Prevention of Burn Injuries in Pre-School Children
Total Page：16
File Type：pdf, Size：1020Kb
RANDOMISED CONTROLLED TRIAL OF A MULTIMEDIA- BASED PARENTING INTERVENTION FOR THE PREVENTION OF BURN INJURIES IN PRE-SCHOOL CHILDREN Chukwudi Oliver Okolie MBBS, MPH Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy Cochrane Institute of Primary Care and Public Health School of Medicine Cardiff University March 2017 SUMMARY Childhood burn injuries are a leading cause of death and disability worldwide and a major public health concern. Children younger than five years of age are more at risk. Majority of burn incidents occur as accidents within the home. Poor parental burn hazard perception and knowledge of burns first aid have been reported. This PhD project aimed to determine whether a targeted preventative parenting intervention ‘Toddler-safe’ improved parental burns safety and first aid knowledge and behaviour in the home, and reduced the risk of future childhood burns. A systematic review of the literature was undertaken to assess the effectiveness of parenting interventions at preventing unintentional injuries in pre-school children. The review found that parenting interventions that provided home visitation, education, and free/discounted safety devices, delivered on a one-to-one basis, during the perinatal or early postnatal period, were associated with significantly fewer childhood injuries, and improvements in parental safety knowledge and practices. However, there was a lack of prevention intervention research specifically for burn injuries in children under the age of five. Findings from the systematic review informed the design and methodology of the Toddler-Safe study. Toddler-Safe was conducted as a randomised controlled trial. One hundred and fifty six parents allocated to the intervention arm of the trial received an intervention consisting of a burns safety and first aid video, and an injury safety leaflet. An equal number of controls received only the injury safety leaflet. The study was evaluated using pre- and post-test questionnaires. Outcome measures included first aid knowledge and burns prevention, knowledge, attitude, and practices; and parent-reported or medically attended injuries. Just over half of the study participants were available for follow-up at six months. Non-responders were found to be younger and from lower socioeconomic backgrounds. Toddler-Safe was not effective at improving parental burns prevention and first aid knowledge, attitudes, and practices at i follow-up. Burn injuries were reported in four children living with participating families. Participant attrition and omission of key knowledge and attitude topics from the intervention were major limitations of the study. ii AUTHOR’S DECLARATION This work has not been submitted in substance for any other degree or award at this or any other university or place of learning, nor is being submitted concurrently in candidature for any degree or other award. Signed…………………………………………(candidate) Date………………………… STATEMENT 1 This thesis is being submitted in partial fulfilment of the requirements for the degree of PhD Signed …………………………………………(candidate) Date ………………………… STATEMENT 2 This thesis is the result of my own independent work/investigation, except where otherwise stated. Other sources are acknowledged by explicit references. The views expressed are my own. Signed ………………………………………… (candidate) Date ………………………… STATEMENT 3 I hereby give consent for my thesis, if accepted, to be available for photocopying and for inter-library loan, and for the title and summary to be made available to outside organisations. Signed …………………………………………(candidate) Date ………………………… iii ACKNOWLEDGMENTS I owe thanks to many people who have supported me in various ways, on the road to completing this piece of work. Firstly, I would like to thank my supervisors, Professor Alison Kemp and Dr Sabine Maguire for providing invaluable guidance, advice and encouragement throughout my time as a PhD student. I would like to thank the Early Years and Core Info staff, especially Diane Nuttall, Vanessa Tempest, Laura Harding, Laura Cowley, Amanda Summers, Mala Mann, and Rebecca Lumb for their support and for sustaining my morale over the whole course of my studies. Thank you also to all of the parents who gave their time and effort to be a part of this study; without whom this research would not have been possible. I am grateful to Laszlo Trefan, Daniel Farewell, Rebecca Cannings-John, and Saiful Islam for their valuable statistical advice. Not to forget Pauline Jones and Linda Phillips for assisting with data collection. My special thanks are due also to Helen Snooks, Bridie Angela Evans, Jenna Bulger, and Julie Peconi for taking the time to proof-read my thesis and for providing excellent comments. I would like to acknowledge the BCIRPU team Vancouver, Canada, for permitting me to modify their questionnaire for this project; and also Health Challenge Caerphilly County Borough for granting me permission to incorporate sections of their ‘Small Steps to Safety’ DVD, into my intervention. Finally, I would like to thank my family who have been a constant source of encouragement throughout my academic journey. Above all I would like to thank my wife, Uju, and my daughter, Olanna, for their unwavering support, kind words, and for tolerating my frequent absences – I promise to make it up to both of you. iv LIST OF ABBREVIATIONS ADHD: Attention Deficit Hyperactivity Disorder BCIRPU: British Columbia Injury Research and Prevention Unit BCT: Behaviour Change Technique CAPIC : Collaboration for Accident Prevention and Injury Control CAPT: Child Accident Prevention Trust CI: Confidence Interval CONSORT: Consolidated Standards of Reporting Trials CRD: Centre for Reviews and Dissemination CSH: Controllable Safety Hazards DVD: Digital Versatile Disc ED: Emergency Department GCP: Good Clinical Practice GCSE: General Certificate of Secondary Education GP: General Practitioner HBM: Health Belief Model HOME: Home Observation for Measurement of the Environment ICC: Intracluster Correlation Coefficient IOBI: Injury Observatory for Britain and Ireland IRAS: Integrated Research Application System ISBI: International Society for Burn Injuries ITT: Intention-to-treat KAP: Knowledge, Attitudes, and Practices LMIC: Low and Middle-Income Countries LOCF: Last Observation Carried Forward MLU: Midwifery Led Unit MRC: Medical Research Council NHS: National Health Service NISCHR: National Institute for Social Care and Health Research NS-SEC: National Statistics Socio-economic Classification OR: Odds Ratio PICOS: Population, Intervention, Comparator, Outcomes, and Study design PPI: Patient and Public Involvement v PRISMA: Preferred Reporting Items for Systematic Reviews and Meta- Analyses R&D: Research and Development RCT: Randomised Controlled Trial REC: Research Ethics Committee ROSPA: Royal Society for the Prevention of Accidents RR: Risk Ratio RTA: Road Traffic Accident SCT: Social Cognitive Theory SD: Standard Deviation SLT: Social Learning Theory SPSS: Statistical Package for the Social Sciences STD: Sexually Transmitted Disease TBSA: Total Body Surface Area TMV: Thermostatic Mixing Valve TPB: Theory of Planned Behaviour TRA: Theory of Reasoned Action TTM: Transtheoretical Model UHW: University Hospital of Wales UK: United Kingdom UKCRN: UK Clinical Research Network USA: United States of America UV: Ultraviolet WHO: World Health Organisation vi TABLE OF CONTENTS SUMMARY I AUTHOR’S DECLARATION III ACKNOWLEDGMENTS IV LIST OF ABBREVIATIONS V TABLE OF CONTENTS VII LIST OF TABLES XIII LIST OF FIGURES XIV CHAPTER ONE 1 CHAPTER ONE: INTRODUCTION 2 1.1 Background 2 1.2 Structure of the thesis 4 1.3 Chapter overview 5 1.4 Methodology of the literature review 6 1.4.1 Search methods for identification of studies 6 1.4.2 Electronic database searches 6 1.4.3 Extending the search strategy 7 1.5 Classification of burns 7 1.6 Burn wound extent 9 1.7 Pathophysiology of burns 11 1.8 Types of burn injury 13 1.9 Epidemiology of childhood burns 17 1.9.1 Incidence of burns in children 17 1.9.2 Mortality from childhood burns 19 1.9.3 Gender distribution 20 1.9.4 Age distribution of burns in children 21 1.9.5 Risk factors for burns in children 22 1.9.6 Seasonal variation 23 1.9.7 Place of occurrence 23 1.10 Childhood burns from maltreatment 24 1.11 Pre-hospital management of burns 25 1.12 Childhood burns prevention strategies 27 1.12.1 Passive measures 28 1.12.2 Active measures 28 1.13 Behaviour change theory and childhood injury prevention 29 1.13.1 Behaviour change interventions 29 1.13.2 Applying behaviour change theory to injury prevention research 32 1.14 Health education and behaviour change 36 vii 1.14.1 Health education and childhood burns prevention 37 1.14.2 Strategies for enhancing health educational messages 38 1.14.3 Parenting programmes and interventions 39 1.14.4 Delivering health educational messages 41 1.14.5 Multimedia-based education 42 1.15 Rationale for research 44 1.16 Research aims and objectives 49 1.16.1 Research aims 49 1.16.2 Research objectives 49 1.17 Hypothesis 50 1.18 Summary of chapter one 50 CHAPTER TWO 53 CHAPTER TWO: A SYSTEMATIC REVIEW OF PARENTING INTERVENTIONS FOR THE PREVENTION OF UNINTENTIONAL INJURIES IN PRE-SCHOOL CHILDREN 54 2.1 Introduction 54 2.2 Chapter overview 54 2.3 Background 55 2.4 Review objectives 57 2.5 Research questions 57 2.6 Methodology of the systematic review 58 2.6.1 Eligibility criteria 58 2.6.1.1 Inclusion criteria: Population 58 2.6.1.2 Inclusion criteria: Intervention 58 2.6.1.3 Inclusion criteria: Comparator 59 2.6.1.4 Inclusion