Rebecca Ivers

Overcoming barriers to use of child car seats in an urban Aboriginal community—formative evaluation of a program for Aboriginal Community Controlled Health Services

BackgroundLittle is known about the barriers to use of child car seats in Australian Aboriginal communities, or the acceptability of programs to increase appropriate car seat use. This formative evaluation sought to consult and partner with Aboriginal Community Controlled Health Services (ACCHS) to develop and evaluate the feasibility and acceptability of a program intended to improve optimal use of child car seats.MethodsFocus groups were conducted with parents and carers of Aboriginal children to identify the barriers and facilitating factors for child car seat use, and staff of two ACCHS were interviewed to inform program development. Following the implementation of the resulting multi-faceted program, consisting of staff training, education, hands-on demonstrations and a subsidised car seat distribution scheme, interviews were conducted to assess process issues and acceptability with 13 staff members.ResultsParents and carers in the focus groups reported a lack of awareness of child car seat use, confusion about the right car seats for different aged children but agreed about the importance of safety and community responsibility to keep children safe in cars. Interviews with service staff informed an approach to deliver relevant information. Information and resources were delivered to families, while the car seat distribution scheme supplied 33 families with child car seats. Following the conclusion of the program, staff reported that the program was relevant to their role. They also valued the car seat distribution scheme. Staff training in selection and installation of car seats increased confidence in staff knowledge.ConclusionsWe developed a program to promote child car seat use in ACCHS, which focused on developing capacity, made use of existing infrastructure and developed resources for use in this setting. The program shows promise as a means to promote child car seat use in Aboriginal communities; however, the impact on child car seat use will need to be evaluated in a larger scale prospective trial.

Growing the next generation of researchers in injury prevention

A review of the material published in Injury Prevention highlights the interdisciplinary nature of our field. From identifying the number and nature of injuries in different settings to implementing and evaluating the injury control measures we develop, a range of expertise, experiences and approaches are required.1 It is clear that research alone does not prevent injury.2 As a field, injury prevention has long embraced the need to ensure research findings are relevant to practice and society.3 This is never more evident than at the biannual Australasian Injury Prevention Network (AIPN) conference, where the mix and interaction of research, policy and practice papers, across different disciplines, is showcased and celebrated. Although injury prevention is interdisciplinary and global in scope, one notable challenge is that the size of the workforce is relatively small—certainly smaller than the injury problem we are working to address. Planning and effort to build a workforce capable of addressing growing global demands for injury and violence prevention is needed,4 one that can adapt to changing demands and priorities and collaborate to achieve collective goals, without unnecessary duplication or resource …

PA 15-4-1813 Evaluation of a culturally appropriate fall prevention program for older aboriginal people

Fall-related injury amongst older Aboriginal people is a growing health issue yet our recent audit of services identified few Aboriginal-specific fall prevention programs. Informed by stakeholder interviews and Yarning Circles with over 70 older Aboriginal people, a fall prevention program was developed in partnership with Aboriginal community groups. The aim of this study was to evaluate a culturally appropriate fall prevention program for older Aboriginal people. The Ironbark Program is an on-going, weekly, group-based, strength and balance exercise class with an education component held within Yarning Circles. The program was delivered in 6 communities in NSW over a 6 month period from June 2015. A mixed methods approach was used for evaluation; measures of strength and balance were collected to measure changes in physical outcomes, and participants completed questionnaires and interviews to assess program acceptability. Ninety-eight participants (mean age=64, 71% women) registered for the program; 77 (85%) completed baseline and follow-up measurements. Positive ongoing feedback was received, and attendance was good. On average across all sites, there was significant improvement in participant leg strength (time to complete 5 repetition sit-to-stand: 14 s to 11 s, p<0.01), balance (timed single-leg stance: 5.6 s to 7.8 s, p<0.01) and gait speed (timed 4 meter walk: 0.51 m/s to 0.94 m/s, p<0.01), and a significant decrease in BMI (p<0.01). Participants reported both the exercise and yarning components of the program were enjoyable and valuable. The Ironbark program was effective in improving fall-related measures; funding has now been received for a large scale cluster randomized trial to test its effectiveness in preventing falls. Collaboration between Aboriginal community leaders, Aboriginal health and community service providers facilitated development of a unique, culturally appropriate program that addressed a variety of health, social and cultural needs, translating knowledge into action for positive change.

190 Behind the wheel: driving exposure and participation from a randomised controlled trial program for older drivers

Background We used a randomised controlled trial, with nested process evaluation, to measure the impact of the Behind the Wheel program on driving and community participation of drivers aged 75 years and older in northwest Sydney. Methods Driving exposure/week was measured by continuous in-vehicle monitoring for 12 months. The Keele Assessment of Participation (KAP), self-regulation behaviour profile and depressive symptoms were assessed at 12 months. Using intention-to-treat, generalised estimating equations modelled driving exposure, adjusting for weekly measures and ordinal regression for behaviour profiles. A logic model was built to explain program inputs, outputs and outcomes, based on relationships between process measures (program fidelity, acceptability, dose delivered and received) and program outcomes. Results 380 drivers enrolled (mean age: 80 ± 4 years), 366/380 completed the study. There was no between group difference in distance driven/week over 12-months (−5.5 km, 95% CI: −24.5,13.5 km), or KAP (−0.1, 95% CI: −0.6,0.3). The intervention group were more engaged in self-regulation (OR: 1.6, 95% CI: 1.1,2.3). Older drivers with low-function in the intervention group were three times more likely to report depressive symptoms (OR 3.1, 95% CI: 1.04,9.2). Intervention participants who developed a retirement from driving plan, on average, reduced their total distance driven per week (38 km, 95% CI: −7.5,−68.7 km) and kilometres driven outside of daylight hours per week (7 km, 95% CI: −3.5,−10.4 km). Both understanding of program content (β = 2.1, p = 0.03, 95% CI: 0.2–4.1) and achieving a safe mobility plan (β = 3.3, p = 0.003, 95% CI: 1.2–5.5) were important to engagement in self-regulation. Females were 2.7 times more likely to develop safe mobility plans than men (OR 2.7, 95% CI: 1.1–6.9). Conclusions The program engaged older drivers in self-regulation but this did not translate to reduced mileage. The logic model informs decision making to channel resources to those who will benefit most.

Self-Harm and Risk of Motor Vehicle Crashes in Youth: The Drive Prospective Cohort Study

Background Some crashes, particularly single vehicle crashes, may result from intentional self-harm behaviour but research on this topic is limited. Self-harm is the deliberate injuring of oneself and includes actions such as cutting, attempted hanging and poisoning. This study aimed to assess the risk that intentional self-harm poses for prospective motor vehicle crashes among novice drivers. Methods Questionnaire responses from 20 822 newly licensed drivers aged 17 to 24 were prospectively linked to licensing and police-reported crash data. The mean follow-up was 2 years. Multivariable Poisson regression models were used to investigate the role of recent self-harm on the risk of crash, taking into account potential confounders including driving exposure, duration of sleep, remoteness of residence, socio-economic status, psychological symptoms and substance abuse. Results A total of 871 drivers reported engaging in self-harm in the year before the survey. Self-harm was more common among youth who were women, Australian-born, living in rural areas, driving more per week, sleeping less and using drugs and alcohol. Young people who reported engaging in self-harm behaviour were at significantly increased risk of crash (RR 1.42; 95% CI 1.15 to 1.76 unadjusted; RR 1.37; 95% CI 1.09 to 1.72 adjusted). Interpretation This first and largest ever study of the relationship between self-harm and crash in young drivers found self-harm to be a predictor of subsequent motor vehicle crash, with most crashes involving multiple vehicles.