A randomised safety promotion intervention trial among low-income families with toddlers

Abstract

Background Toddler-aged children are vulnerable to unintentional injuries, especially those in low-income families. Objective To examine the effectiveness of an intervention grounded in social cognitive theory (SCT) on the reduction of home safety problems among low-income families with toddlers. Methods 277 low-income mother–toddler dyads were randomised into a safety promotion intervention (n=91) or an attention-control group (n=186). Mothers in the safety promotion intervention group received an eight-session, group-delivered safety intervention targeting fire prevention, fall prevention, poison control and car seat use, through health education, goal-setting and social support. Data collectors observed participants’ homes and completed a nine-item checklist of home safety problems at study enrolment (baseline), 6 and 12 months after baseline. A total score was summed, with high scores indicating more problems. Linear mixed models compared the changes over time in home safety problems between intervention and control groups. Results The intent-to-treat analysis indicated that the safety promotion intervention group significantly reduced safety problems to a greater degree than the attention-control group at the 12-month follow-up (between-group difference in change over time (β=−0.54, 95% CI −0.05 to −1.03, p=0.035), with no significant differences at the 6-month follow-up. Conclusions A safety promotion intervention built on principles of SCT has the potential to promote toddlers’ home safety environment. Future studies should examine additional strategies to determine whether better penetration/compliance can produce more clinically important improvement in home safety practices.

Effectiveness of home fire safety interventions. A systematic review and meta-analysis

“…Study size ranged from 76 to 499 participants. Trials were conducted in Canada, USA and UK [18–20, 22–26]. Only two out of the eight trials were registered in a clinical trials register [20,22].…”

“…Trials were conducted in Canada, USA and UK [18–20, 22–26]. Only two out of the eight trials were registered in a clinical trials register [20,22]. In addition, three trials did not include statements on sources of funding or potential sources of conflicts of interest [24–26].…”

“…Performance bias (lack of or inadequate blinding of participants who could influence how interventions, including co-interventions are performed/administered) was rated at high risk in all the included trials (n = 8) [18–20, 22–26]. Detection bias [18, 22–25] (lack of or inadequate blinding of participants who could influence the measurement or interpretation of outcomes) and attrition bias [20, 22–24, 26] were rated at high risk in five trials. Selection bias [18–28, 23–25] and selective reporting bias [18–19, 23–26] (significant or imbalanced missing outcome data) were rated at high risk in six trials.…”

“…Among the eligible RCTs, four recruited parents/caregivers of children [20–23,26], three included primary school children [18–19, 24], and one recruited adult participants [25]. Among the eligible prospective cohort studies, one included school children [21], and the one recruited adult participant [27].…”

“…Home fire safety knowledge was assessed in 7 RCTs and 2 prospective cohort studies [18–19, 22–26]. Home fire safety behaviour was examined in 6 RCTs [18–20, 22–23, 25]. The follow-up period ranged from immediate to 12 months post-intervention.…”