Children and young people's behaviour in accidental dwelling fires: A systematic review of the qualitative literature

© 2017 Elsevier Ltd Children and young people are considered one of the most vulnerable population groups when exposed to accidental dwelling fires. Understanding how children behave in these circumstances and the reasons for their decision making are important to support rescue and fire safety education. We undertook a systematic review of the qualitative literature to identify studies where children and young people were asked to recount their experiences of being in an accidental dwelling fire in order to inform UK Fire and Rescue Service training and fire safety education programmes. We found no studies designed specifically to explore children's behaviours in dwelling fires, and only four studies (including 39 children's stories) where their behaviours had been recorded coincidentally to the main study aim. The evidence arising from these stories was frequently incomplete, often out of date (15–20years old), and 38/39 (97%) of stories were from the United States. This review indicates there is inadequate evidence of the current lived experience of children in accidental dwelling fires to support fire and rescue services in either their fire and rescue training or community fire safety education activities, particularly for non-US countries

Bridging the Gap:Parent and Child Perspectives of Living With Cerebral Visual Impairments

Cerebral Visual Impairment (CVI) is an umbrella term which includes abnormalities in visual acuity, or contrast sensitivity or colour; ocular motility; visual field and the conscious and unconscious filtering or processing of visual input. Children with CVI have specific needs and problems relating to their development from infancy to adulthood which can impact on their wellbeing. Recent research indicates the complexities of living with CVI but there remains limited information of the full impact of CVI on families’ everyday lives. The qualitative interviews reported here explored families’ experiences to discover the impact of CVI on all aspects of everyday life. Parents and children (aged 6–18) were invited to participate in semi-structured interviews, either face to face, by phone or video call between January 2018 and February 2019. Topics covered everyday practicalities of living with CVI, focusing on challenges and what worked well at school and home. Interviews were audio-recorded and subject to thematic analysis to look for patterns across the data. Twenty families took part in interviews, with eight children/young people within those families contributing interviews of their own. Four themes were developed from the interviews: (1) Assessment and understanding implications of CVI, (2) Education, (3) Family life, (4) Psychological wellbeing and quality of life. The interviews provide valuable insights into the impact of living with CVI and highlight the need for more awareness of the condition among professionals in both health and education settings

Improving outcomes for primary school children at risk of cerebral visual impairments (the CVI project):study protocol for the process evaluation of a feasibility cluster-randomised controlled trial

Introduction Brain-related visual impairments, also known as cerebral visual impairment (CVI), are related to damage or poor function in the vision-related areas of the brain. There is broad agreement that CVI is an appropriate term to describe visual impairments that are not accounted by disorders of the eye or optic nerve, but differences remain as to which impairments can be included in this term. The CVI project is a programme of work that includes the development of a complex intervention to share knowledge with teachers, so that they can make both targeted and universal changes to support children with CVI. A feasibility study for a cluster-randomised controlled trial to evaluate this intervention is underway. This paper describes the protocol for an accompanying process evaluation to explore how the intervention is implemented and provide context for the interpretation of the feasibility trial outcomes.Methods and analysis A logic model has been developed to guide data collection. Both qualitative and quantitative data will be collected to assess the feasibility and acceptability of the intervention, the study design and explore how any changes that occur are brought about. Interviews with key primary school staff and parents will investigate responses to the intervention and trial processes. Surveys will collect data on intervention implementation and knowledge of CVI. Photographs of classroom walls will document any changes to visual clutter and document analysis will look for changes to school special educational needs and disability (SEND) policies.Ethics and dissemination Ethical approval was granted by the University of Bristol Faculty of Health Sciences Ethics Committee. Findings will contribute to the development of a full-scale cluster-randomised controlled trial to assess the effectiveness of the intervention with adequate statistical power. The results will also support the refinement of the intervention and its underlying theory

Reducing injuries in the early years: Home safety training

Injury Prevention Briefing. Preventing unintentional injuries to the under fives: a guide for practitioners (IPB) was developed as part of a five year programme of research, Keeping Children Safe at Home, funded by the National Institute for Health Research. The IPB has been endorsed by NICE (resource E0079) (April 2016).Dissemination of the IPB was an integral part of the KCS programme: following a dissemination workshop in Bristol, Bristol City Council (BCC) awarded us ‘Public Health New Investment’ funding for further dissemination workshops across Bristol and to academic and community practitioners further afield, including UWE students (children’s nursing and SCPHN). An initial workshop exit evaluation form was given out at the end of each workshop. With additional competitive funding from the University of the West of England, a six month post-workshop on-line survey was undertaken which aimed to assess the impact of the IPB. This included questions about its use, what aspects were used, who with and with how many families/parents. KCS IPB injury Prevention workshops have been delivered to 332 delegates. The delegates attending covered a wide range of professionals and students: including early years’ practitioners and teaching staff, health visitors, children’s centre staff, community nurses and children’s nursing and Specialist Community Public Health Nurse students at UWE.The immediate feedback following the workshop and evaluation of the IPB at the six months follow-up both indicate that the IPB has been, and is expected to be, of benefit to practitioners within a wide variety of settings . The IPB has been used in face-to-face and one-to-one discussions with parents at home, as well as in group sessions at children’s centres. Teachers and mentors are continuing to use it with families and to educate health visitors and community professionals, students, and colleagues, thus its impact will continue

Approaches used by parents to keep their children safe at home: a qualitative study to explore the perspectives of parents with children aged under five years

BACKGROUND: Childhood unintentional injury represents an important global health problem. Many unintentional injuries experienced by children aged under 5years occur within the home and are preventable. The aim of this study was to explore the approaches used by parents of children under five in order to help prevent unintentional injuries in the home and the factors which influence their use. Understanding how parents approach risk-management in the home has important implications for injury practitioners. METHODS: A multi-centre qualitative study using semi-structured interviews. A thematic approach was used to analyse the data. Sixty five parents of children aged under 5years, from four study areas were interviewed: Bristol, Newcastle, Norwich and Nottingham. RESULTS: Three main injury prevention strategies used by parents were: a) Environmental such as removal of hazards, and use of safety equipment; b) parental supervision; and c) teaching, for example, teaching children about safety and use of rules and routine. Strategies were often used in combination due to their individual limitations. Parental assessment of injury risk, use of strategy and perceived effectiveness were fluid processes dependent on a child's character, developmental age and the prior experiences of both parent and child. Some parents were more proactive in their approach to home safety while others only reacted if their child demonstrated an interest in a particular object or activity perceived as being an injury risk. CONCLUSION: Parents' injury prevention practices encompass a range of strategies that are fluid in line with the child's age and stage of development; however, parents report that they still find it challenging to decide which strategy to use and when

Implementing an Injury Prevention Briefing to aid delivery of key fire safety messages in UK children’s centres: qualitative study nested within a multi-centre randomised controlled trial

Background To improve the translation of public health evidence into practice, there is a need to increase practitioner involvement in initiative development, to place greater emphasis on contextual knowledge, and to address intervention processes and outcomes. Evidence that demonstrates the need to reduce childhood fire-related injuries is compelling but its translation into practice is inconsistent and limited. With this knowledge the Keeping Children Safe programme developed an "Injury Prevention Briefing (IPB)" using a 7 step process to combine scientific evidence with practitioner contextual knowledge. The IPB was designed specifically for children’s centres (CCs) to support delivery of key fire safety messages to parents. This paper reports the findings of a nested qualitative study within a clustered randomised controlled trial of the IPB, in which staff described their experiences of IPB implementation to aid understanding of why or how the intervention worked. Methods Interviews were conducted with key staff at 24 CCs participating in the two intervention arms: 1) IPB supplemented by initial training and regular facilitation; 2) IPB sent by post with no facilitation. Framework Analysis was applied to these interview data to explore intervention adherence including; exposure or dose; quality of delivery; participant responsiveness; programme differentiation; and staff experience of IPB implementation. This included barriers, facilitators and suggested improvements. Results 83% of CCs regarded the IPB as a simple, accessible tool which raised awareness, and stimulated discussion and behaviour change. 15 CCs suggested minor modifications to format and content. Four levels of implementation were identified according to content, frequency, duration and coverage. Most CCs (75%) achieved ‘extended’ or ‘essential’ IPB implementation. Three universal factors affected all CCs: organisational change and resourcing; working with hard to engage groups; additional demands of participating in a research study. Six specific factors were associated with the implementation level achieved: staff engagement and training; staff continuity; adaptability and flexibility; other agency support; conflicting priorities; facilitation. CCs achieving high implementation levels increased from 58% (no facilitation) to 92% with facilitation. Conclusion Incorporating service provider perspectives and scientific evidence into health education initiatives enhances potential for successful implementation, particularly when supplemented by ongoing training and facilitation

The Bumps and BaBies Longitudinal Study (BaBBLeS): a multi-site cohort study of first-time mothers to evaluate the effectiveness of the Baby Buddy app

Background: Health mobile applications (apps) have become very popular, including apps specifically designed to support women during the ante- and postnatal periods. However, there is currently limited evidence for the effectiveness of such apps at improving pregnancy and parenting outcomes. Aim: to assess the effectiveness of a pregnancy and perinatal app, Baby Buddy, in improving maternal self-efficacy at three months post-delivery. Methods: Participants were 16-years and over, first-time pregnant women, 12-16 weeks gestation, recruited from five English study sites. The Tool of Parenting Self-efficacy (TOPSE) (primary outcome) was used to compare mothers at three months post-delivery who had downloaded the Baby Buddy app compared to those who had not downloaded the app, controlling for confounding factors. Results: 488 participants provided valid data at baseline (12-16 weeks gestation), 296 participants provided valid data at 3 months post-birth, 114 (38.5%) of whom reported that they had used the Baby Buddy app. Baby Buddy app users were more likely to use pregnancy or parenting apps (80.7% vs 69.6%, p=.035), more likely to have been introduced to the app by a healthcare professional (p=.005) and have a lower median score for perceived social support (81 vs 83, p=.034) than non-app users. The Baby Buddy app did not illicit a statistically significant change in TOPSE scores from baseline to 3 months post-birth (adjusted OR 1.12, 95%CI 0.59 to 2.13, p=.730). Finding out about the Baby Buddy app from a healthcare professional appeared to grant no additional benefit to app users compared to all other participants in terms of self-efficacy at three months post-birth (adjusted OR 1.16, 95%CI 0.60 to 2.23, p=.666). There were no statistically significant differences in the TOPSE scores for the in-app data between either the type of user who was engaged with the app and non-app users (adjusted OR 0.69, 95%CI 0.22 to 2.16, p=.519) or those who were highly engaged and non-app users (adjusted OR 0.48, 95%CI 0.14t o 1.68, p=.251). Conclusion: This study is one of few, to date, that has investigated the effectiveness of a pregnancy and early parenthood app. No evidence for the effectiveness of the Baby Buddy app was found. New technologies can enhance traditional healthcare services and empower users to take more control over their healthcare but app effectiveness needs to be assessed. Further work is needed to consider, a) how we can best use this new technology to deliver better health outcomes for health service users and, b) methodological issues of evaluating digital health interventions

Bumps and Babies Longitudinal Study (BABBLES): An independent evaluation of the Baby Buddy app

Introduction: Developments in information and communication technologies have enabled and supported the development and expansion of electronic health in the last decade. This has increased the possibility of self-management and care of health issues.Objectives: To assess the effectiveness of on maternal self-efficacy and mental wellbeing three months post-birth in a sample of mothers recruited during the antenatal period. In addition, to explore when, why and how mothers use the app and consider any benefits the app may offer them in relation to their parenting, health, relationships or communication with their child, friends, family members or health professionals.Design: A mixed methods approach, including a longitudinal cohort study, a qualitative study and detailed analysis and synthesis of data from the Baby Buddy app about the way in which mothers accessed and used the app content.Setting: The study was conducted in five geographically separate sites in England: Coventry, Lewisham, Bradford, Blackpool and Leicester. These areas were chosen as they were geographically, ethnically and socio-economically diverse and where the Baby Buddy app was reported to be well-embedded, both formally and informally, into the maternity and child health pathways by the relevant healthcare staff.Participants: Pregnant women who were aged 16 years and over, had no previous live child, were between 12-16 weeks and six days gestation and booked with the maternity services in each of the five study sites were invited to take part.Interventions: Self-reported use of the Baby Buddy app at one of the three data collection time-points: 12-16+6 weeks gestation, 35 weeks gestation and three months post-birth.Outcome measures: The primary outcome measure was parental self-efficacy at three months post-birth using the Tool to measure Parenting Self-Efficacy (TOPSE). The main secondary outcome was maternal mental well-being at three months post-birth using the Warwick and Edinburgh Mental Wellbeing Scale (WEMWBS).Results: Recruitment took place between September 2016 and February 2017. A total of 488 participants provided valid data at baseline (12-16 weeks gestation), 296 participants also provided valid data at 3 months post-birth, 114 (38.5%) of whom reported that they had used the Baby Buddy app at one or more of the data collection time-points (‘app user’). Seventeen first-time mothers participated in the qualitative arm via telephone interviews (n=9) and a focus group (n=8). Twenty healthcare professionals participated in interviews (n=5) and two focus groups (n=15). Consent was gained from 98 participants who gave permission for their in-app4data to be made accessible but just 61 participants could be identified from the database provided, of whom 51 were included in the analyses.At recruitment there were no differences between Baby Buddy app users and non-app users in respect to: age, IMD, ethnicity, highest education, employment, relationship status. Baby Buddy app users were more likely to use pregnancy or parenting apps (80.7% vs 69.6%, p=.035), more likely to have been introduced to the app by a healthcare professional (p=.005) and have a lower median score for perceived social support (81 vs 83, p=.034) than non-app users. The Baby Buddy app did not illicit a statistically significant change in TOPSE scores from baseline to 3 months post-birth (adjusted OR 1.12, 95%CI 0.59 to 2.13, p=.730). Finding out about the Baby Buddy app from a healthcare professional appeared to grant no additional benefit to app users compared to all other participants in terms of self-efficacy at three months post-birth (adjusted OR 1.16, 95%CI 0.60 to 2.23, p=.666).Apps were popular; Baby Buddy app users were more likely to use other pregnancy-related apps than non-Baby Buddy users and the most frequent source from which Baby Buddy app users found out about the app was a midwife. A post-hoc analysis found that Baby Buddy app users were more likely to breastfeed than non-Baby Buddy app users. This was a consistent pattern for both exclusive breastfeeding and any breast feeding: there was a 9% increase in exclusive breastfeeding at any time up to 3 months post-birth in Baby Buddy app users and a 12% increase in any breastfeeding up to three months post-birth, compared to non-app users. Whilst this is an important finding, this needs to be used with care due to the post-hoc element of the analysis.First-time mothers who participated in the qualitative arm of the study found that the Baby Buddy app worked well due to its accessibility and that the information was concise and easy to find. They liked that it followed the progress of pregnancy with appropriately-timed information and that different aspects could be accessed as and when needed. The app was designed to be an adjunct to service delivery not a replacement for healthcare. The importance of this was demonstrated by many first-time mothers reporting that they preferred in-practice support from a healthcare professional.The qualitative data indicated that the four preconditions of normalisation process theory: implementation, adoption, translation and stabilisation were met in regard to healthcare professionals’ use of the Baby Buddy app. This suggests that the healthcare professionals were actively integrating the Baby Buddy app into clinical practice with other professionals and first-time mothers, therefore embedding the Baby Buddy app into their service delivery.The in-app data from the sub-sample of participants (n=51) suggest that there was a difference in the amount of time participants spent accessing elements of the app; the median time spent using the app per session was 8.3 minutes (SD 5.8 minutes). The most popular features that5were used were ‘Today’s Information’, videos, ‘Bump/Baby Booth’, ‘Ask Me’ and ‘What does that mean?’. Participants used the app most often between 9-10am with another peak in the evening around 8-9pm. There were also a broad range of topics and issues that the participants searched for, of which the most searched words included: ‘labour’, ‘form’, ‘birth’, ‘pregnant’ and ‘developing’. In the sub-sample for whom we had in-app data, there was a large range for the number of times the app was used, from 0-593 times. The median number of times the app was opened was 146.5 but the data were positively skewed (LQ 52.5 – UQ 329). This indicates that the data are bunched towards the smaller number of times opened. Within this sub-sample, 21.6% of the engaged type of user used the app up to 25 times and 47% of this type of user used the app more than 100 times. This contrasts with the highly engaged type of user where 43% used the app 25 or less times and just 9.8% of this proactive type of user used it more than 100 times.We found no statistically significant difference in the TOPSE or the WEMWBS scores between the type of user who was engaged with the app and non-app users (adjusted OR 0.69, 95%CI 0.22 to 2.16, p=.519 and adjusted OR 1.54, 95%CI 0.57 to 4.16, p=.329, respectively). Similarly, we found no statistically significant difference between the type of users who were highly engaged users and non-app users (TOPSE: adjusted OR 0.48, 95%CI 0.14t o 1.68, p=.251; WEMWBS: adjusted OR 1.40, 95%CI 0.52 to 3.76, p=.509).Strengths and limitations: The primary objective was to explore the impact of the Baby Buddy app on parental self-efficacy and the Tool for Parenting Self-Efficacy (TOPSE website, Kendall, Bloomfield and Nash 2009), a validated measure, was selected to measure the primary outcome. The retention rate of 60.7% from baseline to three months post-birth demonstrates the difficulty of engaging new mothers during this demanding period of their lives. Nevertheless, in the initial and final samples, app users and non-users remained generally comparable and relevant confounders were adjusted for. Mothers were invited to take part in interviews and/or focus groups, the latter of which were held in a baby-friendly, welcoming environment for women and babies. Telephone interviews were offered for greater convenience for the women. Analysing the in-app data, we were able to compare outcomes for both the high versus low or non-user app groups and for those mothers who were the type of highly engaged users versus those who were a less engaged type. This was for a relatively small number of mothers but was a new method of analysing the in-app data.The Baby Buddy app was publicly available, meaning randomisation was not possible and therefore participants were only asked about their specific use of the app after the 35 weeks gestation data collection point to avoid directed app use. The participants were a self-selected group, especially those for whom we had in-app data and this is reflected in the higher than the national average for women who were degree holders (58.6% in final sample versus 42% nationally). The overall TOPSE scores were high at baseline which meant there was little room6for improvement. Nevertheless, there was no difference between the Baby Buddy app users and those participants who did not use the app.Conclusions: First-time mothers in the study found the app accessible and the information concise. The quantitative results, including those from the in-app data, found no evidence of impact from the Baby Buddy app on the primary outcome of parental self-efficacy or mental well-being (secondary outcome) at three months post-birth. The participant mothers had lower social support scale scores, which might suggest that the app attracted mothers who had a smaller social support network. Both mothers and healthcare professionals valued the fact that the Baby Buddy app was professionally endorsed which encouraged the women to trust the contents and the healthcare professionals to use it in their everyday practice. The most frequent source from which Baby Buddy app users found out about the app was a midwife, which suggests that the embedding of the app into service delivery by Best Beginnings was beneficial. A post-hoc finding was that women who used the Baby Buddy app were significantly more likely to exclusively breastfeed, or ever breastfeed, than those not using the app. The Baby Buddy app has gone some way to help to ‘Make Every Contact Count’ for both first-time mothers and healthcare professionals

Poison prevention practices and medically attended poisoning in young children: multicentre case-control study

Introduction Childhood poisonings are common, placing a substantial burden on health services. Case-control studies have found inconsistent evidence about modifiable risk factors for poisonings amongst 0-4 year olds. This study quantifies associations between poison prevention practices and medically attended poisonings in 0-4 year olds. Methods Multicentre case-control study conducted at hospitals, minor injury units and family practices from four study centres in England between 2010 and 2013. Participants comprised 567 children presenting with unintentional poisoning occurring at home, and 2320 community control participants matched on age, sex, date of event and study centre. Parents/caregivers provided data on safety practices, safety equipment use, home hazards and potential confounders, by means of self-completion questionnaires. Data were analysed using conditional logistic regression. Results Compared with community controls, parents of poisoned children were significantly more likely not to store medicines out of reach (adjusted odds ratio (AOR) 1.59; 95%CI, 1.21, 2.09; population attributable fraction (PAF) 15%), not to store medicines safely (locked or out of reach (AOR 1.83; 95%CI 1.38, 2.42; PAF 16%) and not to have put all medicines (AOR 2.11; 95%CI 1.54, 2.90; PAF 20%) or household products (AOR 1.79, 95%CI 1.29, 2.48; PAF 11%) away immediately after use. Conclusions Not storing medicines out of reach or locked away and not putting medicines and household products away immediately after use increased the odds of secondary care attended poisonings in 0-4 year olds. If associations are causal, implementing these poison prevention practices could each prevent between 11% and 20% of poisonings