This Much Water: a qualitative study using behavioural theory to develop a community service video to prevent child drowning in Western Australia

Caregiver water safety knowledge and views of toddler water competency

BACKGROUND

Drowning is the leading cause of death for toddlers. When caregivers are knowledgeable about water safety, they can provide the best protection against drowning. The aim of this study is to survey caregivers of toddlers to better understand factors associated with water safety knowledge, attitudes about pool supervision, and toddler water competency skills.

METHODS

An online survey of 650 parents/caregivers of 1-4-year-old toddlers asked about the caregiver's water safety and swimming background and views on pool supervision. Surveys included a true/false section of ten basic water safety knowledge questions. Caregivers also reported on toddler swim lesson history and whether their toddler could perform six standard water competency skills. Linear regression identified factors predictive of water safety knowledge.

RESULTS

On average, caregivers selected the correct answer on six out of ten water safety knowledge questions. Water safety knowledge was predicted by the relationship of the caregiver to the toddler, gender, race, education, prior CPR training, caregiver swim capability, and reported pool supervision style. On average, caregivers reported that their toddler could perform half of the water competency skills. The majority of the toddlers had taken swimming lessons. One third of caregivers believed that after a toddler has had swimming lessons, they don't need to be watched as closely when they are in a pool.

CONCLUSIONS

Findings suggest that water safety knowledge is poor and that there are misconceptions about toddler supervision needs. Efforts are needed to improve water safety knowledge and to change perceptions about supervision among caregivers of toddlers.

Exploring parental risk perception regarding childhood unintentional home injuries: A cross-sectional study

INTRODUCTION

While previous studies on childhood injury focused mainly on the relationship between parents' preventive behavior and its determinants, knowledge about parental risk perception that can help to develop, implement, and evaluate successful interventions to prevent childhood unintentional home injuries is still limited. The aim of this study was to gain a deeper understanding of parental risk perception regarding unintentional home injuries of children under six years of age.

METHOD

A convenience sample of 469 parents, residing in Germany, completed a web-based questionnaire assessing factors potentially associated with parental risk perception on the child, parental, and environmental level. Descriptive statistics, p for trend, and Spearman's Rho correlation coefficients were calculated.

RESULTS

Key factors influencing parental risk perception included children's sex, age, migrant status, emotionality, and injury risk as well as parents' parenting style and external locus of control. While parental risk perception was positively associated with children's injury risk, the analyses showed no associations between parental risk perception and parents' preventive behavior.

CONCLUSIONS

Our findings add to a better understanding of parental risk perception, provide practical implications for injury prevention, and indicate that the relationship between parental risk perception and parents' preventive behavior is based on a complex mechanism which is possibly moderated by parents' locus of control.

PRACTICAL APPLICATIONS

The identified key factors help to assess parental risk perception more accurately. Therefore, they should be considered in the development of tailored interventions to prevent unintentional home injuries of children, for instance, by targeting specific groups of parental risk perception.

Building the Foundation of Aquatic Literacy in 4-6 Years-Old Children: A Systematic Review of Good Pedagogical Practices for Children and Parents

Children between the ages of 4–6 years represent the population most affected by drowning accidents, while their early involvement in physical activity, and more specifically in aquatic activities is a key factor in their future physical life journey. The systematic review’s purpose was to identify aspects in the intervention’s studies with children and/or their parents that had a significant impact on the Aquatic Literacy (AL) dimensions mentioned as motor, psychological, affective, and cognitive. The PICO method was used to define the research question and PRISMA checklist searched for articles in nine databases: Cochrane, Embase, ERIC, ProQuest, PsychInfo, PubMed, Scopus, SportDiscus, and Web of Science. Eligibility criteria were: (1) English language, (2) primary research, (3) population of 4–6 year old children or their parents, (4) intervention study design, and (5) results related to at least one of the AL domains. The strength of evidence and the risk of bias were assessed. Results showed relatively poor number of studies for such a vulnerable population regarding the drowning risk (n = 8 for parents and n = 14 for children intervention). Studies did not show a consensus on which educational approach was more beneficial than others. Concerning parental education, results were rather homogeneous, especially concerning the theoretical frameworks employed and the relevancy to include parents in swimming programs. The development of pedagogical tools for promotion and evaluation, based on the AL theoretical framework, could help to clarify the question of “how to teach” children to prevent drowning and engage young children in long-term physical activities.

A Year of Child Injury Prevention on Instagram

Injury is the leading cause of death for children but little is known about what types of injury prevention messages are communicated on Instagram. Conducted in the United States, the aim of this study was to better understand child injury prevention messages on Instagram to develop recommendations for the future. Informed by Social Cognitive Theory, a quantitative content analysis was conducted on all Instagram posts from selected organizations from May 2018 through April 2019. Of the 818 injury prevention posts, almost all included an image (575, 70%) or video (211, 26%). Of the 575 images, 245 (42.46%) had in image that did not match the topic of the post. Regarding injury prevention recommendations, 579 posts (71%) provided a clear action that parents should take. For these posts, 115 (20%) had an image that communicated the desired safety recommendation, but many more (285, 50%) did not; in 23 cases it was not clear if there was a match or not. There are missed opportunities for child health and injury organizations to reach parents and caregivers through Instagram. Posts made during the study period often lacked specificity about action-oriented measures and failed to utilize images that demonstrated the recommended practices. Organizations posting on Instagram and other social media platforms should provide clear action tips and utilize images that depict child injury prevention recommendations.

Reducing inequities among adult female migrants at higher risk for drowning in Australia: The value of swimming and water safety programs

ISSUE ADDRESSED

Drowning is a global public health challenge with a need to ensure equity to drowning prevention information and interventions. In Australia, people born overseas are identified as being at greater risk of drowning. This paper presents findings from a community-based qualitative evaluation of swimming and water safety (SWS) programs delivered to adults from migrant backgrounds in Sydney, Australia.

METHODS

A qualitative study was conducted in November-December 2019 among 35 female participants of SWS programs targeted to adult migrants. While offered to all SWS program participants, no males took part in the study. Focus groups and interviews were recorded, transcribed and thematically analysed using a deductive approach. The domains of enquiry were guided by the health belief model and the theory of planned behaviour.

RESULTS

Study participants were ≥25 years, first generation and most had lived in Australia for ≥10 years. Most were nonswimmers and were fearful of water prior to the program. Key themes were: direct SWS program outcomes, health and well-being; enablers and barriers to participation including: motivation, a program coordinator, fear and settlement priorities.

CONCLUSION

Findings suggest that in order to increase SWS participation among migrant communities, the broader determinants of health need to be considered. Culturally appropriate strategies are required to enable both men and women equal opportunities to access SWS programs.

SO WHAT

SWS programs provide multiple benefits for adult migrants; however, the impact on reducing inequities is limited, with broader multi-strategic health promotion approaches and policies required for inclusion and sustainability.

Media reporting of summer drowning: A partial picture, useful for advocacy

ISSUE ADDRESSED

Media reporting of drowning deaths can be used for multiple purposes, including advocacy, enhancing data on drowning and supporting policy development. Accurate, current and comprehensive data help ensure the development of effective prevention programs as well as being a tool for advocacy. Advocacy for drowning prevention through the media can create behaviour change aligned to the Health Belief Model (HBM).

METHODS

This study compares media reports of fatal unintentional drowning across the 2017/18 Australian summer (1-December-2017 to 28-February-2018) with drowning cases in the National Coronial Information System (NCIS).

RESULTS

Media monitoring identified 84 cases, of which nine (11%), were deaths but not drowning. There were 104 NCIS deaths during this time of which 75 were reported in the media (72% capture). Media captured 100% of drowning incidents involving people 0-24 years and in ocean/harbour locations. Drowning incidents among older people (75+ years; 36% capture), in bathtubs (0% capture), swimming pools (33% capture) and with an unknown activity (27% capture) were poorly reported.

CONCLUSIONS

Where there are a lack of timely data on drowning, the use of media can help capture deaths, with limitations. Transmission of messages about drowning risk factors and prevention strategies, during summer, may lead to behaviour change at a time when drowning risk is highest. SO WHAT?: Working with the media to help enhance advocacy efforts, in particular the development and use of effective drowning prevention messages, is key to informing the public about risk factors in the HBM to achieve behaviour change.

What does 'Keep Watch' mean to migrant parents? Examining differences in supervision, cardiopulmonary resuscitation training and water familiarisation

OBJECTIVES

Drowning is a public health challenge. Children of migrants may be at increased risk as parents may be unaware of local water safety issues. This study explores differences between Australian-born and migrant parents in Western Australia for: (1) swimming ability; (2) supervision; (3) water familiarisation; and (4) cardiopulmonary resuscitation (CPR) training.

METHODS

A cross-sectional survey of parents and carers of children aged under 5 years residing in WA (n = 1506) captured demographics, knowledge of appropriate supervision, water safety knowledge and skills. Logistic regression was conducted.

RESULTS

Migrants were significantly less likely to identify adequate supervision (p = 0.004); have participated in child water familiarisation programmes (p = 0.000); or perceived themselves as able swimmers (p = 0.000). Significantly less migrants had also undertaken CPR training (p = 0.000).

CONCLUSIONS

Findings add to the small but growing body of literature highlighting the importance of tailored drowning prevention strategies for migrants in countries such as Australia with a strong aquatic culture.

Examination of a pilot intervention program to change parent supervision behaviour at Australian public swimming pools

ISSUE ADDRESSED

Drowning is one of the leading causes of unintentional death in children worldwide. There is limited evidence about the effectiveness of programs targeting child drowning prevention at public swimming pools. We examined the effectiveness of a public education program (Keep Watch @ Public Pools) for improving child supervision levels by parents at public swimming pools.

METHODS

The program was evaluated via an observational study of parent supervision behaviour with children aged 0-14 years. Measures included domains of attention, proximity and preparedness. A rating scale from 0 = least effective to 4 = most effective was used, based upon the supervision domains. Seven public swimming pools in Melbourne, Victoria, Australia were randomised to either intervention or control pool. The intervention occurred over six weeks, and observations were taken over a one-week period both pre- and postintervention. Observations of a total of 10 186 children and 6930 parents/carers were recorded and analysed.

RESULTS

A significant improvement in attention, proximity and preparedness was observed in parents of children aged 6-10 years at intervention pools. However, similar results were not observed in parents of children aged 0-5 years and 11-14 years.

CONCLUSIONS

Supervision behaviour of parents can be modified, and the implications of these results for the community through to practice and policy are discussed. SO WHAT?: Targeted public education programs provide an effective way of improving parental supervision of children at public swimming pools. Such education programs should be widely implemented throughout public swimming pools, as one part of a comprehensive approach to drowning prevention.

Using a retrospective cross-sectional study to analyse unintentional fatal drowning in Australia: ICD-10 coding-based methodologies verses actual deaths

OBJECTIVES

Fatal drowning estimates using a single underlying cause of death (UCoD) may under-represent the number of drowning deaths. This study explores how data vary by International Classification of Diseases (ICD)-10 coding combinations and the use of multiple underlying causes of death using a national register of drowning deaths.

DESIGN

An analysis of ICD-10 external cause codes of unintentional drowning deaths for the period 2007-2011 as extracted from an Australian total population unintentional drowning database developed by Royal Life Saving Society-Australia (the Database). The study analysed results against three reporting methodologies: primary drowning codes (W65-74), drowning-related codes, plus cases where drowning was identified but not the UCoD.

SETTING

Australia, 2007-2011.

PARTICIPANTS

Unintentional fatal drowning cases.

RESULTS

The Database recorded 1428 drowning deaths. 866 (60.6%) had an UCoD of W65-74 (accidental drowning), 249 (17.2%) cases had an UCoD of either T75.1 (0.2%), V90 (5.5%), V92 (3.5%), X38 (2.4%) or Y21 (5.9%) and 53 (3.7%) lacked ICD coding. Children (aged 0-17 years) were closely aligned (73.9%); however, watercraft (29.2%) and non-aquatic transport (13.0%) were not. When the UCoD and all subsequent causes are used, 67.2% of cases include W65-74 codes. 91.6% of all cases had a drowning code (T75.1, V90, V92, W65-74, X38 and Y21) at any level.

CONCLUSION

Defining drowning with the codes W65-74 and using only the UCoD captures 61% of all drowning deaths in Australia. This is unevenly distributed with adults, watercraft and non-aquatic transport-related drowning deaths under-represented. Using a wider inclusion of ICD codes, which are drowning-related and multiple causes of death minimises this under-representation. A narrow approach to counting drowning deaths will negatively impact the design of policy, advocacy and programme planning for prevention.