Joanne Vincenten

Leadership, infrastructure and capacity to support child injury prevention: Can these concepts help explain differences in injury mortality rankings between 18 countries in Europe?

BACKGROUND Mortality and morbidity rates, traditionally used indicators for child injury, are limited in their ability to explain differences in child injury between countries, are inadequate in capturing actions to address the problem of child injury and do not adequately identify progress made within countries. There is a need for a broader set of indicators to help better understand the success of countries with low rates of child injury, provide guidance and benchmarks for policy makers looking to make investments to reduce their rates of fatal and non-fatal child injury and allow monitoring of progress towards achieving these goals. This article describes an assessment of national leadership, infrastructure and capacity in the context of child injury prevention in 18 countries in Europe and explores the potential of these to be used as additional indicators to support child injury prevention practice. METHODS Partners in 18 countries coordinated data collection on 21 items relating to leadership, infrastructure and capacity. Responses were coded into an overall score and scores for each of the three areas and were compared with child injury mortality rankings using Spearmans rank correlation. RESULTS Overall score and scores for leadership and capacity were significantly negatively correlated to child injury mortality ranking. CONCLUSIONS Findings of this preliminary work suggest that these three policy areas may provide important guidance for the types of commitments that are needed in the policy arena to support advances in child safety and their assessment a way to measure progress.

Why isn't more injury prevention evidence-based?

The focus on evidence-based practice is critical to addressing the issue of injuries, yet advances in the science of injury prevention have not always led to advances in practice. Effective approaches are not always adopted, or when adopted and transferred from one setting to another, they do not always achieve expected results. These challenges were the basis of two breakout sessions at the second European Injury Control and Safety Promotion Conference in Paris, France (October 2008). In summarising the key issues raised during those sessions, this article describes what is meant by evidence-based practice, discusses why evidence-based practice tends not to occur and considers approaches that may facilitate the adoption and implementation of evidence-based strategies. To address the challenge, specific action is required, both on the part of the research community and those responsible for developing and implementing injury prevention policies and programmes.

Facilitators and barriers for the adoption, implementation and monitoring of child safety interventions: a multinational qualitative analysis

The efficiency and effectiveness of child safety interventions are determined by the quality of the implementation process. This multinational European study aimed to identify facilitators and barriers for the three phases of implementation: adoption, implementation and monitoring (AIM process). Twenty-seven participants from across the WHO European Region were invited to provide case studies of child safety interventions from their country. Cases were selected by the authors to ensure broad coverage of injury issues, age groups and governance level of implementation (eg, national, regional or local). Each participant presented their case and provided a written account according to a standardised template. Presentations and question and answer sessions were recorded. The presentation slides, written accounts and the notes taken during the workshops were analysed using thematic content analysis to elicit facilitators and barriers. Twenty-six cases (from 26 different countries) were presented and analysed. Facilitators and barriers were identified within eight general themes, applicable across the AIM process: management and collaboration; resources; leadership; nature of the intervention; political, social and cultural environment; visibility; nature of the injury problem and analysis and interpretation. The importance of the quality of the implementation process for intervention effectiveness, coupled with limited resources for child safety makes it more difficult to achieve successful actions. The findings of this study, divided by phase of the AIM process, provide practitioners with practical suggestions, where proactive planning might help increase the likelihood of effective implementation.

Action indicators for injury prevention

There is considerable confusion about the nature of indicators, their use in the injury field and surprisingly little discussion about these important tools. To date discussions of injury indicators have focused on the content and presentation of health outcome measures and on the dearth of data on exposure measures. Whereas these are valuable measures and assessing the optimal use of available routinely collected data in forming indicators is important, they do not provide sufficient information to support comprehensive prevention efforts, nor do they harness the full potential of indicators as tools to support prevention efforts. This paper provides an overview of the characteristics and uses of indicators for the field of injury prevention in order to make the case for action indicators and provide a framework for their appropriate use.

Barriers and Facilitators to the Elimination of Asbestos Related Diseases—Stakeholders’ Perspectives

Despite sound scientific knowledge and evidence that any exposure to asbestos fibers in all of its forms, are carcinogenic to humans, its presence, use and trade is still substantial, including in the World Health Organization (WHO) European Region. Banning the production and use of all forms of asbestos, as recommended by the International Labour Organization (ILO) and WHO, has been proven as the most efficient evidence-based strategy to eliminate Asbestos Related Diseases (ARDs). To effectively move elimination of ARDs forward, attaining a greater understanding of key stakeholders perspectives was identified as an important action. The WHO Regional Office for Europe, the European Centre for Environment and Health, undertook semi-structured interviews, and follow-up discussions with diverse representatives dealing professionally with asbestos. The interview questionnaire was developed based on the current ARDs WHO Report, the Evidence Implementation Model for Public Health and categories of the theory of diffusion. Data were attained on three main questions within the interview questionnaire: (1) Identifying barriers to implementation of WHO evidence-based asbestos recommendations; (2) Describing roles of key stakeholders; and, (3) Proposing possible solutions. The results demonstrated use of sound and convincing scientific evidence along with economic evidence and facilitators can be used to achieve evidence-based policy development, and comprehensive diverse actions.

CHILD SAFETY REFERENCE FRAMEWORKS : A POLICY TOOL FOR CHILD INJURY PREVENTION AT THE SUB-NATIONAL LEVEL

OBJECTIVES The aim of this paper is to present the Child Safety Reference Frameworks (CSRF), a policy advice tool that places evidence-based child safety interventions, applicable at the sub-national level, into a framework resembling the Haddon Matrix. METHOD The CSRF is based on work done in previous EU funded projects, which we have adapted to the field of child safety. The CSRF were populated following a literature review. RESULTS Four CSRF were developed for four domains of child safety: road, water and home safety, and intentional injury prevention. CONCLUSION The CSRF can be used as a reference, assessment and comparative tool by child safety practitioners and policy makers working at the sub-national level.

68 Implementation of the ‘School Travel Safety Survey’ for Data Linkage Research

Background The School Travel and Child Safety Survey (STCSS) was developed as part of the European TACTICS project (Tools to Address Childhood Trauma, Injury and Children’s Safety) to address the lack of standardised data on children’s safety and exposure to risk across Europe. Description of the Problem Current methods used to collect data on child safety and exposures to risk are not collected in a coordinated way, making research and policy evaluation in these areas difficult. The STCSS was developed with European partners, as a standardised tool which could be adopted by member states, to collect child safety data and enable comparisons between different regions/countries for policy development and evaluation. Travel behaviour data (e.g. mode of transport and distance travelled) is also limited; but vitally important for monitoring active travel and road safety interventions. Results The STCSS was developed for children aged 10–13 years to be undertaken in school, and was successfully piloted in 5 countries across Europe (n = 636, participation rate = 88.37%). A sample of children were retested to establish the survey reliability, and per cent agreements were ≥96%. The STCSS has been further developed in Wales, to enable the results to be anonymised and incorporated into the Secure Anonymised Information Linkage (SAIL) databank at Swansea University. Data linkage methods within SAIL allow the STCSS results to be linked to other individual and household level datasets; for example, socioeconomic, demographic, health and education data. Conclusions The ability to link the results from this survey to other routinely collected data in the SAIL database, will provide much needed evidence on the medium and long-term effectiveness of child safety interventions and policies; as well as provide regional, national and international policy makers with data to support the planning and evaluation of interventions.