Title: Keeping children safe at home: a multicentre collaborative research programme to reduce childhood injuries
Funder: Department of Health (England)

Abstract: This programme aims to increase evidence-based NHS injury prevention by assessing cost-effectiveness of interventions to prevent falls, poisoning and scalds (F,P&S), developing Injury Prevention Briefings (IPBs) for cost-effective interventions and evaluating the implementation of one IPB in Children's Centres. AIMS AND OBJECTIVES The research questions, relating to home injuries amongst pre-school children are: 1.Which interventions are effective in protecting against F,P&S? 2.What are the NHS and child and family costs of F,P&S? 3.What interventions are being undertaken by Children's Centres to prevent F,P&S? 4.What are the barriers and faciltators to implementing F,P&S prevention interventions amongst Childrens' Centres, professionals and community members? 5.How cost-effective are strategies for preventing F,P&S? 6.How effective and cost-effective is implementing an IPB, developed based on the findings from the decision analysis, for one exemplar injury prevention intervention?? BACKGROUND Unintentional injury is the major public health challenge facing pre-school children in England today.It is the leading cause of death in 1-4 year olds and falls, poisoning and thermal injuries (most of which are scalds) are the most common injuries resulting in hospital admission and Emergency Department (ED) use in this age group.The costs of these ED attendances alone exceeds £17million per year.There are also steep social gradients in injury mortality and morbidity.The importance of reducing childhood injuries and their inequalities is emphasised in Saving Lives: Our Healthier Nation, Choosing Health, The NSF for Children,The Children’s Act and Every Child Matters.The 2002 Accidental Injury Task Force recommended action at all levels within the NHS, yet the 2007 Audit/Healthcare Commission report ‘Better Safe than Sorry’, found little evidence of a systematic strategic approach to develop, implement and monitor programmes to prevent unintentional injuries in children within the NHS. RESEARCH PLANS We propose a series of interlinked studies to address the research questions outlined above. 1.Multi-centre case-control studies to assess the effectiveness of potential interventions (exposures) to prevent F,P&S injuries.Cases will be defined as children attending EDs with a F,P or S injury. Community and hospital controls will be used.Exposures and counfounders will be measured by questionnaire, using validated measures where possible.Analyses will adjust for confounders and assess differential effects by child and family factors and injury severity. 2.Prospective study measuring NHS and family costs of injury and quality of life, with validation of the PedsQL over a one week period. 3.Survey of injury prevention activity in Children's Centres. 4.Systematic review of quanitative and qualitative evidence on barriers and facilitators to injury prevention, and semi-structured interviews of parents and Children's Centre managers and staff to explore barriers and facilitators.These interviews will also assess acceptability and likely impact of the intervention (see 6 below). 5.Decision analyses to assess the most cost-effective strategies for preventing falls, poisoning and thermal injuries. Models will be populated with data from studies to address Q1-Q3 and from a review of systematic reviews. IPBs will be developed for interventions found to be cost-effective. 6.Cluster RCT evaluating effectiveness and cost effectiveness of implementing one IPB in Children's Centres with qualitative study exploring factors associated with implementation.The design of the intervention will be informed by studies addressing Q3 and 4. RESEARCH TEAM This programme builds on previous work conducted by the team, forming a logical extension to their work assessing effectiveness of interventions to prevent injury and measuring the burden of injury. The team have extensive and complementary skills, involving research and methodological development in trials, systematic reviews, meta-analyses, epidemiological studies, questionnaire design, decision analysis and qualitative studies. RESEARCH ENVIRONMENT All centres have excellent academic-service links, based on previous collaborations between applicants and NHS partners. Researchers will be NHS based, and will be extensively supported by the lead academic in each centre. OUTPUTS, OUTCOMES, IMPACT The programme will produce evidence on effectiveness of interventions to prevent F,P&S and on barriers and facilitators to injury prevention, a series of decision analyses and IPBs for preventing F,P&S, "Best Buy" recommendations for safety equipment schemes and a strategy for implementing IPBs. The potential impact is a reduction in injuries, inequalities and NHS costs. PUBLIC INVOLVEMENT We have previously worked successfully with research advisors from the Nottingham Primary Care Research Partnership on injury prevention research and these advisors are collaborating on this programme.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;8.1 ORGANISATION AND DELIVERY OF SERVICES;2.2 FACTORS RELATING TO PHYSICAL ENVIRONMENT
Health categories: INJURIES AND ACCIDENTS