Who's prepared for advocacy? Another inverse law

Local stakeholders' perspectives on improving the urban environment to reduce child pedestrian injury: implementing effective public health interventions at the local level

Local-level public health interventions require action from multiple agencies, organizations and individuals, yet little is known about how best to work with stakeholders to facilitate change. We sought local stakeholders' perspectives on how best to address impediments to implementing interventions designed to reduce child pedestrian injury by improving the pedestrian environment. We conducted 20 in-person, key informant interviews with people who would be the likely advocates for environmental change to improve the pedestrian environment in one US city, Baltimore, Maryland. We discuss the importance of reframing child pedestrian injury risk as a livability issue, increasing awareness about the potential impact of environmental changes to improve public safety, and the need for a formal efficient process to facilitate communication between local government and other stakeholders. These findings provide public health professionals and advocates with useful insight into how local stakeholders view the issue and their perspectives on how best to achieve change.

How willing are parents to improve pedestrian safety in their community?

STUDY OBJECTIVE

To determine how likely parents would be to contribute to strategies to reduce pedestrian injury risks and how much they valued such interventions.

DESIGN

A single referendum willingness to pay survey. Each parent was randomised to respond to one of five requested contributions towards each of the following activities: constructing speed bumps, volunteering as a crossing guard, attending a neighbourhood meeting, or attending a safety workshop.

SETTING

Community survey.

PARTICIPANTS

A sample of 723 Baltimore parents from four neighbourhoods stratified by income and child pedestrian injury risk. Eligible parents had a child enrolled in one of four elementary schools in Baltimore City in May 2001.

MAIN RESULTS

The more parents were asked to contribute, the less likely they were to do so. Parents were more likely to contribute in neighbourhoods with higher ratings of solidarity. The median willingness to pay money for speed bumps was conservatively estimated at $6.43. The median willingness to contribute time was 2.5 hours for attending workshops, 2.8 hours in community discussion groups, and 30 hours as a volunteer crossing guard.

CONCLUSIONS

Parents place a high value on physical and social interventions to improve child pedestrian safety.

Parents of fatally injured children discuss taking part in prevention campaigns: an exploratory study

This qualitative study explores how a small group of parents who have lost children to accidental injuries feel about taking part in prevention campaigns. Prospective participants were identified through a state medical examiner's office. Six mothers and 5 fathers of children who had died 3-5 years earlier agreed to be interviewed. All participants thought that it was appropriate to approach bereaved parents about such opportunities, after the most disabling phase of grief had subsided. Yet they raised cognitive, emotional, and practical barriers to engaging in prevention work. The appealing aspects of becoming a safety advocate included preventing emotional and physical injuries to others, as well as advancing their own recovery. It is very possible that the volunteers we spoke with held more positive views on participation than the many mothers and fathers who chose not to participate in our study. Nonetheless, their comments give us our first insights into how collaborating on prevention may feel to those for whom prevention has failed.

Accidental injury: risk and preventative interventions

OBJECTIVE

To evaluate the relation between risk factors for childhood unintentional injury and requests for injury prevention interventions as part of the Nottingham Safe at Home project, a primary care based controlled intervention study assessing the effectiveness of a package of injury prevention interventions.

SETTING

17 practices in Nottingham randomly selected from 55 practices volunteering to take part in the study.

METHODS

Postal questionnaire to all parents of children aged 3 to 12 months registered with the intervention practices (n = 1124) to assess risk factors for injury and to elicit requests for three injury prevention interventions: free home safety checks, low cost safety equipment, and free first aid training.

RESULTS

73% of parents responded to the questionnaire. The distribution of sociodemographic variables among responders was similar to that for the population of Nottingham. One third of parents (34%) requested one intervention, 21% requested two interventions, and 10% requested three. Receipt of means tested benefits, ethnicity, and residence in a deprived area were independently associated with requesting home safety checks. Non-owner occupation, lack of access to a car, receipt of means tested benefits, ethnicity, and unemployment were independently associated with requesting low cost safety equipment. Non-owner occupants were less likely to request first aid training.

CONCLUSIONS

Families with risk factors for childhood unintentional injury do request home safety checks and low cost safety equipment, but they are less likely to request first aid training. Other methods for providing first aid advice may be needed to reach such families.