The 'WHO Safe Communities' model for the prevention of injury in whole populations

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Authors


Abstract

Background

The World Health Organization (WHO) 'safe communities' approach to injury prevention has been embraced around the world as a model for co-ordinating community efforts to enhance safety and reduce injury. Approximately 150 communities throughout the world have formal 'Safe Communities' designation. It is of public health interest to determine to what degree the model is successful, and whether it reduces injury rates. This Cochrane Review is an update of a previous published version.

Objectives

To determine the effectiveness of the WHO Safe Communities model to prevent injury in whole populations.

Search methods

Our search included CENTRAL, MEDLINE and EMBASE, PsycINFO, ISI Web of Science: Social Sciences Citation Index (SSCI) and ZETOC. We handsearched selected journals and contacted key people from each WHO Safe Community. The last search was December 2008.

Selection criteria

Two authors independently screened studies for inclusion. Included studies were those conducted within a WHO Safe Community that reported changes in population injury rates within the community compared to a control community.

Data collection and analysis

Two authors independently extracted data. Meta-analysis was not appropriate due to the heterogeneity of the included studies.

Main results

We included evaluations for 21 communities from five countries in two geographical regions in the world: Austria, Sweden and Norway, and Australia and New Zealand. Although positive results were reported for some communities, there was no consistent relationship between being a WHO designated Safe Community and subsequent changes in observed injury rates.

Authors' conclusions

There is marked inconsistency in the results of the studies included in this systematic review. While the frequency of injury in some study communities did reduce following their designation as a WHO Safe Community, there remains insufficient evidence from which to draw definitive conclusions regarding the effectiveness of the model.

The lack of consistency in results may be due to the heterogeneity of the approaches to implementing the model, varying efficacy of activities and strategies, varying intensity of implementation and methodological limitations in evaluations. While all communities included in the review fulfilled the WHO Safe Community criteria, these criteria were too general to prescribe a standardised programme of activity or evaluation methodology.

Adequate documentation describing how various Safe Communities implemented the model was limited, making it unclear which factors affected success. Where a reduction in injury rates was not reported, lack of information makes it difficult to distinguish whether this was due to problems with the model or with the way in which it was implemented.

摘要

背景

預防全人口受傷的“WHO安全社區”模式

世界衛生組織(World Health Organization (WHO))用來預防受傷的“安全社區”方法已被全世界提倡,作為共同整合社區力量以增加安全性並減少受傷的模式。全世界將近有150個社區有正式的“安全社區”名稱。公共衛生關心的是哪一種等級的模式是成功的,以及是否因此而減少受傷率。這篇考科藍回顧更新了先前已發表的文章。

目標

確定WHO安全社區模式對於預防全人口受傷的效果。

搜尋策略

我們檢索包括CENTRAL,MEDLINE及EMBASE,PsycINFO,ISI Web of Science:Social Sciences Citation Index (SSCI)及ZETOC。我們人工檢索特定的期刊並連絡每個WHO安全社區的主要人員。最近的檢索是在2008年12月。

選擇標準

兩名作者分別獨立篩選研究以納入本篇回顧。納入WHO安全社區的研究,報告安全社區與對照社區內人口受傷率的改變。

資料收集與分析

兩名作者分別摘錄資料。由於納入研究的異質性,因此不適合進行統合分析。

主要結論

我們納入全球兩個地理區域的五個國家的21個社區:奧地利,瑞典與挪威,及澳洲與紐西蘭。雖然對於某些社區有正向的結果,但WHO規劃的安全社區與後續觀察受傷率的改變之間沒有一致的關係。

作者結論

這篇系統性回顧納入的研究結果很明顯不一致。某些研究社區在被指定為WHO安全社區後其受傷頻率確實有減少,但仍然缺乏足夠的證據證明模式效果的最終結論。結果缺少一致性也許是因為執行模式的方法的異質性,活動與策略的效益不同,執行的密集度不同與方法學上的限制。當完全符合WHO安全社區標準的所有社區納入回顧時,由於這些標準太過於普通,以致於無法規定一個標準化的活動或評估方法學的計畫。足夠的文件描述了各種安全社區執行模式是如何受到限制,因此不清楚何種因素會影響計畫成功。沒有報告何處的受傷率有減少,由於缺少資訊使得辨別這是因為模式或執行方式的問題而變的困難。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

世界衛生組織(WHO)的安全社區宣言說明“全人類應有獲得健康與安全的相同權利”。安全社區方法的重點是在於合作,夥伴關係與社區建設的能力,以減少受傷的發生率並促進受傷減少的行為。全世界將近150個社區已被規劃為“安全社區”,國家多如瑞典,澳洲,中國,南非與捷克共合國。計畫主要針對高危險的族群或環境並促進弱勢族群的安全。包括從瑞典促進自行車騎士配戴安全帽到南非的反對暴力計畫,南韓的交通安全提倡與紐西蘭的原住民社區受傷預防計畫。回顧的作者確定了只有21個安全社區被作為評估控制受傷結果的對象。這些社區是來自兩個地理區域:奧地利,瑞典與挪威的歐洲國家,及澳洲與紐西蘭的太平洋國家,相較於世界其他地理區域,這兩者皆有相對的經濟福利,較高的健康標準與較低的受傷率。雖然某些社區的受傷率有正向減少,但整體的結果大不相同,且是否採用安全社區模式可以導向顯著減少受傷率的問題仍未提供明確的答案。關於計畫如何被執行,它們對受傷危險因素的影響與持續性只能獲得有限的資訊。而且大部分納入的評估其方法學也有很多限制。沒有獲得世界其他地區的評估,尤其是那些經濟與健康標準較差的國家。

Plain language summary

The 'WHO Safe Communities' model for the prevention of injury in whole populations

The World Health Organization (WHO) Manifesto for Safe Communities states that "All human beings have an equal right to health and safety". The emphasis of the Safe Communities approach is on collaboration, partnership and community capacity building to reduce the incidence of injury and promote injury-reducing behaviours. Approximately 150 communities throughout the world have been designated as 'Safe Communities', in countries as diverse as Sweden, Australia, China, South Africa and the Czech Republic. Programmes target high-risk groups or environments and promote safety for vulnerable groups. They range from bicycle helmet promotion in Sweden to anti-violence programmes in South Africa, traffic safety initiatives in South Korea and indigenous community injury prevention programmes in New Zealand.

The review authors identified that only 21 of the Safe Communities have been the subject of controlled injury outcome evaluations. These communities are from two geographical regions: the European countries of Austria, Sweden and Norway and the Pacific nations of Australia and New Zealand, both of which have relative economic wealth, higher health standards and lower injury rates than many other parts of the world. Although positive injury rate reductions were reported for some communities, the overall results varied substantially and overall do not provide a clear answer to the question of whether the adoption of the Safe Communities model leads to a significant reduction in injury. Limited information is available about how the programmes were implemented, their impact on injury risk factors and sustainability. There were also substantial methodology limitations associated with most of the included evaluations. No evaluations were available from other parts of the world, particularly those with lower economic and health standards.

Laienverständliche Zusammenfassung

Das "WHO Sichere Gemeinden" Modell zur Verhinderung von Verletzung in gesamten Populationen

Im Manifest der Weltgesundheitsorganisation (WHO) für Sichere Gemeinden heißt es, dass "alle Menschen das gleiche Recht auf Gesundheit und Sicherheit haben." Der Schwerpunkt des Konzeptes für sichere Gemeinden liegt auf Zusammenarbeit, Partnerschaft und Aufbau von Kapazitäten in den Gemeinden, um die Inzidenz von Verletzung zu vermindern und verletzungsminderndes Verhalten zu fördern. Rund 150 Gemeinden weltweit wurden als "Sichere Gemeinden" bezeichnet, in so unterschiedlichen Ländern wie Schweden, Australien, China, Südafrika und der Tschechischen Republik. Programme visieren besonders gefährdete Gruppen oder Umgebungen an und fördern die Sicherheit für gefährdete Gruppen. Sie reichen von der Förderung von Fahrradhelmen in Schweden bis hin zu Anti-Gewalt-Programmen in Südafrika, Verkehrssicherheitsinitiativen in Südkorea und Programmen zur Verhinderung der Verletzung von indigenen Gemeinden in Neuseeland.

Die Review-Autoren identifizierten, dass nur 21 der sicheren Gemeinden Gegenstand kontrollierter Beurteilungen mit dem Endpunkt Verletzung waren. Diese Gemeinden stammen von zwei geographischen Regionen: den europäischen Ländern Österreich, Schweden und Norwegen und den pazifischen Nationen Australien und Neuseeland, beide mit relativem wirtschaftlichen Wohlstand, höheren Gesundheitsstandards und niedrigeren Verletzungsraten im Vergleich zu vielen anderen Teilen der Welt. Obwohl für manche Gemeinden positive Verminderungen der Verletzungsrate berichtet wurden, variierten die Gesamtergebnisse erheblich und geben insgesamt keine klare Antwort auf die Frage, ob die Annahme des Modells der sicheren Gemeinden zu einer signifikanten Verminderung an Verletzungen führt. Eingeschränkte Informationen sind verfügbar darüber, wie die Programme umgesetzt wurden, über ihren Einfluss auf Risikofaktoren für Verletzungen und Nachhaltigkeit. Es waren auch erhebliche methodische Einschränkungen mit den meisten der eingeschlossenen Beurteilungen assoziiert. Es waren keine Beurteilungen von anderen Teilen der Welt verfügbar, insbesondere von denen mit niedrigeren wirtschaftlichen - und Gesundheitsstandards.

Anmerkungen zur Übersetzung

C. Zollbrecht, freigegeben durch Cochrane Deutschland.

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