Special issues in injury prevention research: developing the science of program implementation.

INTRODUCTION: Despite widespread application of the public health approach to injury prevention, there is an acknowledged limitation in the extent to which it facilitates translation of research evidence to injury prevention practice. AIM: In this paper we clarify the ecoepidemiological principles that underpin the public health approach to injury control in order to support explicit efforts to address the multilevel component causes and improve the evidence base on which effective program implementation depends. KEYPOINTS: If injury causation is understood in terms of the ecoepidemiological model rather than the proximal risk factor model, then quantification of the context in which the event occurs is evidently as important as quantification of the energy exchange event itself. The ecoepidemiological model of injury causation recognises barriers and facilitators to injury prevention as component causes of population burden of injury and thus delineates these factors as legitimate targets for intervention. Injury prevention programs that are designed to specifically address the factors causally related to the program's implementation, as well as the contextual factors that determine the characteristics of the energy exchange event, are more likely to be implemented and more likely to result in effective uptake of recommended energy exchange countermeasures. CONCLUSION: Interventions to reduce the burden of injury in the population should address the individual level factors that increase the risk of injury, but also the upstream factors that influence the extent to which there is widespread adoption by individuals of the recommended countermeasures.

Uncovering evidence on community-based injury prevention: A review of programme effectiveness and factors influencing effectiveness.

This study examines systematic reviews of community-based injury prevention programmes to obtain an overview of the evidence base on the effectiveness of these programmes and to analyse how effectiveness is measured and the extent to which factors contributing to achieving programme effectiveness are examined in these reviews. Thirteen systematic reviews were found, encompassing a total of 121 programmes. The results reinforced the well-documented point that the evidence regarding the effectiveness of community-based injury prevention programmes is inconsistent. Some of the programmes targeting specific injury categories, e.g. specific injury types and/or age groups, were successful, whilst more broadly targeted programmes demonstrated less convincing results. Effectiveness was predominantly measured as injury rate reductions. Only one of the reviews identified contextual factors that could have impacted on programme effectiveness. To advance the field, researchers and systematic reviews need to include evidence on factors that may explain how the effects were achieved.

Longitudinal predictors of changes to illicit drug use among young Australian women.

AIM: Much information regarding predictors of illicit drug initiation and cessation is drawn from cross-sectional data. This paper aims to determine the longitudinal changes in factors associated with initiation and cessation of illicit drugs by young Australian women over a 3-year period. PARTICIPANTS: The sample was the cohort of young women moving from their mid- to late 20s, completing the Australian Longitudinal Study on Women's Health (ALSWH) survey in 2000 and 2003, who were either 'new' users or 'quitters' at the 2003 survey. MEASUREMENTS: Crude and multivariate associations between changes in predictor variables and the probability of illicit drug initiation or cessation were evaluated. Variables significant in univariate analyses were used to create multivariable logistic regression models which predicted initiation and cessation of illicit drugs. FINDINGS: All categories of smokers, except ex-smokers and those who adopted and quit smoking between surveys, were less likely to cease the use of illicit drugs. Women who became pregnant were more likely to cease illicit drug use. Women who continued to drink at levels described as long-/short-term risk and women who suffered continuing emotional abuse were less likely to cease use of illicit drugs. CONCLUSIONS: Longitudinal studies that examine factors associated with illicit drug initiation are best conducted in a cohort aged in their late teens to early 20s. Following the current cohort into their late 30s may further explain predictors of illicit drug cessation.

Quantifying the effect of a community-based injury prevention program in Queensland using a generalized estimating equation approach.

OBJECTIVE: To develop a generalized estimating equation (GEE) model of childhood injury rates to quantify the effectiveness of a community-based injury prevention program implemented in 2 communities in Australia, in order to contribute to the discussion of community-based injury prevention program evaluation. DESIGN: An ecological study was conducted comparing injury rates in two intervention communities in rural and remote Queensland, Australia, with those of 16 control regions. A model of childhood injury was built using hospitalization injury rate data from 1 July 1991 to 30 June 2005 and 16 social variables. The model was built using GEE analysis and was used to estimate parameters and to test the effectiveness of the intervention. RESULTS: When social variables were controlled for, the intervention was associated with a decrease of 0.09 injuries/10,000 children aged 0-4 years (95% CI -0.29 to 0.11) in logarithmically transformed injury rates; however, this decrease was not significant (p = 0.36). CONCLUSIONS: The evaluation methods proposed in this study provide a way of determining the effectiveness of a community-based injury prevention program while considering the effect of baseline differences and secular changes in social variables.

Simplifying data collection for process evaluation of community coalition activities--an electronic web-based application.

ISSUE ADDRESSED: It is important to document and measure coalition-based program activities in order to analyse and evaluate the process of program implementation. This paper describes the development and implementation of an electronic, web-based application to simplify data collection for this research process. METHODS: Childhood injury prevention project officers collaborated with injury prevention researchers to adapt a process log monitoring system initially developed by the Centers for Disease Control and Prevention to track coalition activities for evaluating community efforts to prevent cardiovascular disease. The adapted process log was converted into an electronic, web-based application that project officers completed daily. RESULTS: The web-based electronic log proved to be a practical tool that not only simplified the documentation and reporting processes for health professionals involved in the program, but also provided a rich source of data for subsequent comprehensive analysis of project implementation. CONCLUSION: Development, implementation and evaluation of this web-based process log, to the best of our knowledge, is the only program of its kind in use and provides a simple data collection solution for practitioners, policy makers and researchers involved in injury prevention programs and other community-based programs throughout the world.

Where do all the undergraduate and new graduate nurses go and why? A search for empirical research evidence.

OBJECTIVE: To review the published scientific literature for studies quantifying or examining factors associated with the attrition of undergraduate nursing students in pre-registration programs and the retention of graduate nurses in the workforce. METHODS: The following selection criteria were used to systematically search the literature: target populations were either students in pre-registration nursing programs or registered nurses in their graduate year; the studies were to be primary observational or analytical (cross-sectional, case-control or prospective cohort studies) in design; and outcome measures were attrition in undergraduate programs and/or retention of graduates within the workforce. Three authors guided by a standardised procedure performed data extraction and quality assessment independently. Synthesis of the data appears in text and tabular format. Due to the heterogenic nature of the study methods, meta-analysis was not possible. RESULTS: This review found only four studies that met all inclusion criteria. All four studies examined undergraduate attrition as an outcome with two studies reporting a range of 25-27% attrition within the first year. No studies were found that quantified or examined retention of new graduates as an outcome measure. Only two of the four studies followed cohorts of students prospectively and were able to provide a high level of evidence, although each of these studies was designed to assess specific exposures as potential predictors of attrition, rather than assess actual factors associated with students leaving their program. CONCLUSION: There is a paucity of research studies in the literature from which evidence quantifying attrition and retention and the reasons why students leave undergraduate nursing programs or new graduates leave the profession can be obtained. Clearly there is a need to systematically track undergraduates and new graduates to quantify and understand attrition, retention and workforce choices within the nursing profession and begin to build this evidence-base.

Validity and reliability of responses to a self-report home safety survey designed for use in a community-based child injury prevention programme.

OBJECTIVE: To quantify the validity and reliability of responses to a self-report home safety survey designed for use in a community-based child injury prevention program. METHODS: A cross-sectional study of home-based injury risk factors and safety practices was administered to a random sample of households (n = 614) in two rural and remote communities in Queensland, Australia using a Computer Assisted Telephone Interview (CATI) survey. The survey was re-administered during subsequent home interviews with a sub-sample (n = 85) of CATI participants. RESULTS: For all self-reported hazards and safety practices, prevalence estimates obtained from the CATI survey were significantly different from those directly observed at the home interview with proportions of homes exposed to hazards between 10-21% under reported at CATI survey and safety practices over-reported at CATI survey by 17-24%. There was no statistically significant difference however between the estimates of prevalence of hazards and safety practices self-reported at CATI and home interview. Validity of the CATI survey was poor with sensitivity of the CATI question ranging from 0 to 71 and specificity from 32 to 97. While the marginal distribution of prevalences of hazard prevalences and safety practices were similar between CATI and home interviews, the low level of response concordance (kappa = -0.24 to 0.41) indicates that reliability of the responses to these questions was low. CONCLUSION: In view of these limitations in the accuracy of CATI risk factor surveys, their use for priority setting and evaluation in community-based injury prevention programs needs to be considered with caution.

Inflatable rescue boat-related injuries in Queensland surf lifesavers: the epidemiology - biomechanics interface.

The objective was to describe the relationship between epidemiological and biomechanical factors in the causal pathway of inflatable rescue boat (IRB)-related injuries in Australian surf lifesavers; to develop epidemiological and biomechanical methodologies and measurement instruments that identify and measure the risk factors, for use in future epidemiological studies. Epidemiological and biomechanical models of injury causation were combined. Host, agent and environmental factors that influenced total available force for transfer to host were specified. Measurement instruments for each of the specified risk factors were developed. Instruments were piloted in a volunteer sample of surf lifesavers. Participant characteristics were recorded using demographic questionnaires; IRB operating techniques were recorded using a custom-made on-board camera (Grand RF-Guard) and images of operating techniques were coded by two independent observers. Ground reaction forces transmitted to the host through the lifesaver's feet at the time of wave impact were measured using a custom-built piezoelectric force platform. The demographic questionnaire was found practical; the on-board camera functioned successfully within the target environment. Agreement between independent coders of IRB operating technique images was significant (p < 0.001) with Kappa values ranging from 0.5 to 0.7. Biomechanical instruments performed successfully in the target environment. Peak biomechanical forces were 415.6N (left foot) and 252.9N (right foot). This study defines the relationship between epidemiological and biomechanical factors in modifying the risk of IRB-related injury in a population of surf lifesavers. Preliminary feasibility of combining epidemiological and biomechanical information has been demonstrated. Further testing of the proposed model and measurement instruments is required.

Making evaluation an integral part of injury programme implementation.

Uncertainty about the nature of evaluation can lead to injury prevention programme evaluations being poorly resourced and poorly conducted. The aim of this paper is to demystify programme evaluation and, by stressing its function, offer a perspective on evaluation that may encourage its more widespread integration in the general activity of injury prevention and control. Programme evaluation is best understood simply as the process of getting answers to essential questions about a programme. Methodology used in evaluation needs to be based in empirical science but is otherwise unrestricted except by the chosen question and the practical circumstances relating to the programme and the community in which it is implemented. Discussion about which methodology is appropriate for evaluation research is (unwittingly) a debate about 'which questions should you be asking?'. If the right people ask the right (and properly formulated) questions and build the means of obtaining the information to answer these questions (using appropriate methodology) into the conduct of the programme then evaluation will no longer be a problem but an essential component of the overall effort to reduce the community burden of injury.