%) experienced some kind of home injury within the past one year. Among those who were injured, the higher prevalence was reported among boys; 13.1% (95% CI: 12.00-14.20), rural dwellers; 12.4% (95% CI: 11.20-13.80), children aged 0-4 years old 11.8% (95% CI: 10.90-12.80), Indians; 14.7% (95% CI: 11.80-18.20) and children from high family incomes. Multiple logistic regression analysis revealed that boys (aOR=1.424, p<0.001), rural dwellers (aOR=1.243, p=0.015), children from ethnic Indians (aOR=1.949, p<0.001), others ethnics (aOR=1.865, p<0.001) and Malays (aOR=1.427, p=0.007) were more likely to sustain a home injury. Children from high (aOR=1.607, p=0.006) and medium (aOR=1.255, p=0.016) family income were also significantly associated to sustain home injury after adjusting all other predictors. As a result from home injury, about 11.6% (95% CI: 9.7-13.8) were unable to perform activities whilst 4.8% (95% CI: 3.7-6.3) of them had been admitted to the hospital. Conclusion:Home injury among children is still a health problem which should not be taken lightly. Educational and interventional programs need to be implemented accordingly in order to help Malaysians understand the importance of making a safe home environment for children thus preventing home injuries.

The feasibility of using a parenting programme for the prevention of unintentional home injuries in the under-fives: a cluster randomised controlled trial

Unintentional injury is the leading cause of preventable death of children over the age of 1 year in the UK and a major cause of attendance at emergency departments. Children having one injury are at increased risk of further injuries. Parenting programmes can reduce injuries in preschool children if delivered in the home and on a one-to-one basis. It is not known if group-based programmes delivered outside the home are effective. To develop (1) a parenting programme to prevent recurrent unintentional home injuries in preschool children and (2) a tool for parents to report unintentional home injuries occurring to their preschool children. To assess the feasibility of delivering and evaluating the parenting programme through a cluster randomised controlled trial, specifically to (1) assess methods for the recruitment and retention of parents; (2) determine the training, equipment and facilities needed for the delivery of the programme; (3) establish appropriate primary and secondary outcome measures and methods for their collection; (4) determine how 'normal care' in a comparison arm should be defined; and (5) determine the resource utilisation and costing data that would need to be collected for the cost-effectiveness component of a future trial; and (6) produce estimates of effect sizes to inform sample size estimation for a main trial. Feasibility multicentre, cluster, randomised, unblinded trial. Eight children's centres in Bristol and Nottingham, UK. Ninety-six parents of preschool children who had sustained an unintentional injury requiring medical attention in the previous 12 months. The First-aid Advice and Safety Training (FAST) parent programme, comprising parenting support and skills combined with first aid and home safety advice. Parent-reported medically attended injuries in the index child and any preschool siblings sustained during a 6-month period of observation. An 8-week parenting programme was produced, designed with participant-friendly, incrementally progressive content. A slimline, month-to-a-view injury calendar, spiral bound and suitable for hanging on a wall, was designed for parents to record injuries occurring to their preschool children during the 6-month period of observed time. Fifty-one parents were recruited (40 meeting eligibility criteria plus 11 following 'open invite' to participate); 15 parents completed the FAST parent programme and 49 provided data at baseline and during follow-up. Completion of the programme was significantly greater for participants using the 'open invite' approach (85%) than for those recruited using the original eligibility criteria (31%). Prototype resource use checklists, unit costs and total costs were developed for phases 0, 1 and 2 of the study for use in a future trial. This feasibility study has developed an innovative injury prevention intervention and a tool to record parent-reported injuries in preschool children. It was not feasible to recruit parents of children who had sustained a recent injury, or to ask health visitor teams to identify potential participants and to deliver the programme. A trial should target all families attending children's centres in disadvantaged areas. The intervention could be delivered by a health professional supported by a member of the children's centre team in a community setting. Current Controlled Trials ISRCTN03605270. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 3. See the NIHR Journals Library website for further project information.

Disseminating Childhood Home Injury Risk Reduction Information in Pakistan: Results from a Community-Based Pilot Study

Background: Most childhood unintentional injuries occur in the home; however, very little home injury prevention information is tailored to developing countries. Utilizing our previously developed information dissemination tools and a hazard assessment checklist tailored to a low-income neighborhood in Pakistan, we pilot tested and compared the effectiveness of two dissemination tools. Methods: Two low-income neighborhoods were mapped, identifying families with a child aged between 12 and 59 months. In June and July 2010, all enrolled households underwent a home hazard assessment at the same time hazard reduction education was being given using an in-home tutorial or a pamphlet. A follow up assessment was conducted 4–5 months later. Results: 503 households were enrolled; 256 received a tutorial and 247 a pamphlet. The two groups differed significantly (p < 0.01) in level of maternal education and relationship of the child to the primary caregiver. However, when controlling for these variables, those receiving an in-home tutorial had a higher odds of hazard reduction than the pamphlet group for uncovered vats of water (OR 2.14, 95% CI: 1.28, 3.58), an open fire within reach of the child (OR 3.55, 95% CI: 1.80, 7.00), and inappropriately labeled cooking fuel containers (OR 1.86, 95% CI: 1.07, 3.25). Conclusions: This pilot project demonstrates the potential utility of using home-visit tutorials to decrease home hazards in a low-income neighborhood in Pakistan. A longer-term randomized study is needed to assess actual effectiveness of the use of allied health workers for home-based injury education and whether this results in decreased home injuries.

Home Safety Practices in an Urban Low-Income Population

Home-related injuries are overrepresented in children from low-income households. The objectives of this study were to determine frequencies of home safety behaviors and the level of agreement between parental self-report and observed safety practices in low-income homes. In a prospective, interventional home injury prevention study of 49 low-income families with children <5 years old, a trained home visitor administered baseline parental home safety behavior questionnaires and assessments. There was high agreement between caregiver self-report and home visitor observation for lack of cabinet latch (99%, 95% confidence interval [CI] = 88%-99%) and stair gate use (100%, 95% CI = 88-100%). There was lower agreement for the safe storage of cleaning supplies (62%, 95% CI = 46%-75%), sharps (74%, 95% CI = 59%-85%), and medicines/vitamins (83%, 95% CI = 69%-92%) because of the overreporting of safe practices. Self-reports of some home safety behaviors are relatively accurate, but certain practices may need to be verified by direct assessment.

Childhood Unintentional Injuries: Need for a Community-Based Home Injury Risk Assessments in Pakistan

Background. A substantial proportion of the annual 875,000 childhood unintentional injury deaths occur in the home. Very few printed tools are available in South Asia for disseminating home injury prevention information. Methods. Three tools were planned: an injury hazard assessment tool appropriate for a developing country setting, an educational pamphlet highlighting strategies for reducing home injury hazards, and an in-home safety tutorial program to be delivered by a trained community health worker. Results. The three tools were successfully developed. Two intervention neighborhoods in Karachi, Pakistan, were mapped. The tools were pretested in this local setting and are now ready for pilot testing in an intervention study. Conclusion. Planning for an innovative, community-based pilot study takes considerable time and effort in a low-income setting like Pakistan. The primary outcome of the pre-testing phase of the study was the development of three important tools geared for low-income housing communities in Pakistan.

Identifying facilitators and barriers for home injury prevention interventions for pre-school children: a systematic review of the quantitative literature

Injuries are the leading cause of childhood death internationally; steep social gradients exist in mortality and morbidity. The majority of pre-school injuries occur in the home, but implementing research into practice for injury prevention has received little attention. This systematic review describes key facilitators and barriers when implementing injury prevention interventions. The review used articles included in a Cochrane systematic review of the effectiveness of home safety education, with or without the provision of safety equipment. Each paper was screened to ensure that children under 5 years, intervention details and process measures and/or barriers and facilitators were included. Two authors independently reviewed each paper and extracted data. Themes were identified and framework analysis used in an iterative process. Ninety-nine papers were identified, 42 excluded and 57 included in the analysis. Seven facilitators and six barriers were identified. Facilitators related to the approach used, focused messages, minimal changes, deliverer characteristics, equipment accessibility, behaviour change and including incentives. The barriers included complex interventions, cultural, socio-economic, physical and behavioural barriers and deliverer constraints. Barriers and facilitators should be addressed when implementing injury prevention interventions and studies should explicitly explore factors that help or hinder the process.

Recent developments in behavioural research and prevention of childhood injuries

In most developed nations, unintentional injuries are the leading cause of death for children. In this symposium, an international panel of speakers will present behavioural research designed to promote safe...

Non-fatal injuries among Chinese aged 65 years and older: findings from the Fourth National Health Services Survey

ObjectiveTo understand the epidemiology of non-fatal injuries among adults aged 65 years and older in China.DesignCross-sectional survey (the Fourth National Health Services Survey of China).ParticipantsUrban and rural residents aged 65...

Patterns of Unintentional Domestic Injuries in Korea

To investigate the patterns of unintentional home injuries in Korea. The study population was 12,382,088 people who utilized National Health Insurance services due to injuries (main diagnosis codes S00 to T28) during 2006. Stratified samples(n=459,501) were randomly selected by sex, age group and severity of injury. A questionnaire was developed based on the International Classification of External Causes of Injury and 18,000 cases surveyed by telephone were analyzed after being projected into population proportionately according to the response rates of their strata. Domestic injury cases were finally included. Domestic injuries (n=3,804) comprised 21.1% of total daily life injuries during 2006. Women were vulnerable to home injuries, with the elderly and those of lower income (medical-aid users) tending to suffer more severe injuries. Injury occurred most often due to a slipping fall (33.9%), overexertion (15.3%), falling (9.5%) and stumbling (9.4%), with severe injury most often resulting from slipping falls, falls and stumbles. Increasing age correlated with domestic injury-related disability. The present findings provide basic information for development of home injury prevention strategies, with focus on the elderly.

Child home injury prevention: understanding the context of unintentional injuries to preschool children

Injury to young children at home is a public health problem. In New Zealand, over half the injury deaths and hospitalisations among 0–4 year olds occur at home. Causes and risk factors for child injury have been identified, but their circumstances are not well described. Understanding the context, however, is important for developing and implementing effective prevention. To obtain the descriptions of injury events, semi-structured interviews were conducted with a convenience sample of 100 caregivers of 0–4 year olds attending an emergency department for a home injury. Analysis from this exploratory study indicated that most events occurred within usual family activity, but had multiple factors interacting. Injury was rarely the expected outcome. Findings concurred with findings from others’ research that reported home injury to be complex and multifaceted. Factors related to the environment, the child, the parent, their behaviours and activity interacted, with common patterns preceding injury being evident such as times of day and disrupted routines. Factors were often found to occur regardless of the cause of injury. Complex parental factors were identified, such as not anticipating risk, having unrealistic expectations of children, lacking knowledge of child development and accepting injury as a norm. Directions for further research are identified.

Recognition of home injury risks by novice parents of toddlers

Objective Unintentional injury in the home is a leading cause of death for toddlers. The majority of injuries occur at home; parents play a significant role in injury prevention. Health-related behavior change theory suggests that behavior change is only possible if individuals (a) recognize the problem, and (b) believe they are vulnerable. This study examined these characteristics among novice parents of toddlers by investigating how well parents recognize hazards in the home and whether they believe their toddlers are vulnerable to those hazards. Methods Three types of participants were recruited: novice parents of toddlers ages 12–36 months, daycare employees, and pediatric healthcare workers. All participants were examined three rooms simulating a typical toddler's bedroom, a living room, and a bathroom. Participants marked any hazards they recognized with stickers. Parents completed the hazard identification task twice, once identifying hazards for all toddlers and another time identifying hazards for their child. Results Participants identified less than half the hazards present in the simulated rooms; parents identified more hazards than comparison groups. Parents identified significantly fewer hazards for their own child than they identified for other children. Discussion Although parents identified more hazards than the professionals, they failed to identify a large portion of hazards and they perceived their own children to have less vulnerability than toddlers more broadly. Results indicate that education about toddler's vulnerability to injury in the home, as well as instructing parents about what situations are hazardous, might be considered during development of toddler home injury prevention programs.

Partnering With Mutual Aid Associations to Provide Home Injury Prevention

Injury is the leading cause of death and a leading cause of morbidity among children in the US. Poor, minority children, especially those with language and cultural differences, are disproportionately affected. The traditional childhood injury prevention approaches (eg, physician office counseling, public service announcements) may not be effective when significant language and cultural differences exist between provider and client. Partnering with mutual aid associations to create low literacy education tools for their home visitors to use to teach immigrant families about home safety may be one method to provide injury prevention information.

The use of mapping to identify priority areas for the prevention of home injuries

Geographical information system (GIS) technology is a potentially useful tool for policy makers to identify priority areas for the prevention of injuries in the home environment. An analysis of hospitalised injuries in New South Wales (NSW), Australia, that occurred in the home environment was conducted using Bayesian methods to calculate the expected relative home injury risk for common injury mechanisms. The results show geographic differences in the mechanism of home injuries. The risk of hospitalised fall-related injuries for people aged 75 years and over and poisoning of children four years of age or less was spread over NSW, while cut/pierce and struck by/struck against injuries showed less extensive areas of risk. This study shows that the use of geographic mapping and spatial statistics can provide a useful means of estimating home injury risk, eliminating the instability of estimates, while showing overall geographic patterns. In the future, geographical mapping of injury locations, coupled with satellite imagery, are likely to provide an additional level of detail for injury surveillance within a defined area.

A cost-outcome approach to pre and post-implementation of national sports injury prevention programmes

In New Zealand (NZ), the Accident Compensation Corporation (ACC) has developed a pre and post-implementation cost-outcome formulae for sport injury prevention to provide information regarding the success of a prevention programme. The ACC provides for the cost of all personal injuries in NZ and invests in prevention programmes to offset 1.6 million annual claims that cost $NZD 1.9 billion. The ACC invests in nine national community sport injury prevention programmes that represent 40% of sport claims and costs. Pre-implementation is used to determine the decision whether to invest in implementation and to determine the level of such investment for the injury prevention programme. Post-implementation is calculated two ways: unadjusted, assuming ceteris paribus; and adjusted assuming no prevention programme was in place. Post-implementation formulae provide a return on investment (ROI) for each dollar invested in the programme and cost-savings. The cost-outcome formulae approach allows ACC to manage expectations of the prevention programme as well as when it will provide a ROI, allowing it to take a long-term view for investment in sport injury prevention. Originally developed for its sport injury prevention programmes, the cost-outcome formulae have now been applied to the other prevention programmes ACC invests in such as home, road and workplace injury prevention.

Use of the modified Delphi technique to identify and rate home injury hazard risks and prevention methods for young children

Objective: For children aged 1–5 years, the authors used the Delphi method to determine (1) the most important injury hazards in each area of the home; (2) the most important...

Long term effects of a home visit to prevent childhood injury: three year follow up of a randomized trial

Objective: To assess the long term effect of a home safety visit on the rate of home injury. Design: Telephone survey conducted 36 months after participation in a randomized controlled...