LATROBE VALLEY BETTER HEALTH PROJECT EVALUATION OF THE INJURY PREVENTION PROGRAM 1992-1996 by Lesley M. Day Joan Ozanne-Smith Erin Cassell Alicia McGrath July, 1997 Report No. 114 11 MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE REPORT DOCUMENTATION PAGE Report No. Date ISBN Pages 114 July 1997 0 7326 0694 2 111 Title and sub-title: Latrobe Valley Better Health Project: Evaluation of the Injury Prevention Program 1992-1996 Author(s) Type of Report & Period Covered: Day L, Ozanne-Smith J, Cassell E.& McGrath A. General, 1992-1996 Sponsoring Organisation(s): Victorian Health Promotion Foundation Public Health Research and Development Committee, NHMRC Abstract: Evidence for the effectiveness of the community based approach to "all age all injury prevention" applied in the Australian context is limited. This study's aim was to evaluate the Latrobe Valley Better Health Injury Prevention Program, a community based intervention in south-east Victoria, Australia. The evaluation design was quasi-experimental including pre- and post-intervention observations in a population of approximately 75,000. There was no single comparison community, rather comparative data was used where possible. Process measures included key informant interviews with local organisation representatives. Impact evaluation relied mainly on self-reported changes in injury risk and protective factors, gathered by a random telephone survey. Outcome evaluation was based on five years of emergency department injury surveillance data for the Latrobe Valley. Modelling of injury rate data was performed using both Poisson and logistic regression. The program built strategic partnerships, increasing the emphasis on safety at the local level. Promotional and educational activities were implemented in the targeted areas of home, sport, and playground injuries, and alcohol misuse among the youth. Some 51,000 educational contacts were made with the community and 7470 resource items distributed. There was a 7.3% increase in the proportion of households purchasing home safety items (p=0.55). Unsafe equipment was replaced and undersurfacing upgraded in municipal playgrounds. The demand for and availability of protective equipment for sport increased. The age standardised rate per 100,000 persons for emergency department presentations for all targeted injury fell from 6594 in the first program year to 4821 in 1995/96 (p=0.017). There were significant decreases in the presentation rates for home injuries among all age groups except for those 65 years and over, playground injuries among 5-14, 15-24 and 25-64 year olds, and sport injury among 15-24 year olds only. The direct program cost per injury prevented was $272. There were no decreases in alcohol purchases by liquor outlets, and the rate of arrest for being drunk and disorderly increased among 10-24 year olds. However, significant reductions were observed for assaults among 10-24 year olds compared to those over 25 years. Most program objectives were met to some extent. The lack of a comparison community and injury data limits the conclusions which can be drawn about the association between the program and the injury reductions observed. However, the reductions were associated to some extent with changes in injury risk and protective factors and were greatest for the injury issues subjected to the most intense activity. There is merit in monitoring the impact of the ongoing injury prevention program, only with improvements to the evaluation design including a comparison community. Key Words: (IRRD except when marked*) Disclaimer evaluation, injury prevention, community-based This report is disseminated in the interest of infonnation exchange. The views expressed here are those of the authors, and not necessarily those ofMonash University Reproduction of this page is authorised Monash University Accident Research Centre, WellingtonRoad, Clayton, Victoria, 3168, Australia. Telephone: +61 399054371, Fax: +61 3 99054363 LATROBE VALLEY BETTER HEALTH PROJECT III IV MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE Contents EXECUTIVE SUMMARy Xl 1. INTRODUCTION 1 2. PROG RAM STRUCTURE 3 2.1 AIMS AND OBJECTIVES 3 2.2 COMMITTEES AND WORKING GROUPS 3 2.3 IMPLEMENTATION 4 3. EVALUAliON METHODS 5 3.1 EVALUATION DESIGN 5 3.2 PROCESS EVALUATION 5 3.3 IMPACT EVALUATION 6 3.3.1 Telephone survey 6 3.3.2 Other methods 7 3.4 OUTCOME EVALUATION 7 3.4.1 Definition of program region 7 3.4.2 Self reported injury 7 3.4.3 Emergency department injury presentations 8 3.4.4 Injury hospitalisations : 10 3.4.5 Motor vehicle crash data 11 3.4.6 Drunk and disorderly arrests 12 3.5 STATISTICAL ANALYSES 12 3.6 COSTS PER INJURY PREVENTED 14 4. RESULTS 15 4.1 GENERAL 15 4.2 HOME INJURY PREVENTION 15 4.2.1 Aims and objectives 15 4.2.2 Process measures 16 4.2.3 Impact measures 20 4.2.4 Outcome measures 21 4.3 PLAYGROUND INJURY PREVENTION 21 4.3.1 Aims and objectives 21 4.3.2 Process measures 22 4.3.3 Impact measures 22 4.3.4 Outcome measures 23 4.4 SPORTS INJURY PREVENTION 24 4.4.1 Aims and objectives 24 4.4.2 Process measures : 25 4.4.3 Impact measures 26 4.4.4 Outcome measures ; 26 LATROBE VALLEY BEITER HEALTH PROJECT v 4.5 ALCOHOL MISUSE 27 4.5.1 Aim and objectives 28 4.5.2 Process measures 28 4.5.3 Impact measures '" 30 4.6 STRATEGIC LINKS WITH LOCAL ORGANISATIONS 32 4.7 INJURY OUTCOME '" 33 4.7.1 Self reported injury (telephone survey) 33 4.7.2 Emergency department presentations 33 4.8 COST BENEFIT ESTIMATES 34 4.9 INSTITUTIONALISATION AND SUSTAINABILITY 34 4.9.1 Design and permanent environmental changes 35 4.9.2 Policy and legislative changes 35 4.9.3 Institutionalisation 35 5. DISCUSSION AND RECOMMENDATIONS 39 5.1 EVALUATION DESIGN AND METHODS 39 5.2 ATI AINMENT OF PROGRAM OBJECTIVES 40 5.3 INJURY REDUCTIONS 41 5.4 COST EFFECTIVENESS OF COMMUNITY BASED INJURY PREVENTION 42 5.5 PROGRAM SUSTAINABILITY 43 5.6 FUTURE DIRECTIONS '" 43 5.6.2 Continuing evaluation of the Latrobe Valley Better Health Injury Prevention Program 44 5.6.3 Future directions for community-based injury prevention program evaluation 44 APPENDIX 1 PRE AND POST INTERVENTION SURVEYS 47 APPENDIX 2 COMPARISON OF PRE AND POST INTERVENTION SURVEY SAM PLES 57 APPENDIX 3 STATISTICAL LOCAL AREAS FOR LA TROBE VALLEY PROGRAM REGION AND COMPARISON OF SMALL RURAL CENTRE AREAS 61 APPENDIX 4 EMERGENCY DEPARTMENT PRESENTATIONS: POISSON REG RESS ION ANALYSIS ...•......•..•......................•.................•....•••.................•.••.•........•..•• 63 APPENDIX 5 EMERGENCY DEPARTMENT PRESENTATIONS: LOGISTIC REG RESS ION ANALYSIS ........•..•.............••................•.......•....•••..•.................................•.. 65 APPENDIX 6 INJURY FREQUENCIES AND RATES ...................•......•......•......•............••... 73 APPENDIX 7 STRATEGIC LINKS WITH LOCAL ORGANiSATIONS ................•.•..........•.•. 79 APPENDIX 8 MATCHING OF PROGRAM OBJECTIVES WITH ACHIEVEMENTS MEAS URE D ••.•.•....•.•......••....•......••....•.......••....••...•...•...•.........•..••..••....•..........•...•..........•..•.• 85 RE F E RENC ES 91 VI MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE Figures FIGURE 1 AGE STANDARDISED UNINTENTIONAL HOME INJURY EMERGENCY DEPARTMENT PRESENTATIONS (INCLUDING THOSE ADMITTED), LRH 1991/92-1995/96. OTHER UNINTENTIONAL EXCLUDES PROGRAM TARGETED INJURY, ROAD AND WORK RELATED INJURIES ....•..•.•.•.•.••.•.•...•..•..•.•.•..•.•.••.•.•.••. 21 FIGURE 2 AGE STANDARDISED UNINTENTIONAL PLAYGROUND AND PLAYGROUND EQUIPMENT INJURIES, EMERGENCY DEPARTMENT PRESENTATIONS (INCLUDING THOSE ADMITTED), LRH 1991/92• 1995/96. OTHER UNINTENTIONAL EXCLUDES PROGRAM TARGETED INJURY, ROAD AND WORK RELATED INJURIES •...•..........•.•....•....•.....•...•...........•.....••......•........................•.••.•.••..•.•...•...•....•..•..•.....• 24 FIGURE 3 AGE STANDARDISED UNINTENTIONAL SPORTS INJURY, EMERGENCY DEPARTMENT PRESENTATIONS (INCLUDING THOSE ADMITTED), LRH 1991/92-1995/96. OTHER UNINTENTIONAL EXCLUDES PROGRAM TARGETED INJURY, ROAD AND WORK RELATED INJURIES ••..•.•.•.••..•.•..•......•..•....•.•.••..••..•.•.. 27 FIGURE 4 DRUNK AND DISORDERLY ARREST RATES, LATROBE V ALLEY BETTER HEALTH INJURY PREVENTION PROGRAM REGION, 1991/92-1995/96 31 FIGURE 5 HIGH ALCOHOL TIME SERIOUS MOTOR VEmCLE CRASH CRUDE AGE SPECIFIC RATES FOR 0-24 YEAR AGE GROUP, LATROBE V ALLEY PROGRAM REGION AND VICTORIAN SMALL RURAL CENTRES (COMPARISON REGION), 1987/88-1995/96 32 FIGURE 6 INTENTIONAL INJURY INFLICTED BY OTHERS, EMERGENCY DEPARTMENT PRESENTATIONS (INCLUDING THOSE ADMITTED), LRH 1991/92-1995/96 32 FIGURE 7 AGE STANDARDISED UNINTENTIONAL EMERGENCY DEPARTMENT PRESENTATIONS (INCLUDING THOSE ADMfITED), LRH 1991/92-1995/96. ALL TARGETED INJURY INCLUDES HOME, PLAYGROUND AND SPORT INJURY. OTHER EXCLUDES PROGRAM TARGETED INJURY, ROAD AND WORK RELATED INJURIES ..••..•..•.••..•.••....•....•....•...••...•... ,...•••...•...................•.•...•••.....•..•.•..•...•..•.•.•..••. .34 Tables TABLE 1: EVALUATION PHASES, LATROBEVALLEYBETTERHEALTHINJURYPREVENTIONPROGRAM, 1992- 1996 5 TABLE 2: TELEPHONE SURVEYS, LATROBE VALLEY BETTER HEALTH PROJECT EVALUATION, VICTORIA ••.••.••.•.•.•. 7 TABLE 3: LATROBE VALLEY BETTER HEALTH INJURY PREVENTION PROGRAM REGION, VICTORIA, 1992-1996 ..... 8 TABLE 4: DATA SOURCES FOR THE INJURY OUTCOME ANALYSES, LATROBE VALLEY BETTER HEALTH INJURY PREVENTION PROGRAM, VICTORIA, 1992-1996 8 TABLE 5: CAPTURE RATES (%), VICTORIAN INJURY SURVEILLANCE SYSTEM, LATROBE REGIONAL HOSPITAL, 1991/92-1995/96 , 9 TABLE 6: SELECTION CRITERIA FOR INJURY DATA EXTRACTION, VICTORIAN INJURY SURVEILLANCE SYSTEM,