Stay One Step Ahead Implementation Study
Research type
Research Study
Full title
Stay One Step Ahead: Research Study Evaluating the Implementation of Systematic Evidence-Based Child Home Safety Promotion (part of the Small Steps Big Changes Programme)
IRAS ID
218243
Contact name
Hannah Carpenter
Contact email
Sponsor organisation
University of Nottingham
Duration of Study in the UK
4 years, 0 months, 0 days
Research summary
In 2014, Nottingham Citycare partnership, was awarded a 10 year grant from the Big Lottery Fund as part of the “A Better Start” programme to improve the lives and outcomes of young children via the Small Steps Big Changes (SSBC) Project. As part of the SSBC project, Nottingham CityCare are delivering evidence-based child home safety promotion in 4 wards in Nottingham. The Stay One Step Ahead research study is evaluating the implementation of this home safety promotion.
This research study aims to identify whether implementing systematic evidence-based home safety promotion improves key home safety practices (having at least one fitted and working smoke alarm, a safety gate on stairs (where applicable) and poisons stored out of reach). There are also a number of secondary outcomes including injury rates, acceptability to parents and service providers, implementation factors and economic outcomes.This is a non-randomised, controlled before and after research study (CBA), with nested interviews, observations of home safety promotion and an economic evaluation.
As a controlled before and after study, the research will compare four electoral wards that currently receive the Small Steps Big Change programme, and five control wards that are not receiving the programme.
The study will recruit approximately 400-500 SSBC ward families and 400-500 control ward families who will complete questionnaires. In addition, we will ask families if they are interested in taking part in other parts of the study:
- Economic evaluation - consenting to access to medical records
- Face-to-face or telephone interviews
- Observations of 9-12 month and 2 year reviewsThe study will recruit staff members for interviews and to take part in observations of the child reviews.
There is also a service evaluation being conducted by the study team, running concurrently with this study. The service evaluation assesses service provider home safety activities and in-service training. Ethical approval for the service evaluation will be sought from the University of Nottingham ethics committee.
The study will derive new knowledge about the impact, acceptability, implementation facilitators and barriers and cost-effectiveness of evidence based home safety promotion. Given the similarity of health visiting and children’s centre service provision across the UK, study findings should be generalisable across the country. Findings will inform child home safety promotion across Nottingham city wards in the later years of the Small Steps Big Changes programme, and importantly, they will inform development and commissioning of child home safety promotion in other areas of the UK.
Lay summary of study results: Our main study aim was to determine whether the SOSA programme would lead to more families performing three key safety practices: having a fitted and working smoke alarm, having a stairgate (or no stairs), and storing medications and cleaning products out of the reach of pre-school children.Seventy percent of families who started participating in the study completed the final study questionnaire, which was sent out two years after the beginning of the study.
We found that at the end of the study more families that received the SOSA programme had a safer home than those in control areas (who did not receive the programme), but that this difference was not statistically significant (a ‘statistically significant’ finding is one that is unlikely to have been due to chance). This may have been due to some data being missing because some families did not complete the final questionnaire.
We then used standard statistical methods to account for missing data. Results of our subsequent tests found that more families that received the SOSA programme had a safer home than those in control areas, and that this difference was statistically significant.
When we looked at specific safety practices, we found that at the end of the study families living in programme areas were significantly more likely than those living in control areas to perform the following:
o Storing medications and cleaning products out of children’s reach o Having a plan for how to escape from their house in the event of a fire o Either using a fireguard or not having a fire for heating at home.Families living in programme areas also carried out a significantly larger number of home safety practices than families living in control areas.
The programme didn’t significantly reduce the number of accidental child injuries that occurred. This was expected because much larger studies than this are needed to show significant reductions in injuries.
The study showed that the programme cost £30.22/child and for every £1 spent on the programme, there was a return of £1.39.
Interviews and observations with families showed that the programme was acceptable to families and practitioners, the importance of the relationship with the practitioner providing the safety information, that families receive their information from a wide range of sources and that they valued the advice from the programme.
Observations of programme deliver showed some areas were left out and so ongoing quality assurance is vital.
Conclusions · We conclude that systematic evidence-based home safety promotion for families living in areas of high levels of need improves some safety practices and increases the number of safety practices being performed.
· It is cost effective and acceptable to families and practitioners. · It is important that the SOSA programme is delivered as planned, without local variations. If it is implemented in areas without Family Mentors (or similar roles) the results may not be comparable to those found in the evaluation. · Based on our study results, we would recommend widespread implementation of the Stay One Step Ahead programme.
https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Finjuryprevention.bmj.com%252Fcontent%252F29%252F3%252F227%2FNBTI%2FnanDAQ%2FAQ%2Fb9252a55-58b6-4a4a-b494-963c15193bc0%2F3%2FqDE0f_8wWb&data=05%7C02%7Cleicestercentral.rec%40hra.nhs.uk%7Ca205197c39384766632e08de754f91eb%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C639077181794569739%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=QJ9%2FFxLTYlQlv81X3Nbhkuys%2B8gTCioiA6EOjZT8dLQ%3D&reserved=0REC name
East Midlands - Leicester Central Research Ethics Committee
REC reference
17/EM/0240
Date of REC Opinion
31 Jul 2017
REC opinion
Further Information Favourable Opinion