Swim Skills Literature Review
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Swimming Skills Literature Review A FINAL report for Royal National Lifeboat Institution (RNLI) Evaluation Services Contents Introduction ................................................................................................................................................................. 1 Context ......................................................................................................................................................................... 4 Do ‘swimming skills’ protect people from risk of drowning in open water? ............................................... 7 What methods best deliver swimming skills? .................................................................................................... 16 How do other countries approach this issue? ................................................................................................... 19 Conclusions ................................................................................................................................................................ 28 Bibliography ................................................................................................................................................................ 30 Appendix A: Intervention Research ..................................................................................................................... 34 Authors: Richard Sutcliffe, Matthew Terry & Kathryn Crowther Cloud Chamber Limited [email protected] www.cloud-chamber.co.uk October 2016 Swimming Skills literature review 1 Introduction Background The Royal National Lifeboat Institution (RNLI) commissioned Cloud Chamber to undertake a literature review related to the contribution of swimming skills and aquatic survival training to drowning prevention among children and young people. This work will inform the Swim Safe programme, a 45 minute safety advice and open water tuition programme for 7 to 14 year olds, delivered by the RNLI in partnership with the Amateur Swimming Association (ASA). The review will also inform other RNLI community safety programmes and initiatives. Methodology and research questions Research questions The following research questions were developed in conjunction with the RNLI at a scoping meeting held on 18th July 2016: o Do swimming skills protect people from risk of drowning in open water? o What methods best deliver swimming skills? o How do other countries approach this issue? Method The drowning prevention literature is wide ranging, internationally focused and methodologically challenging. The review therefore placed some criteria on what studies should be included: o Our search centred on evidence from high income countries. While good evidence can be found from the developing world (notably Bangladesh), this review primarily informs provision in the UK so we focused our attention on places with similar governmental structures, culture and social issues to maximise the relevance of the work. Similarly, our review of drowning prevention strategies is also limited to selected Western, English-speaking countries for practical reasons o We focused primarily (but not exclusively) on issues relating to open-water drowning incidents, which is in line with the main scope of the RNLI’s operations and the aims and objectives of the Swim Safe programme o Our review has been age-focused with our primary groups of interest being children, young people and young adults o We have tried to relate the review to features of the Swim Safe delivery model, i.e. an experiential model undertaken in open water. While it may be obvious to many readers of this review, it is worth mentioning specifically one of the most significant challenges of conducting research in this area: that the victims of drowning themselves are not able to help us understand the specific context of their individual deaths; explore their swimming skills (or water competence); and or judge the likelihood that such skills may have made a difference in the tragic incidents in which they lost their own lives. Swimming Skills literature review 2 We adopted a simple methodology for this assignment: o Scope the research questions o Agree search terms with RNLI o Systematically search the literature o Consult with experts to sense-check findings and signpost us to additional evidence Figure 1 shows our initially agreed search terms mapped against the research questions. These terms were used as a starting point for the literature search. Specifically, we tested terms individually and in different combinations, and searched key word combinations across multiple databases. Key word combinations, databases searched and the number of articles returned are shown in Figure 2. Figure 1: Initial search terms Research question Key words Do swimming skills protect Drowning or Drowning prevention Young people or Children or people from risk of drowning Water safety Adolescent in open water? Program or intervention Open water Swimming Swimming lessons Aquatic skills or aquatic competence Swimming education What methods best deliver Water competence Safety education swimming skills? Evaluation How do other countries Drowning or Drowning prevention Open water approach this issue? Water safety Best practice Policy Awareness campaigns Legislation Education Attitudes to risk EU, G8, US, Canada, New Zealand, Culture Australia Figure 2: Number of returned articles by key word combination and database source Search term CINAHL Pubmed Scopus Web of Complete Science “Drowning prevention” 231 190 150 96 “Water Safety” & Drowning 178 107 46 Open water drowning 3 2,979* 142 154 “Open water” & “Drowning Prevention” 18 20 17 Swimming lessons 14 207 201 176 Swimming education 44 7 5 3 Water safety program 0 10 141 79 Aquatic skills 1 13 17 9 Open water swimming** Swimming lessons 0 207 201 176 “Drowning prevention” evaluation 0 122 17 11 * Mainly medical literature, ** Only returned results related to competitive open water swimming A broad collection of articles was collected and reviewed as part of this exercise. Subsequent identification of literature was done through examining references and bibliographies of these articles. We also undertook searches of Google and Google Scholar to identify grey literature Swimming Skills literature review 3 (evaluation reports, strategies, interventions etc.). Our literature review includes 74 sources of evidence including academic articles and reports. The academic literature was very limited for research question 3: ‘how do other countries deal with this issue?’. In this case we relied on searches among the publications of key drowning prevention bodies, search engines, and our consultations with drowning prevention experts. We contacted ten international experts in drowning prevention from Australia, New Zealand, the US, Norway and Bangladesh. We received responses from six of those ten individuals, interviewed four and two declined to be interviewed. Structure of this report Our presentation of the literature in this report is structured as follows: o Section 2 presents context relevant to the review including drowning statistics and trends, the policy context and information about RNLI interventions the review will inform o Section 3 examines the links between swimming skills and drowning prevention / drowning risk o Section 4 considers the evidence on which methods best deliver swimming skills o Section 5 discusses approaches to drowning prevention in other high income countries o Section 6 sets out our conclusions based on the available evidence Swimming Skills literature review 4 Context There are over 300 water-related deaths in the UK. The number of water-related deaths from accidents or natural causes has decreased over the last three years from 381 in 2013, to 338 in 2014 and 321 in 2015 (Walker, 2016, 2015). However, drowning still remains one of the leading causes of unintentional death in the UK and is considered highly preventable (National Water Safety Forum, 2015). As is the case in many countries across the world, males are significantly over-represented in drowning statistics. In the UK in 2015, 72% of people who died from accidental or natural water- related causes were male (National Water Safety Forum, 2016). The majority of fatalities (30%) were coastal (occurred at the coast, beach, or shore) and 27% occurred in rivers (Walker, 2016). Water-related deaths are strongly linked to leisure and recreation activities. In 2015, the activity most associated with fatalities was walking or running (25% of fatalities) while swimming accounted for 9% of all fatalities (National Water Safety Forum, 2016). The 20-29 and 60-69 age group accounts for the greatest number of fatalities in 2015 (47 respectively). Children and young people (aged 0-19) accounted for 12% of fatalities in 2015. Within 0-19 year olds, more fatalities occurred in the 15-19 age category (23), four 10-14 year olds and five children aged between 0 and 9 lost their lives in 2015. Full data is shown in Figure 3. Figure 3: Accidental & natural cause fatalities in the UK in 2015 by age group Note: N=275 as 46 cases had insufficient information on age and gender. Source: National Water Safety Forum (2016) Internationally, 372,000 people die from drowning every year and those most at-risk are aged under 25. This group accounts for 50% of deaths globally, with drowning being one of the 10 leading causes of death for people aged 1-24 in every region of the world. Developing countries have drowning rates over three