Randomized studies carried out at the household
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Swart,1919 Swart L, van Niekerk A, Seedat M, Jordaan E. Paraprofessional home visitation program to prevent childhood unintentional injuries in low-income communities: a cluster randomized controlled trial. Inj Prev. 2008;14:164-169. 2008; South Africa |
To evaluate the effectiveness of the Home Visiting Program (HVP) in the reduction of household risks for injuries related to burns, intoxications, and falls in children aged ≤10 years. |
IG received safety devices (safety locks and paraffin container caps) with demonstrations on how to use each one. Four visits were carried out by trained professionals to instruct parents/caregivers on the prevention of specific traumatic injuries, such as burns (by paraffin and electric), intoxications/poisonings, and falls, as well as to perform home inspections to identify sources of risk for the assessed injuries. |
The CG received the visit at the baseline and at the outcome evaluation, when the same devices that the IG received were delivered. |
Households visited = 731 Eligible = 515 Participated = 410 Lost = 33 Completed the study = 377 (189 from IG and 188 from CG) |
Reductions were observed for the risks of traumatic injuries related to safety practices for burns. At the baseline, IG showed a mean of 3.4 risks and after the intervention, this mean value decreased to 2.5 (p-value = 0.02). |
Odendaal,2020 Odendaal W, van Niekerk A, Jordaan E, Seedat M. The impact of a home visitation programme on household hazards associated with unintentional childhood injuries: a randomised controlled trial. Accid Anal Prev. 2009;41:183-190. 2009; South Africa |
To evaluate the effectiveness of the Home Visiting Program (HVP) in a community with similar socioeconomic characteristics as the Swart study (2008),2020 Odendaal W, van Niekerk A, Jordaan E, Seedat M. The impact of a home visitation programme on household hazards associated with unintentional childhood injuries: a randomised controlled trial. Accid Anal Prev. 2009;41:183-190. verifying whether there was a decrease in the household risks associated with burns, intoxication, and falls. |
Visit 1 (Assessment of child development): Caregivers were provided with information on child development stages, household hazards, and emergency treatment for traumatic injuries; Visit 2 (Assessment of burn risks): caregivers received information about the risks for burns at home; Visit 3 (Assessment of intoxication and poisoning hazards): information on the risk of intoxication and poisoning at home was passed on to the caregivers; Visit 4 (Assessment of falls hazards): Families received a first aid kit. |
There were no visits. |
Eligible households = 391 Visited = 265 Excluded = 54 Randomized = 211 (99 CG and 112 IG) Completed the study = 91 CG and 101 IG |
A reduction in the risks associated with the use of electrical appliances and paraffin (candles?) was observed, as well as those related to poisoning. Differences were observed for total burns between IG (mean = 12.4) and CG (mean = 14.3) and poisonings (IG mean = 2.0 and CG mean = 4.0). |
Phelan,1313 Phelan K, Khoury J, Xu Y, Liddy S, Hornung R, Lanphear B. A randomized controlled trial of home injury hazard reduction: the HOME injury study. Arch Pediatr Adolesc Med. 2011;165:339-345. 2011; USA |
To test the efficacy of safety devices installed at home to reduce risks related to traumatic injuries in childhood. |
Subjects received instructions based on the The Injury Prevention Program of the American Academy of Pediatrics. During a home visit, interviewers showed safety products to the families. After this stage, the interviewers installed all safety products when the family agreed. |
Subjects received only general information about child development provided by the American Academy of Pediatrics on the Injury Prevention Program. |
Eligible = 1,263 Baseline = 413 Randomized = 355 (181 IG and 174 CG) Completed the study = 167 IG families and 159 CG families. |
Risks for traumatic injuries decreased in the households of the IG, but not in the controls between the 12th and 24th months of the study. At the 12-month visit, the same risks decreased by 15% in IG when compared with CG. At 24 months, only the mean number of hazards remained significant in the IG. The rate of injuries treated by health professionals at the end of the study was reduced by 2.3/100 children in the IG and 7.7/100 children in the CG. |
Babul,1515 Babul S, Olsen L, Janssen P, McIntee P, Raina P. A randomized trial to assess the effectiveness of an infant home safety programme. Int J Inj Contr Saf Promot. 2007;14:109-17. 2007; Canada |
To test the efficacy of the safety kit intervention to promote parental safety behaviors and reduce childhood traumatic injuries. |
Both groups received: (1) Safety kit + a home visit: walking around the house and identifying potential risks; when the latter were identified, parents were taught to remove or modify them (2) Safety kit only: no home visit. * Kit contents: smoke alarm, 50% discount for a safety gate, table corner guards, cabinet locks, and bearings for loose cables. |
Received the standard service offered by the health unit for families with newborns (growth assessment, information and advice on feeding, child development, and vaccination). |
811 parents were eligible; of these, 600 agreed to participate in the study. 483 parents (80.5%) completed the questionnaires in the three follow-up periods. |
Of the 14 safety behaviors, an increase in the rate of use was observed for two of them among the parents of the IG. In the IG that received only the safety kit, 69.3% reported being careful regarding the water temperature. vs. 53.7% in the CG (OR = 2.21 95% CI: 1.32–3.69). In the IG that received a safety kit + home visit, both at the six-month visit (OR = 2.25 and 95% CI: 1.37–3.71) and at the 12-month visit (OR = 2.6 and 95%CI: 1.57–4.46), an increase in care related to water temperature was observed. |
Randomized studies carried out in healthcare services
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Pless,1717 Pless I, Hagel B, Patel H, Leduc D, Magdalinos H. Preventing product-related injuries - a randomized controlled trial of poster alerts. Can J Public Health. 2007;98:271-275. 2007; Canada |
To determine how much posters in physicians’ offices alert parents to the dangers associated with strings or cords (strangulation) and whether changes in behavior occur when they are alerted. Assess the parents’ knowledge of the “Health Canada” site and document other sources of information on safety. |
Intervention week: two posters were placed in the waiting rooms of the physicians’ offices (one on the dangers of curtain ropes and the other on garment strings) about the risk of strangulation. |
Control week: no procedure was done. |
Selected medical practices = 115 Refusals = 28 Did not respond = 64 Total number of participating medical practices = 23 Selected parents = 1188 Parents who agreed to participate = 940 Interviewed parents = 808 |
No differences were observed between the changes reported in poster-related behaviors. Even after adjusting for the socioeconomic level, no differences were found. None of the parents mentioned the posters, websites, or pediatricians as the main source of information on dangerous products. |
Gielen,1212 Gielen A, McKenzie L, McDonald E, Shields W, Wang M, Cheng Y, et al. Using a computer kiosk to promote child safety: results of a randomized, controlled trial in an urban pediatric emergency department. Pediatrics. 2007;120:330-9. 2007; United States |
To evaluate a theory based on an intervention called “Safety in seconds,” providing parents with knowledge about child safety, use of the car seat, smoke alarm, and storage of products that cause poisoning. |
A questionnaire with 10 to 12 items, which assess child safety, was implemented on a computer in a kiosk. Based on the parents’ responses, a report was printed and delivered with safety information. The report contained the child's name, ethnicity, and age, and was adapted to the parents’ profile. Parents with good safety behavior were given incentives in the report. |
Subjects answered a questionnaire, with the same duration of the IG, on overall demographic and child health issues. At the end of the tool, they received printed information about the family's behavioral profile, identified with the child's name. |
Eligible parents = 1412 Excluded = 239 Refusals = 201 Losses = 69 Interviewees = 901 (448 in the IG and 453 in the CG). |
The subjects in the IG group had a higher knowledge score, which were related to smoke alarms (mean = 82.5 ± 23.6) and to toxic product storage (mean = 81.2 ± 21.6), as well as a higher total score = 72.6 ± 13.9). |
Nansel,1414 Nansel T, Weaver N, Jacobsen H, Glasheen C, Kreuter M. Preventing unintentional pediatric injuries: a tailored intervention for parents and providers. Health Educ Res. 2008;:656-669. 2008; United States |
To evaluate the effectiveness of information transmission on traumatic injury prevention to parents and to parents and physicians regarding the implementation of safety practices (age-appropriate behaviors and devices recommended by the American Academy of Pediatricians). |
Subjects received personalized information (with the child's name) aimed at the prevention of traumatic injuries to parents (T-IPI), as well as material for the children. They also received motivational messages about safety practices. Information given to parents plus personalized supplemental material with additional information (T-IPI + P): the abovementioned information and one page including charts with traumatic injury risk scores for each of the six addressed areas. The interviewers encouraged parents and reinforced their importance in behavior changes. |
Generic injury prevention information given to parents (G-IPI) according to the child's age. |
Invited parents = 892 Accepted = 601 Completed the baseline questionnaire = 594. Group G-IPI: n = 98 (90 losses) Group T-IPI: n = 107 (85 losses) Group T-IPI + P: n = 100 (121 losses). |
Parents who received T-IPI or T-IPI + P were more likely to report the use of preventive behaviors for new traumatic injuries than those in the G-IPI group (T-IPI = 48.6%; T-IPI + P = 45.0%, G-IPI = 31.6%); these effects were higher in parents with higher educational level. |
Cheraghi,2525 Cheraghi P, Poorolajal J, Hazavehi S, Rezapur-Shahkolai F. Effect of educating mothers on injury prevention among children aged < 5 years using the Health Belief Model: a randomized controlled trial. Public Health. 2014;128:825-830. 2014; Iran |
To evaluate the effect of the Health Belief Model (HBM) related to education on maternal knowledge, attitudes, and practices to increase safety and prevention of traumatic injuries in children under 5 years of age, focusing on prognostic factors and safety behaviors. |
One-hour sessions were held two times/week. The focus of the sessions were the factors present at home that affected maternal practices and knowledge, as well as the perception of severity, barriers, cues for action, and self-efficacy on child safety. The sessions consisted of presentations with drawings and images and, in the end, a discussion occurred. |
The authors did not mention what was done in the control group. |
Participants = 120 Refusals = 9 |
The mean difference in knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues for action, self-efficacy, and practices after the intervention between the two groups were 3.98, 3.57, 3.97, 1.57, −7.08, 0.82, 2.95, and 2.47, respectively. |
Van Beelen,2424 van Beelen M, Beirens T, den Hertog P, van Beeck E, Raat H. Effectiveness of web-based tailored advice on parents’ child safety behaviors: randomized controlled trial. J Med Internet Res. 2014;16:e17. 2014; The Netherlands |
Assess the effect of the E-Health4Uth Home Safety Program on parents’ safety behaviors regarding prevention of falls, poisoning, drowning and burns. |
They received the usual care of newborn care clinics and, in addition, a username and password to access a website and answer questions about safety behaviors regarding prevention of falls, poisoning, drownings, and burns. On the following visit to the clinic, the parents had the opportunity to discuss the internet approach with a healthcare professional. |
They received the usual care at the newborn care clinic with the usual health information |
Baseline = 1409 Completed follow-up = 1292 (687 from CG and 696 from IG) |
The GI was less likely to have unsafe behaviors, when compared with the CG regarding: stored cleaning products (30.33% vs. 39.91%, OR = 0.67, 95% CI: 0.53–0.85); water temperature of the child's bath (23.46% vs. 32.25%, OR = 0.65, 95% CI: 0.51–0.84); ingestion of hot liquids (34.84% vs. 41.73%, OR = 0.76, 95%CI: 0.61–0.96); and access to stoves (79.34% vs. 85.27%, OR = 0.67, 95% CI: 0.50–0.90). |
Randomized studies carried out in schools
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Kendrick,2121 Kendrick D, Groom L, Stewart J, Watson M, Mulvaney C, Casterton R. “Risk Watch”: cluster randomised controlled trial evaluating an injury prevention program. Inj Prev. 2007;13:U8-U93. 2007; England |
To evaluate the efficacy of the Risk Watch program on the increase in safety knowledge, skills, and self-reported safety behavior. |
Teachers, trained by firefighters, delivered Risk Watch leaflets (specific to each age group) with a brief introduction, lessons and activities for their students. Each leaflet covered eight topics, four of which were chosen for evaluation (bicycle and pedestrian safety, falls, intoxications/poisonings, fire and burns). They also offered “Risky Boxes” with extra materials for the lessons. |
The GC schools also participated in the same program, but in a period after the IG. |
Selected schools = 22 Refusals = 2 In total, 20 schools and 459 children (7–10 years old) participated in the trial. |
The IG children correctly answered more questions about fire and burn prevention knowledge than those of the CG (difference between averages = 7.0%, 95% CI: 1.5–12.6%). IG children were more prone to show correct actions in case of fire, regarding clothing and use of helmets (difference between averages = 35.3%, 95% CI: 22.7–47.9% and 6.3%, 95% CI: 1.4–11.1%, respectively). They were also more prone to show correct actions in case of fire at home and when finding medications (OR = 2.80; 95% CI: 1.08–7.22 and OR = 3.50 95% CI: 1.18–10.38, respectively). |
Morrongiello,1818 Morrongiello B, Matheis S. Addressing the issue of falls off playground equipment: an empirically-based intervention to reduce fall-risk behaviors on playgrounds. J Pediatr Psychol. 2007;32:819-830. 2007; Canada |
To evaluate the impact of an intervention to reduce risk behaviors regarding falls in playgrounds, in children aged 6–10 years. |
There were three intervention sessions: Session 1: colored pictures were shown to the children, with child actors performing two of each of the risk behaviors (moderate and high risk), who had received training on how to perform the assessed behaviors before being photographed. Six photos were produced for each equipment (two without risk, two moderate, and two high risk), comprising a set of 24 pictures to create posters. Session 2: Videos with children playing in the playground equipment and generating falls were shown to the children participating in the study. Session 3: The posters made in Session 1 were shown and children were allowed to change and decorate the pictures; it was also recalled that they would have to go to the playground once again and perform the behaviors. |
Subjects underwent only sessions 1 and 3. |
GI = 191 GC = 67 |
A decrease in the risk behaviors was observed in the IG when compared with the CG, mainly regarding those of medium and high risk (mean = 1.04 and 1.49, SD ± 1.89 and ±2.50, respectively, p-value <0.001). |
Non-randomized studies carried out at the household
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Cagle,1111 Cagle K, Davis J, Dominic W, Gonzales W. Results of a focused scald-prevention program. J Burn Care Res. 2006;27:859-863. 2006; United States |
To evaluate the efficacy of the intervention program called “Children Safe at Home Project” |
Participants attended 1-to-2-hour lectures on scalding burns, using pictures and images. Afterwards, a discussion was held on how to prevent scalding burns at home. A bingo game about home safety and a game of scoring the risks at home were applied to parents. At the end of the lectures, parents were given a refrigerator magnet with preventive measures for burns and burn treatment. At the first home visit, anti-scalding burn devices were installed. |
None. |
Selected = 900 Accepted to participate in the study = 173 Completed the study = 62 |
The initial study visit disclosed an average of seven (SD ± 2) scalding burn risks per household. During the follow-up period, this average decreased to two (SD ± 1). Anti-scalding burn devices were installed in 37 homes and remained in 60% of households. Prior to the program, the admission rate in hospitals for burns among children aged 0–5 years was 137/100,000 and, after the program, it decreased to 59/100,000. No new scalding burns were observed in the houses that participated in the program. |
Carlsson,2222 Carlsson A, Bramhagen A, Jansson A, Dykes A. Precautions taken by mothers to prevent burn and scald injuries to young children at home: an intervention study. Scan J Public Health. 2011;39:471-478. 2011; Sweden |
To investigate to what extent information given to mothers individually in low educational settings can improve precautions (taken by mothers) to prevent burns involving young children at home and compare with a group of mothers who did not receive any information. |
Mothers were invited to participate in workshops with other mothers. The workshops focused on discussing how to prevent traumatic injuries caused by scalding and burns incidents at home. Mothers were led to reflect on precautions in descending order of risk. Later, the mothers received a single home visit to teach them about prevention of childhood injuries at home. |
Did not participate in the workshops, but received the home visit. |
Agreed to participate = 100 (50 in IG and 49 in the CG (1 loss)
At the end, 39 individuals from IG and 31 from the CG remained. |
The results showed that the intervention had an impact on the improvement among the participating mothers’ precautions against burns related to stove protection and stove fixation to the floor (OR = 3.08, 95% CI: 1.1–8.7 and OR = 2.3, 95% CI: 0.8–6.6, respectively) in relation to the CG. |
Jetten,2323 Jetten P, Chamania S, van Tulder M. Evaluation of a community-based prevention program for domestic burns of young children in India. Burns. 2011;37:139-144. 2011; India |
To measure the efficacy and use of the burn prevention program among young children in Indore, India. |
Information film, which was delivered to the families after the intervention. A playpen was given to families who lived in a single room and cooked in it and a baby safety gate was given to those who had rooms separate from the kitchen. |
None. |
Participated in the study = 42 families Losses = 8 Included in the analysis = 34 |
A decrease in burns was reported: 18 burns occurred before the intervention and after, only two. Home hazard situations also decreased. |
Stewart,1616 Stewart T, Clark A, Gilliland J, Miller M, Edwards J, Haidar T, et al. Home safe home: evaluation of a childhood home safety program. J Trauma Acute Care Surg. 2016;81:533-540. 2016; Canada |
To evaluate the Home Safety Program (HSP) for injury prevention in children up to 2 years of age. |
The intervention consisted of delivering a kit with ninve safety products to parents, a checklist for parents to evaluate their home, and a video entitled: “Give your child a safe start.” |
No controls were mentioned. |
Invited parents = 3458 Answered the questionnaire = 696 |
81% of the parents considered the electrical outlet plugs as being the most useful product in the kit, followed by water thermometers. 95% used measures to reduce risks. The most common risks reported were electrical outlets, followed by stairs, cabinets, and drawers. |