Studies in safety promotion for preschool children

Abstract: The multifactorial aetiology in childhood injuries indicates a need for a systemic approach in the development of safety promotion strategies. In the present thesis, the feasibility of a systemic approach for the development of safety promotion strategies directed at pre-school children was investigated. In a theoretical paper (I) a system model was outlined and in five empirical papers (II-IV), parts of the model were studied. The framework of Haddon and system models developed within occupational- accident research constituted the point of departure for the elaboration of a system model in paper I. The system model was applied to three common injury situations among pre-school children. A literature review was undertaken in order to describe the importance of potentially modifiable risk factors. Empirical studies where child-, family- and, physical environment risk factors had been quantified by means of relative risks and aetiological fractions were used for the analyses. The model illustrated the multifactorial aetiology in childhood injuries and consequently, a strategy including both active and passive prevention was supported. Safety education is an integral part of most child injury prevention programmes. In the design of safety education, knowledge about the determinants of parental behaviour and their modifiability is crucial. In paper II predictors of parental risk perception was investigated. From this study it was concluded that safety education might increase risk perception in mothers by means of emphasising the involvement of the child in the cause of events leading to an injury. In paper III, risk perception and other potentially modifiable determinants of parental safety behaviour were investigated. Perceived social norms were found to be the most powerful determinants of parental behaviour, and this study indicated that safety promotion programmes should not only use safety education to alter the behaviour of the individual mother, but also aim at changing social norms in society and, thus, take into consideration the societal context in which families live. In the prevention of injuries, injury surveillance is used to feed back information on injuries to receivers at different levels in society. If receivers of injury data shall respond to the feedback by taking preventive measures, the presentation of data must be elaborated in an interpretable way. In paper IV, data from ten local registration systems were compiled and the injury incidence was found to be higher in day-care centres than in the home environment. These data are relevant to incorporate in a feedback system to prevent injuries in day-care centres. In paper V, it was shown that fracture rates in four European regions varied considerably. Fractures constitute a substantial part of all severe injuries in children and can thus serve as an indicator of severe injuries. Furthermore fracture registers have a high validity and are easily accessible, as most persons who have sustained a fracture seek medical care at a hospital. From these papers it was concluded that, as a part of a safety promotion strategy, injury surveillance should be easily accessible, easily interpreted by receivers of information and also maintain a high quality. In paper VI, factors that influence the safety in day-care settings were studied. It was shown that further training of personnel in child safety was a decisive factor in the set-up of the environment from a safety point of view. To offer personnel such further education is a typical decision taken by politicians or civil servants at the municipal level. Thereby, they also constitute receivers of information regarding injury risks in day-care centres. In conclusion, the empirical studies included in this thesis illuminated chains of events that are potentially efficient targets for the promotion of childhood safety and systems thinking illuminated crucial steps in the further development of safety promotion strategies for pre-school children.