Strategies and goals of community-based injury prevention programmes – a mixed-methods study of 25 Scandinavian WHO Safe Communities

Documentation and analysis of prevention goals and interventions employed by community-based injury prevention programmes is vital to advance the knowledge and understanding of synergistic multi-strategy injury prevention programmes. This study examined the goals and interventions of 25 Scandinavian community-based injury prevention programmes in WHO-designated Safe Communities. Collection and analysis of quantitative data from survey questionnaires to the programme coordinators was followed by collection and analysis of qualitative data from structured interviews with programme coordinators from eight of the programmes. The results demonstrated that the programmes under study predominantly relied on ‘intuitive’ and subjective methods for selecting interventions. The programmes largely failed to transform injury surveillance data into information and knowledge that could prioritize community safety strategies and measures, due to insufficient time and personnel resources. The results demonstrated the importance of combining passive approaches with active interventions. Educational efforts were considered essential to the programmes. The programmes preferred to rely on broadly stated goals rather than specific objectives.     

Using local injury surveillance for community-based injury prevention: an analysis of scandinavian WHO safe community and canadian safe community foundation programmes

Injury surveillance is widely recognized as a critical prerequisite for effective injury prevention, yet few studies have investigated its use by community-based injury prevention programmes. This study examined the extent to which local injury data were collected, documented, analysed, linked to injury prevention action and used for evaluation among WHO Safe Communities in Scandinavia (25 programmes) and the Canadian Safe Community Foundation (SCF) network (16 programmes). For each programme, a key informant with relevant local knowledge was selected to respond to an emailed questionnaire. The study demonstrates that community-based injury prevention programmes experience difficulties accessing and effectively utilizing local injury surveillance data. The findings suggest that the responding SCF programmes approach injury prevention more scientifically than the Scandinavian WHO-designated Safe Community programmes, by making greater use of injury surveillance for assessment, integration into prevention strategies and measures, and evaluation. Despite study limitations, such as the low response rate among Canadian programmes and a large number of non-responses to two questions, the results highlight the importance of, and need for, greater use of local injury surveillance.     

Uncovering evidence on community-based injury prevention: A review of programme effectiveness and factors influencing effectiveness

This study examines systematic reviews of community-based injury prevention programmes to obtain an overview of the evidence base on the effectiveness of these programmes and to analyse how effectiveness is measured and the extent to which factors contributing to achieving programme effectiveness are examined in these reviews. Thirteen systematic reviews were found, encompassing a total of 121 programmes. The results reinforced the well-documented point that the evidence regarding the effectiveness of community-based injury prevention programmes is inconsistent. Some of the programmes targeting specific injury categories, e.g. specific injury types and/or age groups, were successful, whilst more broadly targeted programmes demonstrated less convincing results. Effectiveness was predominantly measured as injury rate reductions. Only one of the reviews identified contextual factors that could have impacted on programme effectiveness. To advance the field, researchers and systematic reviews need to include evidence on factors that may explain how the effects were achieved.     

Economic analysis of injury prevention – applying results and methodologies from cost-of-injury studies

Injuries pose an economic problem of immense proportion to communities in every society. The economic burden from injuries can be quantified through cost-of-injury studies, using techniques adopted from cost-of-illness research. This study explores the feasibility of applying results and methodologies from existing cost-of-injury studies in economic analyses of injury prevention interventions and programmes.

The literature on cost-of-injury studies and economic appraisals of injury prevention efforts was examined to elicit studies that calculated injury costs. Studies were accepted for inclusion if they included an analysis of the costs of all injuries occurring in a geographical area (community, region or country) during a specific time period, employed a societal perspective and an incidence-based costing approach and were conducted in industrialized countries. There were 12 studies that met the inclusion criteria.

The average total cost per injury case was US$3536, while the average share of indirect to total cost per injury case was 71%. However, the cost figures showed wide variation across the studies. Based on the limited similarity of findings from the studies, it was concluded that it is not feasible to apply results and methodologies from existing cost-of-injury studies. The cost estimators described in this study could possibly be adapted for use as reference points in economic analyses of existing programmes, but any other uses should be approached with caution. Locally obtained data are needed for reliable economic analyses of injury prevention interventions and programmes.     

Evaluation of community-based injury prevention programmes: methodological issues and challenges

The evaluation of comprehensive community-based injury prevention programmes is complex and poses many methodological challenges. There is little consensus in contemporary literature about the most appropriate methods of evaluating these programmes. This study employed a systematic literature review to examine evaluations of 16 community-based injury prevention programmes with regard to key methodological issues and challenges. Three aspects of the evaluated programmes were analysed: assessed elements (context, structure, process, impact, and outcome); study design; and methodological issues addressed. The results showed that context, structure and process assessments were the most neglected aspects of the evaluation studies. The programmes were typically described with minimal discussion of how the context may have influenced the effectiveness. The process (activities) was described rather than evaluated against appropriate standards of comparisons. Impact evaluations adhered more closely to documented guidelines, but half of the evaluations did not include impact variables. Outcome evaluations focused on injury incidence. Most evaluations employed some qualitative methods, but the vast majority of methods used were quantitative. This study indicated that the quasi-experimental study design has become an accepted norm for the evaluation of community-based injury prevention programmes. Most of the evaluations contained explicit details of the methodology used and of the choices related to the methodology. While threats to internal validity were identified in most studies, problems related to external validity and construct validity were largely overlooked by the evaluators.     

Economic analysis of injury prevention--applying results and methodologies from cost-of-injury studies

Injuries pose an economic problem of immense proportion to communities in every society. The economic burden from injuries can be quantified through cost-of-injury studies, using techniques adopted from cost-of-illness research. This study explores the feasibility of applying results and methodologies from existing cost-of-injury studies in economic analyses of injury prevention interventions and programmes. The literature on cost-of-injury studies and economic appraisals of injury prevention efforts was examined to elicit studies that calculated injury costs. Studies were accepted for inclusion if they included an analysis of the costs of all injuries occurring in a geographical area (community, region or country) during a specific time period, employed a societal perspective and an incidence-based costing approach and were conducted in industrialized countries. There were 12 studies that met the inclusion criteria. The average total cost per injury case was USD $3536, while the average share of indirect to total cost per injury case was 71%. However, the cost figures showed wide variation across the studies. Based on the limited similarity of findings from the studies, it was concluded that it is not feasible to apply results and methodologies from existing cost-of-injury studies. The cost estimators described in this study could possibly be adapted for use as reference points in economic analyses of existing programmes, but any other uses should be approached with caution. Locally obtained data are needed for reliable economic analyses of injury prevention interventions and programmes.     

The evaluation of a surveillance system for violent and non-intentional injury mortality in Colombian cities

Since 2002, the Institute for Peace Promotion and Injury/Violence Prevention (CISALVA) at the Universidad del Valle, Cali, Colombia and the Colombia Program at Georgetown University have developed and implemented 21 epidemiologically based municipal crime observatories in intermediate-sized municipalities in Colombia. These crime observatories serve as monitoring centres that provide low cost, geo-referenced methods of data collection and analysis, which allow cities to develop more responsive policies and prevention programmes and enhance governance. This article focuses on the methodology employed and lessons learned that may be applicable to similar settings. Worth noting within the results was a significant decrease in homicides after the first year of the programme. Whether or not such results could be attributed to the method or to the nature of the interventions and policy initiatives stemming from it remains open to conjecture.     

Injury control research has come a long way,but more needs to be done

Since 2002, the Institute for Peace Promotion and Injury/Violence Prevention (CISALVA) at the Universidad del Valle, Cali, Colombia and the Colombia Program at Georgetown University have developed and implemented 21 epidemiologically based municipal crime observatories in intermediate-sized municipalities in Colombia. These crime observatories serve as monitoring centres that provide low cost, geo-referenced methods of data collection and analysis, which allow cities to develop more responsive policies and prevention programmes and enhance governance. This article focuses on the methodology employed and lessons learned that may be applicable to similar settings. Worth noting within the results was a significant decrease in homicides after the first year of the programme. Whether or not such results could be attributed to the method or to the nature of the interventions and policy initiatives stemming from it remains open to conjecture.     

Motala Municipality - a sustainable Safe Community in Sweden

An extensive research project concerning injury prevention was planned and initiated in Motala Municipality in the early 1980s. This article summarises 25 years of work for injury prevention and safety promotion in Motala. Evaluation of both process and effect were conducted based on a quasi-experimental study design, as well as cost-effectiveness and cost-benefit analyses of interventions. Initial evaluations results showed an annual incidence of injuries of 118.9/1000 citizens in 1983/1984 consisting of injuries at home (35%), sports injuries (18.9%), injuries at work (13.7%), traffic-related injuries (12.8%) and other injuries (19.5%). The annual social economic costs of injuries were estimated at 116 million Swedish crowns (SEK). By 1989, after two years of preventive work, the incidence of injuries was reduced by 13%. The greatest decrease was among the moderate severity category of injuries (41%). The social economic costs were thereby reduced by 21 million SEK per year. Since then, work with injury prevention has continued and annual evaluations have shown that the incidence of injuries, with some fluctuation, has continued to decrease up to the latest evaluation in 2008. The total decrease during the study period was 37%. This study shows that community-based injury prevention work according to the Safe Community model is a successful and cost-effective way of reducing injuries in the local community.     

New Approaches to Evaluating the Performance of Corporate–Community Partnerships: A Case Study from the Minerals Sector

A continuing challenge for researchers and practitioners alike is the lack of data on the effectiveness of corporate–community investment programmes. The focus of this article is on the minerals industry, where companies currently face the challenge of matching corporate drivers for strategic partnership with community needs for programmes that contribute to local and regional sustainability. While many global mining companies advocate a strategic approach to partnerships, there is no evidence currently available that suggests companies are monitoring these partnerships to see if they do, in fact, represent ‘strategic’ investments. This article argues that applying the management concept of ‘investment performance’ to corporate–community partnerships requires questioning traditional evaluation methods that focus on the results of programmes or activities. We adopt a case study approach to introduce an evaluation framework that considers performance from both corporate and community perspectives and that conceptualises partnership performance as comprising four aspects: (1) the contribution of the partnership to the overall portfolio of a company’s community investment programmes, (2) the appropriateness of the partnership model, (3) the effectiveness of the partnering relationship and (4) the ability of the partners to achieve programme goals. The application of this evaluation framework to an established corporate–community partnership programme provided some useful insights as to how partnership performance can be improved.     

Evaluation of the effectiveness of single-session school-based programmes to increase children's seat belt and pedestrian safety knowledge and self-reported behaviours

Young children experience many injuries as pedestrians and as passengers in vehicles. This study evaluated the effectiveness of two single-session school programmes, one to increase pedestrian safety knowledge and behaviour among Grade 1 children and the other to increase seat belt safety knowledge and usage among Grade 2 children. In the intervention groups, assessments were conducted on three occasions: before; soon after; and 2 months after the programmes; control groups did not receive the programme. The results revealed positive effects of these single-session safety programmes, as indicated by significant improvement and long-term retention of safety knowledge for both Grade 1 and Grade 2 children and self-reported increases in safety behaviours. Implications for future research and injury-prevention programming are discussed.     

Perceptions of risk among children with and without attention deficit/hyperactivity disorder

Traditionally, health professionals have positioned injury prevention strategies from their own perspective with little acknowledgement or understanding of the perspective of those who experience risk taking: specific populations of children with differing approaches to risk perception and problem-solving. The present study addresses this oversight by engaging children with and without attention deficit/hyperactivity disorder (ADHD) to explore the meaning of risk from their perspective. Although both groups of children reported similar processes of assessing risk, unique to children with ADHD was the overestimation of their physical abilities, intentional risk taking and anticipation of positive or no consequences of their risk taking. These findings also advance our knowledge of potentially appropriate strategies to effect change in risk taking that could influence risk of injury. Specifically, findings suggest that prevention efforts that incorporate both cognitive and social interventions are the most promising approaches. Integrating this understanding of children's perception of risk builds our knowledge about the contribution of risk perception to injury events and may help to inform future injury prevention initiatives with children with ADHD.     

An epidemiological study of injury in a low socioeconomic context: implications for prevention

Epidemiological information identifying injury magnitude and risks is vital for the development of prevention and safety promotion programmes, especially for low income, marginalised communities where the incidence of injury tends to be disproportionately high. This paper, accordingly, reports on a household survey, conducted in an informal settlement southwest of Johannesburg, South Africa, and designed to gather epidemiological data for the purposes of informing the development of appropriate community-based injury prevention and safety promotion programmes. Data were collected for a one-year period prior to October 1998. An analysis of the data identified the causes of injuries, which residents were most at risk, and where and when injuries most often occurred. By way of conclusion, we make a few recommendations for preventive measures.     

Water safety education among primary school children in Grenada

Drowning is a common cause of death among children. Successful prevention interventions currently used in developed countries are often not transferable into developing countries due to differences in both environment and resources. In this study, we adapted a water safety education programme developed by the American Red Cross for primary school students in Grenada. Water safety knowledge before and after the training session was assessed using a nine-question evaluation tool. Following the training, a survey was administered to all teachers to assess the adaptability and effectiveness of the WHALE Tales training. Fifty-six students (30% males) completed the training. The age range was between 5 and 12 years old. Participants’ water safety knowledge increased 15% (p < 0.01). Mean scores of correct answers increased for every grade level, ranging from a 5% increase for first graders to 33% increase for second graders. The findings from this study suggested that implementation of such a programme is effective. With cultural modifications and outsourcing, we believe this adapted programme would be successful in Grenada and other similar settings.     

An evaluation of the red-light camera programme in the city of Dammam,the Kingdom of Saudi Arabia

This study evaluated the effectiveness of red-light cameras in Dammam, the Kingdom of Saudi Arabia. Two methods were used to assess changes in crash risk at the intersections at which the red-light camera programme had been operating. Geospatial analysis was used to visualize trends in road crash density over the geographical region of Dammam and a pre--post-camera crash analysis was undertaken. The distribution of injury crashes was greater than that of crashes which included property damage, the latter of which was concentrated around central Dammam. The five red-light cameras installed in 2012 were located outside areas of high-crash and injury density, and the total number of crashes reported in the three-month periods after installation was double that before the cameras were installed. This increase in the number of crashes also occurred at the five comparison sites (without red-light cameras), indicating a null effect. The findings from this study are contrary to previous evaluations of speed management programmes associated with red-light cameras. The study highlights the challenges in obtaining data for such research and illustrates that a reliance on overt, fixed camera's to manage speed is unlikely to deliver significant reductions in road trauma.     

Optimising relationship marketing programmes: a holistic approach

Optimising relationship marketing programmes in terms of the mix of marketing activities represents a daunting task; however, it is crucial for the formation of successful marketing strategy. An analysis of research into optimisation of marketing programmes reveals models largely focus on the optimisation task, but fail to present a holistic view. Whilst adopting a systematic approach, this paper develops a model for judging the appropriateness of a relationship marketing programme from the optimisation standpoint. As such, relationship marketing programme optimisation is treated as a complex problem consisting of three partial problems related on a parametric basis. These are forming an optimal relationship marketing programme, measuring return on relationship marketing activities and calculating costs of such activities. The methods applied integer programming, multiple regression analysis, factor analysis and heuristic algorithms. The model was tested by using large-scale data on 40,000 SMEs provided by a bank. The results showed a dramatic increase in efficiency when optimising marketing decisions by applying the suggested model. This paper is among the first to present such a holistic approach and to offer an original framework.     

Fertiliser subsidy and agricultural productivity in Senegal

This paper tackles one of the most complex and multifaceted agricultural policy decisions faced by African governments; that is, whether it makes sense to subsidise fertilisers. It combines a data envelopment analysis to compute efficiency scores and regression analyses that deal with self‐selectivity and endogeneity issues to examine the productive efficiency of farmers who benefited from the subsidy programme in the very atypical irrigated system of the Senegal River Valley. The results based on farm‐level data indicate that the subsidy programme seems to be working, as it appears to be associated with increased efficiency; hence, providing empirical support to the political will to revamp subsidy programmes. The results also suggest various ways to improve the effectiveness of the subsidy programme in conjunction with additional policy options to further unlock the agricultural potentials of the region.     

Transfer of learning from management development programmes: testing the Holton model

Transfer of learning from management development programmes has been described as the effective and continuing application back at work of the knowledge and skills gained on those programmes. It is a very important issue for organizations today, given the large amounts of investment in these programmes and the small amounts of that investment that actually translates into an improved individual and organizational performance. This paper describes the testing of the Holton model of learning transfer and suggests amendments to the model where appropriate. A sample of participants on a management development programme within the Irish health service completed the Learning Transfer System Inventory based on the Holton model. The data obtained were analysed using multiple regression and partial correlation techniques. Results indicate that the model does adequately represent the effects of its factors, although a slightly revised model is presented. Important relationships between factors are identified, and the central role of the learners’ personal capacity for transfer (hitherto unreported in the literature) and their motivation to transfer in facilitating transfer is highlighted. In practical terms, the tested model can be used as a diagnostic tool by identifying individual, training design and work environment transfer issues in need of attention and by developing strategies to deal with them. It can also be used as a framework for the evaluation of training and development interventions, examining factors outside the traditional range of most training evaluation efforts and providing a more complete picture of the success or otherwise of that intervention.     

Home-related injuries among under-five-year children and mothers' care regarding injury prevention in rural areas

This cross-sectional study was conducted in rural areas of Twiserkan (Toyserkan) County, in Iran, to assess factors associated with home-related injuries among under-five-year children and their mothers’ care regarding injury prevention. Mothers who had their under-five-year-old children injured within a 12-month period were identified from recorded information in Twiserkan Health Center. Then, data were gathered using pre-tested questionnaire and through interview with injured children's mothers. The questions were about characteristics of the children's injuries and their mothers’ care regarding injury prevention, using PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation) model with focus on knowledge and attitude; enabling and reinforcing factors; and mothers' preventive behaviours. The study results showed that 197 out of 210 total identified mothers took part in the study. The reported injuries were 11.68%, 39.09%, and 49.24%, respectively, for severe, moderate, and mild cases. Fall was the most frequent injury with 35%. Among PRECEDE model constructs, there was a statistically significant correlation between mothers' knowledge and injury severity among children. Home-related injuries are an important health problem among study population and their prediction and prevention are necessary. Enhancement of mothers’ knowledge can be helpful to improve child injury prevention.     

Patterns of injuries and motor-vehicle traffic accidents in Athens

The extremely high cost of motor-vehicle accidents in public health leads to the necessity of a better injury data collection in the Accident and Emergency Hospital Departments. The 'Asclepeion' of Voula Hospital covers the southeastern suburban areas of the greater Athens area (1,000,000 population). The aim of this study is to present information on the pattern of injuries in Athens, in order to understand the magnitude of the problem and develop rational prevention programmes. Specially trained health visitors of the Emergency Department Injury Surveillance System (EDISS) interviewed in person every injured victim who was brought into the Emergency Service of the 'Asclepeion' of Voula Hospital. The study was performed during a 3-year period, from 1996 to 1998; 4564 persons were interviewed. Traffic accidents were more frequent on weekdays with a seasonal peak in July and among young Greeks (aged 25 - 34 years). The usual type of injuries seen in vehicle-accident victims were cerebral contusion and concussion, while in motorcycle-accident victims, head contusion and fractures. The most common reasons for the accident were excessive speed, poor condition of road, inattention, abstraction or drowsiness and drug effects. A total of 29.8% of motorcycle drivers and 5.7% of motorcycle passengers wore a helmet and 26.3% of car drivers and 14.1% of car passengers were using seatbelts. The identification of road traffic injury patterns can contribute to the development of injury prevention measures and guide rational preventive interventions that can reduce the incidence of these injuries. The EDISS system established at 'Asclepeion' of Voula Emergency Service can provide useful and accurate information about this serious and multidimensional problem of Greek Public Health.