Child Injury Prevention

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  • Phase 1 - Look at the problem
  • Phase 2 - Think and plan
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  • Phase 4 - Relect and evaluate
  • Definitions
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E's of injury prevention

The first 3 E's of injury prevention identified were:

1. Environment and product design or modification to ensure that they are safer for people to live in and use everyday.[26] An example of product design is nursery furniture; baby's cots are now manufactured according to Australian Standards. The cot bars are a certain width apart to prevent head entrapment and subsequent strangulation or suffocation. Examples of environmental design include 'Kiss'n'ride' zones (drop off zones) at schools and not installing play equipment near unprotected bodies of water without barriers.
   
   These strategies are considered passive interventions where individuals are not required to undertake any action to be protected; these strategies have been shown to be more effective than active measures, which require continued effort from individuals.[27] Examples of passive measures include a car airbag, which is activated automatically in a car crash, or tempering valves that automatically reduce the temperature of hot tap water to a safer level.[26]
   
   
2. Enforcement of legislation and policies combined with penalties for not following the legal requirements are used to influence the actions of individuals, organisations and businesses to reduce risk and injury [26] (such as with seatbelt use, enforcement and penalties for non-use). Some of the greatest successes in injury prevention are from a combination of enforcement and education.[27]
   
   
3. Education in injury prevention aims to influence a range of stakeholders (including individuals, communities, health professionals, policy makers, businesses and the media) either one on one or en masse, by increasing their knowledge, changing their attitudes and altering their behaviours. However, it is important to note that education methods alone will not necessarily result in behavioural change. Education is considered an active intervention, which requires an individual to take action each time they undertake a safety measure.[26] [27] Success is dependant on the beliefs, efforts and actions of those that the education is targeting.[26] Injury education is useful when there is a need for new information or when there is no other way to prevent injuries either through product changes, environmental design or legislation.[26]
   
   Overall, education plays an important role in laying the foundation for sound injury prevention approaches. However it should not be used in isolation but rather as a part of an overall multi-strategic approach.

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Over time these original three E's of injury prevention have been expanded to include: 

Evaluation which provides valuable information regarding the appropriateness, adequacy and effectiveness of injury prevention projects/programs or materials and, if necessary, how they can be improved. Evaluation is an important component of project management that is best considered from the start and throughout a project/program and sometimes can occur following the completion of a project/program.[28] During evaluation, there are two types of information that can be collected (ie. qualitative/subjective and quantitative/numerical/objective information).

The four phases of evaluation include:

• formative evaluation or pilot/pre-testing (e.g. focus testing a television commercial whilst in a comic strip format before it was filmed)
• process evaluation used to measure the activities of the project/program, the quality of the project/program and who it is reaching (e.g. how many education session were conducted, attendance rates and the satisfaction of attendees)
• impact evaluation to measure the immediate or short term effect of the project/program (e.g. how a project/program has changed the behaviour, attitudes, skills etc, of those that were being targeted). Often this relates to the project/program objectives
• outcome evaluation to measure the long term effects of the project/program (e.g. how a project/program has reduced injury). Often this relates to the project/program goal.

For more information on evaluation refer to Child Injury Prevention Community Action Model Phase 4 Reflect and Evaluate and Evaluating ChIPP.

Evidence regarding what actions can be taken that have actually been shown to be effective in reducing injury. In order to find out what works it is best to look at the scientific research (particularly systematic reviews/meta analyses or randomised control trials).

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Engagement of stakeholders (including individuals, communities, health professionals, policy makers, businesses and the media) because no one agency can address injury prevention alone. There is a need for collaborative partnerships to be formed and maintained with those who have existing or potential passive and active roles to play in promoting safe behaviours as well as reducing injury exposure and severity. Ongoing and active engagement is best based on identification of mutual benefits and common goals in a setting of trust and respect that in turn, fosters sharing of responsibility and resources.

Epidemiology, which is the study of factors affecting health (including injury), including distribution, occurrence, determinants and control of injury. A range of injury data sources exist which can provide important contextual information for planning injury prevention projects/programs, as well as monitoring their effectiveness.

Economic impact of injury which takes into account the value of life, or loss of normal function and the indirect (eg. loss of work productivity) along with direct (eg. health care related) costs from the injury. Injury prevention has the potential to benefit society and can be cost effective by using interventions that aim to avoid the most costly types of injury care such as hospital treatment and rehabilitation.[28] The economic impact of injury prevention interventions is an important component for evaluation to ensure interventions are cost effective for the project/program and it assists with identifying which intervention/s offer the best value for money compared with other interventions.[29]

Also, there is an increasing recognition that many modern health problems (including injury) are multi-causal resulting from a complex interaction of social, economic, environmental, behavioural, and genetic determinants over the course of a person's life (eg. studies have shown that children from low socioeconomic status (SES) are at increased risk of death and disability from injury compared to children from high SES).[30] As a result there is a need for social determinants to be addressed as an important component of injury prevention. Economic incentives have a role to play in influencing the socioeconomic environment of communities through, for example the distribution of safety products at no cost or low cost to families in need, and working with manufacturers to improve safety devices without increasing their costs.[31]

Other E's
Other E's that you could consider are:

• Enthusiasm
• Empowerment

There could be more E's that you determine as an important part of child injury prevention from your own Experience.

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