Dale Hanson

Closing the gap between injury prevention research and community safety promotion practice: revisiting the public health model

[Extract] Injury is one of the most underrecognized public health problems in the world, with nearly 16,000 people dying from injuries each day. Together, unintentional injury and violence cause more than five million deaths per year, or 9% of the total global mortality—as many deaths as those caused by acquired immunodeficiency syndrome, malaria, and tuberculosis combined. Injury and violence account for eight of the 15 leading causes of death: road traffic injuries, suicides, homicides, drowning, burns, war injuries, poisonings, and falls.¹ These alarming statistics are all the more tragic because injury is preventable.

Research alone is not sufficient to prevent sports injury

This journal aims to promote, publish and promulgate high-quality, innovative research. As laudable as this is, it is not enough. Unless this research culminates in practical and cost-effective interventions capable of attracting the political and social support required to allow effective implementation, it will not prevent harm or save lives.1 The Public Health Model has been proposed as a framework to promote the progression of sports medicine research towards real-world application.2 ,3 In this four-stage model, research progresses in a stepwise manner from problem identification to adoption of effective interventions:4 Unfortunately, most sports injury research does not result in adequate dissemination or widespread use of effective interventions.5 ,6 The problem is not unique to sports medicine. In a review of 1210 articles published in 12 leading public health and health promotion journals, Oldenburg et al 7 found that 63% of publications were descriptive (Stages 1 and 2), 11% were concerned with method development and 16% were intervention-based (Stage 3), and only 5% were concerned with institutionalisation or policy implementation research, with less than 1% containing diffusion research (Stage 4). While researchers have generated considerable knowledge from surveillance, risk factor identification and efficacy and effectiveness studies, this knowledge needs to be adopted by those who can use it to improve sports medicine practice (eg, clinicians, coaches and sporting bodies).1 ,8 Several gaps between injury prevention research and safety promotion practice hamper our efforts:9 These gaps stem from the contrasting approaches that researchers, policy makers, practitioners and the community take to the scientific, practical and social challenges posed by …

Ecological approaches to the prevention of unintentional injuries

Background: Injury as a cause of significant morbidity and mortality has remained fairly stable in countries with developed economies. Although injury prevention often is conceptualised as a biomedical construct, such a reductionist perspective overlooks the importance of the psychological, environmental, and sociocultural conditions as contributing factors to injury and its consequences. This paper describes the potential of the ecological model for understanding the antecedent causes of unintentional injuries and guiding injury prevention approaches. We review the origins and conceptualise the elements of the ecological model and conclude with some examples of applications of ecological approaches to the prevention of unintentional injury and promotion of community safety. Methods: A review of the English-language literature on the conceptualization of ecological models in public health and injury prevention, including the application of the ecological model in the prevention of falls and road traffic injuries and in the community safety promotion movement. Results: Three dimensions are important in social-ecological systems that comprise key determinants of injuries: 1) the individual and his or her behaviour, 2) the physical environment, and 3) the social environment. Social and environmental determinants have profound impact on population health and in the causation of injuries. Conclusions: Social and environmental determinants of injury should be studied with the same energy, urgency, and intellectual rigor as physical determinants. Application of the ecological model in injury prevention shows the most promise in falls injury prevention, road traffic injury prevention, and community safety promotion.

Working From the Inside Out A Case Study of Mackay Safe Community

Mackay Whitsunday Safe Community (MWSC) was established in 2000 in response to high rates of injury observed in the region. MWSC assumed an ecological perspective, incorporating targeted safety promotion campaigns reinforced by supportive environments and policy. By involving the community in finding its own solutions, MWSC attempted to catalyze structural, social, and political changes that empowered the community and, ultimately, individuals within the community, to modify their environment and their behavior to reduce the risk of injury. A community network consisting of 118 members and an external support network of 50 members was established. A social network analysis conducted in 2000 and 2004 indicated that the network doubled its cohesiveness, thereby strengthening its ability to collaborate for mutual benefit. However, while MWSC was rich in social resources, human and financial resources were largely controlled by external agencies. The bridging and linking relationships that connected MWSC to its external support network were the social mechanism MWSC used to access the resources it required to run programs. These boundary-spanning relationships accessed an estimated 6.5 full-time equivalents of human resources and US

Measuring the sustainability of a community safety promotion network: working from the inside out

750,000 in 2004 that it used to deliver a suite of injury control and safety promotion activities, associated with a 33% reduction in injury deaths over the period 2002 to 2010. MWSC can only be understood in its ecological context. The productivity of MWSC was vulnerable to the changing policy priorities of external sponsoring agents and critically dependent on the advocacy skills of its leaders.

CLOSING THE GAP: PROGRESSING FROM INJURY PREVENTION RESEARCH TO SAFETY PROMOTION PRACTICE

Mackay Whitsunday Safe Communities (MWSC) was developed using a capacity building model that consciously attempted to design sustainability into the network. Our aim was to quantify the flow of resources used by MWSC to implement and sustain its injury control activities. Resource exchange among network members was quantified and analysed using social network analysis. In 2004, MWSC accessed an estimated 6.5 full-time staff equivalents and

The injury iceberg: an ecological approach to planning sustainable community safety interventions

0.9 million. However, these resources were largely accessed externally. The linking relationships that connected MWSC to its external support network, more than half of which were maintained by six broker network facilitators, were the critical social asset used to access resources and sustain network productivity. The sustainability of this network and arguably similar safety promotion networks is vulnerable to the changing priorities of external sponsoring agents and highly dependent on its leaders who facilitated access to the resources it required to remain productive.

Documenting the development of social capital in a community Safety Promotion Network: It's not what you know but who you know

Background The application of the public health model to injury prevention starts with: 1. establishing the magnitude of the problem 2. identifying risk factors 3. developing effective interventions 4. disseminating them Unfortunately most research does not result in widespread dissemination of effective interventions. Aims/Objectives/Purpose This paper describes and addresses the barriers that impede the implementation of effective injury prevention interventions. Methods Literature review. Results/Outcome Several gaps between injury prevention research and safety promotion practice are identified: • the efficacy and effectiveness gap (a scientific problem), • the research to practice gap (an implementation problem), • the injury prevention to safety promotion gap (a political problem). These gaps stem from the contrasting approaches researchers, policy makers, practitioners and the community take to the scientific, practical, and social challenges posed by the contextual complexity of injury. Some researchers believe that stages 1–3 constitute the real scientific work of injury prevention arguing that Stage 4, dissemination and adoption, can essentially be delegated to practitioners who merely have to apply their research findings. This approach underestimates the importance of the contextual determinants of success. Significance/Contribution to the Field Three types of experts are required to design effective interventions capable of dissemination into the wider community: • researchers (content experts), • practitioners (process experts) • the target community itself (context experts). From the outset, an open transdisciplinary dialogue that synthesises the expertise of all stakeholders is required to design effective interventions that can be applied in the real world.