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School‐based education programmes for the prevention of unintentional injuries in children and young people

Cochrane database of systematic reviews, 2016-12, Vol.2017 (7), p.CD010246-CD010246 [Peer Reviewed Journal]

Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. ;EISSN: 1465-1858 ;EISSN: 1469-493X ;DOI: 10.1002/14651858.CD010246.pub2 ;PMID: 28026877

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  • Title:
    School‐based education programmes for the prevention of unintentional injuries in children and young people
  • Author: Orton, Elizabeth ; Whitehead, Jessica ; Mhizha‐Murira, Jacqueline ; Clarkson, Mandy ; Watson, Michael C ; Mulvaney, Caroline A ; Staniforth, Joy UL ; Bhuchar, Munish ; Kendrick, Denise ; Orton, Elizabeth
  • Subjects: Accident Prevention ; Accident Prevention - methods ; Accidents, Traffic ; Accidents, Traffic - prevention & control ; Adolescent ; Agriculture ; Athletic Injuries ; Athletic Injuries - prevention & control ; Child ; Child health ; Child, Preschool ; Controlled Before-After Studies ; Cost-Benefit Analysis ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Injury prevention ; Male ; Medicine General & Introductory Medical Sciences ; Orthopaedics & trauma ; Other ; Other injury prevention ; Prevention of injuries ; Primary Prevention ; Primary Prevention - economics ; Primary Prevention - education ; Program Evaluation ; Public health ; Randomized Controlled Trials as Topic ; Safety ; School Health Services ; Schools ; Secondary Prevention ; Secondary Prevention - economics ; Secondary Prevention - education ; Wounds and Injuries ; Wounds and Injuries - epidemiology ; Wounds and Injuries - prevention & control
  • Is Part Of: Cochrane database of systematic reviews, 2016-12, Vol.2017 (7), p.CD010246-CD010246
  • Description: Background Unintentional injuries are the leading cause of death in children aged four to 18 years and are a major cause of ill health. The school setting offers the opportunity to deliver preventive interventions to a large number of children and has been used to address a range of public health problems. However, the effectiveness of the school setting for the prevention of different injury mechanisms in school‐aged children is not well understood. Objectives To assess the effects of school‐based educational programmes for the prevention of injuries in children and evaluate their impact on improving children's safety skills, behaviour and practices, and knowledge, and assess their cost‐effectiveness. Search methods We ran searches on the following electronic databases to 26 June 2015: PsycINFO, British Education Index (BEI), Education Resources Information Center (ERIC), Applied Social Sciences Index and s (ASSIA), International Bibliography of the Social Sciences (IBSS), Sociological s; Latin America and the Caribbean database (LILACS), together with several sources of grey literature. The Cochrane Injuries Information Specialist ran searches, to August 2013, on the Groups Specialised Register (SR‐INJ), the Cochrane Central Register of Controlled Trials (CENTRAL) and other Cochrane Library databases, Ovid MEDLINE, Embase, CINAHL and the ISI Web of Science. In keeping with Cochrane standards, along with Cochrane Injuries' Information Specialist we ran an update search prior to publication (September and October 2016). We have screened the results and placed any relevant studies in the Characteristics of studies awaiting classification section of this review.These will be incorporated in the next version of this review, as appropriate. Selection criteria We included randomised controlled trials (RCTs), non‐randomised controlled trials (non‐RCTs), and controlled before‐and‐after (CBA) studies that evaluated school‐based educational programmes aimed at preventing a range of injury mechanisms. The primary outcome was self‐reported or medically attended unintentional (or unspecified intent) injuries and secondary outcomes were observed safety skills, observed behaviour, self‐reported behaviour and safety practices, safety knowledge, and health economic outcomes. The control groups received no intervention, a delayed injury‐prevention intervention or alternative school‐based curricular activities. We included studies that aimed interventions at primary or secondary prevention of injuries from more than one injury mechanism and were delivered, in part or in full, in schools catering for children aged four to 18 years. Data collection and analysis We used standard methodological procedures expected by Cochrane. Two review authors identified relevant trials from title and s of studies identified in searches and two review authors extracted data from the included studies and assessed risk of bias. We grouped different types of interventions according to the outcome assessed and the injury mechanism targeted. Where data permitted, we performed random‐effects meta‐analyses to provide a summary of results across studies. Main results The review included 27 studies reported in 30 articles. The studies had 73,557 participants with 12 studies from the US; four from China; two from each of Australia, Canada, the Netherlands and the UK; and one from each of Israel, Greece and Brazil. Thirteen studies were RCTs, six were non‐RCTs and eight were CBAs. Of the included studies, 18 provided some element of the intervention in children aged four to 11 years, 17 studies included children aged 11 to 14 years and nine studies included children aged 14 to 18 years. The overall quality of the results was poor, with the all studies assessed as being at high or unclear risks of bias across multiple domains, and varied interventions and data collection methods employed. Interventions comprised information‐giving, peer education or were multi‐component. Seven studies reported the primary outcome of injury occurrence and only three of these were similar enough to combine in a meta‐analysis, with a pooled incidence rate ratio of 0.73 (95% confidence interval (CI) 0.49 to 1.08; 2073 children) and substantial statistical heterogeneity (I2 = 63%). However, this body of evidence was low certainty, due to concerns over this heterogeneity (inconsistency) and imprecision. This heterogeneity may be explained by the non‐RCT study design of one of the studies, as a sensitivity analysis with this study removed found stronger evidence of an effect and no heterogeneity (I2 = 0%). Two studies report an improvement in safety skills in the intervention group. Likewise, the four studies measuring observed safety behaviour reported an improvement in the intervention group relative to the control. Thirteen out of 19 studies describing self‐reported behaviour and safety practices showed improvements, and of the 21 studies assessing changes in safety knowledge, 19 reported an improvement in at least one question domain in the intervention compared to the control group. However, we were unable to pool data for our secondary outcomes, so our conclusions were limited, as they were drawn from highly diverse single studies and the body of evidence was low (safety skills) or very low (behaviour, safety knowledge) certainty. Only one study reported intervention costs but did not undertake a full economic evaluation (very low certainty evidence). Authors' conclusions There is insufficient evidence to determine whether school‐based educational programmes can prevent unintentional injuries. More high‐quality studies are needed to evaluate the impact of educational programmes on injury occurrence. There is some weak evidence that such programmes improve safety skills, behaviour/practices and knowledge, although the evidence was of low or very low quality certainty. We found insufficient economic studies to assess cost‐effectiveness.
  • Publisher: Chichester, UK: John Wiley & Sons, Ltd
  • Language: English
  • Identifier: EISSN: 1465-1858
    EISSN: 1469-493X
    DOI: 10.1002/14651858.CD010246.pub2
    PMID: 28026877
  • Source: MEDLINE
    Alma/SFX Local Collection
    Cochrane Library (Open Aceess)
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