Barriers to, and facilitators of, the prevention of unintentional injury in children in the home: a systematic review and synthesis of qualitative research

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Abstract

Background

This review considers barriers to, and facilitators of, success for interventions to reduce unintentional injury to children in the home through supply and/or installation of home safety equipment, and looks at risk assessments.

Methods

A systematic review of qualitative research. Bibliographic databases were searched for studies on interventions to reduce unintentional child injury in the home, or on related attitudes and behaviours. Studies were quality appraised, findings extracted, and a conceptual framework was developed to assess factors affecting the success of interventions.

Results

Nine peer-reviewed journal articles were included. Barriers and facilitators were highlighted at organisational, environmental and personal levels. Effective provision of safety equipment involves ongoing support with installation and maintenance. Take up and success of interventions depends on adjusting interventions according to practical limitations and parents' cultural expectations. A particular barrier was parents' inability to modify rented or shared accommodation.

Conclusions

The review highlights ways in which health inequalities affect the take up and success of home safety interventions, and how health workers can use this knowledge to facilitate future interventions.

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Most cited references 18

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"Medication career" or "moral career"? The two sides of managing antidepressants: a meta-ethnography of patients' experience of antidepressants.

Alice Malpass, Alison Shaw, Debbie Sharp … (2009)

The UK National Institute for Clinical Excellence (NICE) Clinical Guidelines recommend routine prescription of antidepressants for moderate to severe depression. While many patients accept a prescription, one in three do not complete treatment. We carried out a meta-ethnography of published qualitative papers since 1990 whose focus is patients' experience of antidepressant use for depression, in order to understand barriers and facilitators to concordance and inform a larger qualitative study investigating antidepressant use over time. A systematic search of five databases was carried out, supported by hand searches of key journals, writing to first authors and examining reference lists. After piloting three critical appraisal tools, a modified version of the CASP (Critical Appraisal Skills Programme) checklist was used to appraise potentially relevant and qualitative papers. We carried out a synthesis using techniques of meta-ethnography involving translation and re-interpretation. Sixteen papers were included in the meta-ethnography. The papers fall into two related groups: (1) Papers whose focus is the decision-making relationship and the ways patients manage their use of antidepressants, and (2) Papers whose focus is antidepressants' effect on self-concept, ideas of stigma and its management. We found that patients' experience of antidepressants is characterised by the decision-making process and the meaning-making process, conceptualised here as the 'medication career' and 'moral career'. Our synthesis indicates ways in which general practitioners (GPs) can facilitate concordant relationships with patients regarding antidepressant use. First, GPs can enhance the potential for shared decision-making by reviewing patients' changing preferences for involvement in decision-making regularly throughout the patient's 'medication career'. Second, if GPs familiarise themselves with the competing demands that patients may experience at each decision-making juncture, they will be better placed to explore their patients' preferences and concerns--i.e. their 'moral career' of medication use. This may lead to valuable discussion of what taking antidepressants means for patients' sense of self and how their treatment decisions may be influenced by a felt sense of stigma.

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Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care.

Rona Campbell, Pandora Pound, Catherine Pope … (2003)

Interest in how qualitative health research might be used more widely to inform health policy and medical practice is growing. Synthesising findings from individual qualitative studies may be one method but application of conventional systematic review methodology to qualitative research presents significant philosophical and practical challenges. The aim here was to examine the feasibility of synthesising qualitative research using qualitative methodology including a formative evaluation of criteria for assessing the research to be synthesised. Ten qualitative studies of adult patients' perspectives of diabetes were purposefully selected and questions proposed by the critical appraisal skills programme (CASP) adapted and used to assess papers prior to synthesis. Each study was reviewed independently by two experienced social scientists. The level of agreement between reviewers was determined. Three papers were excluded: one because it turned out not to be qualitative research, one because the quality of the empirical work was poor and one because the qualitative findings reported were also recorded in another paper already included. The synthesis, which had two distinct elements, was conducted using the meta-ethnographic method. Firstly, four papers containing typologies of patient responses to diabetes were synthesised. Secondly, six key concepts were identified from all seven papers as being important in enabling a person with diabetes to achieve a balance in their lives and to attain a sense of well-being and control. These included: time and experience, trust in self, a less subservient approach to care providers, strategic non-compliance with medication, effective support from care providers and an acknowledgement that diabetes is serious. None of the studies included in the synthesis referenced any of the early papers nor did they appear to have taken account of or built upon previous findings. This evaluation confirmed that meta-ethnography can lead to a synthesis and extension of qualitative research in a defined field of study. In addition, from it a practical method of qualitative research assessment evolved. This process is promising but requires further testing and evaluation before it could be recommended for more widespread adoption.

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Social deprivation and the prevention of unintentional injury in childhood: a systematic review.

Therese Dowswell, Elizabeth Towner (2002)

There is a known association between social deprivation and risk of death from unintentional injury in childhood. In the UK context, these inequalities do not appear to be decreasing. This paper reports on the findings of a systematic review of the world literature between 1975 and 2000 on the prevention of childhood injuries, with particular reference to social deprivation. Literature was identified via electronic databases, key journals and informants. All papers were read independently by at least two reviewers and information was extracted using a standardized form. Results indicate that of 155 studies identified in the systematic review, 32 addressed the issue of social deprivation. The way social deprivation was defined in different studies varied considerably. The literature was not evenly spread across different injury types and did not reflect the burden of injury. There is a paucity of evidence relating to the prevention of child pedestrian injury. Very few studies examined the impact of interventions in different social groups. Without such evidence, it remains difficult for those involved in health promotion to know how to design and target interventions to address inequalities in child injury rates.

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Author and article information

Journal

Journal ID (nlm-ta): Inj Prev

Journal ID (publisher-id): ip

Journal ID (hwp): injuryprev

Title: Injury Prevention

Publisher: BMJ Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 1353-8047

ISSN (Electronic): 1475-5785

Publication date (Electronic): 21 November 2010

Publication date (Print): April 2011

Publication date PMC-release: 21 November 2010

Volume: 17

Issue: 2

Pages: 119-126

Affiliations

[1 ]Psychology, College of Life and Environmental Sciences, University of Exeter, Washington Singer Laboratories, Exeter, UK

[2 ]Peninsula Medical School, University of Exeter, Exeter, UK

Author notes

Correspondence to Dr Janet Smithson, Psychology, College of Life and Environmental Sciences, University of Exeter, Washington Singer Laboratories, Perry Road, Exeter EX4 4QG, UK; j.smithson@ 123456exeter.ac.uk

Article

Publisher ID: injuryprev26989

DOI: 10.1136/ip.2010.026989

PMC ID: 3184217

PubMed ID: 21097943

SO-VID: f6098c74-f70a-44b2-99f3-e9c13f8e986c

Copyright © © 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

Barriers to, and facilitators of, the prevention of unintentional injury in children in the home: a systematic review and synthesis of qualitative research

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Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 18

"Medication career" or "moral career"? The two sides of managing antidepressants: a meta-ethnography of patients' experience of antidepressants.

Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care.

Social deprivation and the prevention of unintentional injury in childhood: a systematic review.

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