Home safety education and provision of safety equipment for injury prevention

 

Abstract

Background

In industrialised countries injuries are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home, but there is little meta-analytic evidence that child home safety interventions improve a range of safety practices or reduce injury rates and little evidence on their effect by social group.

Objectives

We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment in increasing home safety practices or reducing child injury rates and whether the effect varied by social group.

Search methods

We searched the Cochrane Library, MEDLINE, EMBASE, CINAHL, DARE, ASSIA, Psychinfo and Web of Science, plus a range of relevant web sites, conference proceedings and bibliographies to June 2004. We contacted authors of included studies and surveyed a range of organisations.

Selection criteria

Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, which reported safety practices, possession of safety equipment or injury.

Data collection and analysis

Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneously combined in meta-regressions by social and demographic variables.

Main results

Eighty studies were included; 37 of which were included in at least one meta-analysis. Twenty-three (62%) were RCTs and 12 (32%) included in the meta-analysis provided IPD. Home safety education was effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.35, 95% CI 1.01 to 180), functional smoke alarms (OR 1.85, 95% CI 1.24 to 2.75), storing medicines (OR 1.58, 95% CI 1.18 to 2.13) and cleaning products (OR 1.63, 95% CI 1.22 to 2.17) out of reach, syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) and poison control centre numbers accessible (OR 3.66, 95% CI 1.84 to 7.27), fitted stair gates (1.26, 95% CI 1.05 to 1.51), socket covers on unused sockets (OR 3.73, 95% CI 1.48 to 9.39) and storing sharp objects out of reach (OR 1.52, 95% CI 1.01 to 2.29). There was a lack of evidence that interventions reduced rates of thermal injuries, poisoning or a range of injuries. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury.

Authors' conclusions

Home safety education provided most commonly as one-to-one, face-to-face education, in a clinical setting or at home, especially with the provision of safety equipment is effective in increasing a range of safety practices. There is a lack of evidence regarding its impact on child injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment was less effective in those at greater risk of injury.

 

Plain language summary

Home safety education and providing safety equipment for injury prevention

Injuries are the leading cause of childhood death in industrialised countries. People living in disadvantaged circumstances are at greater risk of injury than those more advantaged. This review examined whether home safety education and providing safety equipment increased safety behaviours and safety equipment use and reduced injuries. It also looked at whether home safety education was more or less effective in families which are disadvantaged. The review authors found 80 studies, which reported many different safety behaviours, but few studies included information on injuries.

The results often varied between studies, but overall families who received home safety education were more likely to have a safe hot tap water temperature, a working smoke alarm, to store medicines, cleaning products and sharp objects out-of-reach, to have fitted stair gates and socket covers on unused sockets and to have syrup of ipecac and poison control centre numbers accessible. The reviewers did not find that home safety education reduced injury rates, but this may have been due to the small number of studies which measured injuries, and more research is needed to answer this question. The reviewers did not find that home safety education was less effective in families whose children were at greater risk of injury.

 

摘要

背景

居家安全教育並提供安全設備以預防受傷

工業化國家中，受傷為兒童死亡的主因且兒童受傷死亡率及發生率存在著明顯的社會階級。學齡前兒童的傷害主要發生在家中，但幾乎沒有統合分析的證據可以說明改善安全範圍的做法或減少傷害率的兒童居家安全介入措施，且沒有關於社會群體效果的證據。

目標

我們評估居家安全教育，且有或沒有提供低成本，折扣或免費的設備用來增加居家安全的做法或減少兒童受傷率的效果，及效果是否會依據社會群體而有不同。

搜尋策略

我們檢索The Cochrane Library，MEDLINE，EMBASE，CINAHL，DARE，ASSIA，Psychinfo 及 Web of Science，以及一些相關的網站，會議紀錄及參考書目。我們聯絡納入研究的作者和調查範圍的機構。

選擇標準

居家安全教育且有或沒有提供安全設備給19歲以下家庭的隨機對照試驗(Randomised controlled trials (RCTs))，非隨機對照試驗及前後對照研究，其報告安全做法，安全設備的財產或受傷狀況。

資料收集與分析

兩名作者分別評估研究品質並摘錄資料。我們嘗試取得所有納入研究中個別研究對象層級的資料並加總資料，且IPD同時合併社會及人口學變項於統合回歸分析。

主要結論

共納入80篇研究；其中37篇被納入至少一項統合分析中。23篇(62%)為RCTs且提供IPD的12篇(32%)研究納入統合分析中。居家安全教育對於增加熱水龍頭水溫安全(OR為1.35，95% CI為1.01至180)，功能煙霧警報器(OR為1.85，95% CI為1.24至2.75)，貯存藥物(OR為1.58，95% CI為1.18至2.13)及伸手不及清潔用品(OR為1.63，95% CI為1.22至2.17)，ipecac糖漿(OR為3.34，95% CI為1.50至7.44)及中毒控制中心號碼的可得性(OR為3.66，95% CI為1.84至7.27)，安裝樓梯安全門(OR為1.26，95% CI為1.05至1.51)，覆蓋未使用的插座(OR為3.73，95% CI為1.48至9.39)及伸手不及儲存尖銳物體(OR為1.52，95% CI為1.01至2.29)的家庭比例是有效的。缺乏證據顯示介入措施會減少熱傷害，中毒或受傷範圍的比率。沒有一致的證據顯示介入措施對於高受傷風險兒童的家庭的效果較少。

作者結論

居家安全教育的提供通常多為在臨床機構或家中一對一，面對面的教育，尤其安全設備對於增加安全範圍的做法是有效的。缺乏關於它對於兒童傷害率影響的證據。沒有一致的證據顯示居家安全教育，且有或沒有提供安全設備對高受傷風險者的效果較少。

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

待增加。