Jean Simpson

Tackling rugby injury: Iessons learned from the implementation of a five-year sports injury prevention program

Rugby Union football is a very popular sport in New Zealand but of all the major sports played in that country, it has the highest reported incidence of injury. In 1995, a national rugby injury prevention program was instigated to address this problem. Known as Tackling Rugby Injury, this multifaceted program was implemented over a five-year period. The program was based on the results of a prospective cohort study of rugby injury, known as the Rugby Injury and Performance Project (RIPP), and was organised around seven themes, five relating to the prevention of injury: coaching, fitness, injury management, tackling, and foul play, and two relating to the implementation and evaluation of the program. The purpose of this paper is to describe the lessons learned from the implementation of Tackling Rugby Injury. Qualitative research methods were used to describe the process of implementation, including informant interviews, participant observation, and the scrutiny of written, visual and archival material. Among the lessons learned were the importance of basing injury prevention strategies on scientific evidence rather than popular belief, the difficulty in implementing complex interventions, the advantages of a formal agreement between partners in the implementation of a program, the central role played by coaches in promoting injury prevention strategies, and the value of describing the process of implementation as well as monitoring injury outcomes and changes in knowledge, attitudes and behaviour. It is hoped that other sports wishing to develop injury prevention programs can learn from this experience.

The APPLE project: An investigation of the barriers and promoters of healthy eating and physical activity in New Zealand children aged 5-12 years

Objective To use the Analysis Grid for Environments Linked to Obesity (ANGELO) framework to determine the barriers and promoters of healthy eating and physical activity in children aged 5-12 years, as a basis for the development of a pilot community-based programme for preventing obesity in children (APPLE project: A Pilot Programme for Lifestyle and Exercise). Methods Semi-structured interviews were held with nine community stakeholders including doctors, school staff and food outlet operators. This information was used to develop a telephone-administered questionnaire to 101 parents of children in the intervention communities. Finally, structured interviews were undertaken with intervention school principals (n=4) regarding the school environment pertaining to physical activity and healthy eating. Results Major barriers to physical activity identified included lack of facilities, coaches and equipment. Work commitments prevented 40 per cent of parents being physically active with their children. Shared transport would increase opportunities for activity. Socio-cultural influences included family support for sport, lack of initiative to instigate activities and preference for more sedentary options; 70 per cent of parents thought their child preferred TV or computers over sport/games. Cost prevented one-third of children being involved in activity and 45 per cent of parents buying healthier foods. Political barriers to healthy eating included the absence of parental rules regarding purchasing less healthy food options, using treat foods to coerce children to behave and the lack of fruit and vegetable advertising. Over two-thirds of parents thought banning particular foods would have a positive effect on eating habits. One third of parents said their children didn’t like healthy foods and 25 per cent thought it did not matter what their child ate as long as they were growing properly. Conclusions The ANGELO framework used in this assessment identified potential environmental barriers to healthy eating and physical activity in children and provides the basis for an obesity prevention programme in youngsters aged 5-12 years.

Examining child restraint use and barriers to their use: lessons from a pilot study

Objective: To determine the suitability of four research methods to measure the rate of child restraint device (CRD) use and incorrect use in New Zealand and obtain data on barriers to CRD use. Design and setting: To assess the rates of CRD use among vehicles carrying children 8 years of age and under, two methods were piloted—namely, an unobtrusive observational survey and a short interview and close inspection. A self administered questionnaire and focus group interviews were also piloted to assess CRD use, reasons for use and non-use, and to obtain information on barriers to their use. Respondents to all methods except the focus groups were approached in supermarket car park sites at randomly selected times. Focus groups were established with parents identified through early childhood organisations. All methods were assessed on criteria related to efficiency, representativeness, and ability to obtain the necessary data. Results: The observational survey provided a simple method for identifying rates of CRD use, while the self administered questionnaire obtained data on demographic characteristics and reported the installation and use/non-use of CRDs. The interview/inspection addressed all the questions of both the above methods and enabled incorrect CRD use to be examined. The focus groups provided the most meaningful information of all methods on barriers to CRD use. Discussion and conclusion: Advantages and limitations of these methods are discussed and some refinements of the original instruments are proposed. The interview/inspection and focus group methods were identified as being more appropriate for efficiently obtaining reliable data on CRD use and identification of barriers to CRD use.

Correct and incorrect use of child restraints: Results from an urban survey in New Zealand

This study describes the incorrect use of child restraints among car drivers with young children and examines factors that may influence their misuse. A cross-sectional survey was undertaken in supermarket car parks with car drivers travelling with children under the age of 8 years. The main measure was errors in child restraint use. Short interviews were conducted with 1113 drivers with a close inspection of the child restraints used in the vehicles. Only 4% of children were unrestrained but 64% of drivers made at least one error in restraint use. Most respondents thought using a restraint was easy, but 65% of these drivers made at least one error. Child restraints are used, but many are incorrectly fitted and/or have the child incorrectly placed in them. Correct use is a moderately complex task. Restraint systems need to be designed to minimize the opportunity for error and maximize safety.

The epidemiology of home injuries to children under five years in New Zealand

Objective:

Playing conditions, player preparation and rugby injury: a case-control study

This paper investigates the effect of player preparation, ground conditions and weather conditions upon the injury risk for Rugby Union players. A population-based case-control study was performed using a sample (n= 1043) of New Zealand Rugby Union players aged 16 y and above. Details concerning game preparation (warm-up and usual position), and ground and weather conditions (precipitation, wind and temperature) were obtained from the players. If players were injured during the season (n= 624) they were asked to provide details about the game in which they were last injured. Uninjured players (n= 419) provided details about the last game in which they played. Injuries were more likely to occur when games were played on hard grounds or in calm or warm conditions. Playing out of position and the duration of warming up did not significantly alter the risk of injury. When player preparation, ground and weather conditions, grade, age, playing position and rugby experience were simultaneously controlled for, hard ground and the absence of wind were associated with increased risk. The influence of these factors may be indirect, through adaptation to the conditions in which a game is played.

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.

Barriers to safe hot tap water: results from a national study of New Zealand plumbers

Introduction—Many countries still have unacceptably high hospitalizations and deaths from scalds from hot tap water. Prevention strategies implemented in some countries may not work in others. Legislation aimed at changing environments that are conducive to hot tap water scalds may not be effective in many situations for a number of reasons, including lack of acceptability and practicality. Method—A qualitative study of a purposefully selected group of craftsman plumbers across New Zealand was conducted using a structured format with open ended questions. The questionnaire was administered by telephone. Information was sought on the opinions, knowledge, and practice of these plumbers regarding hot tap water safety in homes. Results—Several barriers to hot tap water safety in homes were identified by the plumbers. These included common characteristics of homes with unsafe hot tap water, such as hot water systems heated by solid fuel, and public ignorance of hot tap water safety. Other factors that emerged from the analysis included a lack of knowledge by plumbers of the hazards of hot tap water, as well as a lack of importance given to hot tap water safety in their plumbing practice. Shower performance and the threat to health posed by legionella were prioritized over the prevention of hot tap water scalds. Conclusion—The findings of this study allow an understanding of the practical barriers to safe hot tap water and the context in which interventions have been applied, often unsuccessfully. This study suggests that plumbers can represent a barrier if they lack knowledge, skills, or commitment to hot tap water safety. Conversely, they represent a potential source of advocacy and practical expertise if well informed, skilled, and committed to hot tap water safety.

Evaluating Tackling Rugby Injury. The pilot phase for monitoring injury

Objective: To assess the suitability of two previously unused data sources for monitoring rugby injury throughout New Zealand.

Injury surveillance: unrealistic expectations of safe communities

Designation as a World Health Organization (WHO) Safe Community (SC) is based on local capacity to meet six criteria. Criterion 4 states that communities must have: “Programmes that document the frequency and causes of injuries” (http://www.phs.ki.se/csp/index_en.htm). This is typically interpreted as information that pertains directly to their community. The reasons for doing so have been summarised by Nilsen et al 1: > “Community-based injury prevention programmes need local IS [injury surveillance] to identify and characterize unique community injury problems, to develop tailored prevention strategies and to evaluate the effectiveness of local programme interventions”. In addition: “Local data can play an important role in motivating local action by increasing the community feeling of ownership and accountability for the mitigation of the injury problem” (p36). It is important to note the evaluation need mentioned by Nilsen, since criterion 5 for designation as an SC requires: “Evaluation measures to assess programmes, processes and effects of changes” (http://www.phs.ki.se/csp/index_en.htm). The review of Nilsen et al 1 of 25 WHO SCs in Scandinavian and 16 Canadian Safe Community Foundation programmes reported that many of these programmes experienced significant difficulties accessing local injury data and few utilise these data effectively. In our evaluation of two small SCs, we noted similar difficulties.2 Nilsen et al 1 recommend that, given the limited resources of most SCs, the situation be addressed by a greatly expanded supportive role of the coordinating or affiliate support centres of the two networks. They suggest “…the local programmes or the centres could collect IS data with the centres supporting analysis and interpretation with involvement of collaborating injury prevention researchers” (p41). In this commentary, we demonstrate that expectations of SCs in terms of local surveillance systems are unrealistic. Our commentary is structured as follows: