5 Recommendations for research
The Programme Development Group (PDG) recommends that the following research questions should be addressed to fill the most important gaps in the evidence in relation to this and the other two pieces of NICE guidance that were published in November 2010. These form part of a 'suite' of NICE advice on preventing unintentional injuries:
Preventing unintentional injuries among under-15s in the home. NICE public health guidance 30.
Preventing unintentional injuries among under-15s: road design. NICE public health guidance 31.
The PDG notes that 'effectiveness' in these contexts relates not only to the size of the effect, but also to cost effectiveness and duration of effect. It also takes into account any harmful or negative side effects.
Studies of effectiveness and cost effectiveness should investigate and report on the differential effectiveness for children and young people who are more at risk of unintentional injury. They should collect data on the factors listed in research recommendation 1 and also on the:
short and long-term effects (physical, psychological and financial) on children, young people, their parents and carers (for example, time away from school for children and work for parents and extent of residual disability)
long-term quality-of-life and public sector cost impacts of non-fatal injuries.
5.1 What are the recent epidemiological and aetiological trends in types, causes and impact of unintentional injuries among under-15s? Use data collected by the recommended surveillance systems (see recommendations 7–8) to identify findings for specific groups and activities in the home, on the road and during outdoor play and leisure. Factors to consider are:
cause, nature, location and factors involved in the incident and type, site and severity of injury
numbers of children and young people involved, time spent undertaking the activity and the extent of supervision
demographic details with data presented for subgroups of children and young people (for example, grouped according to age, gender, ethnicity, socioeconomic status, disability and place of residence).
5.2 How do parents, carers, children and young people perceive risk in the home, on the road and during outdoor play and leisure – and how do they perceive the risks and benefits inherent in specific activities? How do these perceptions vary between populations and subgroups based on gender, age, race/ethnicity, socioeconomic status, disability, or other characteristics of the participants or their environment? How strongly associated is children and young people's exposure to risk with their behaviour, the causes, incidence and severity of unintentional injury?
5.3 Does exposure to risk and the opportunity to experience risk-taking have a beneficial effect on children and young people? Does the effect vary according to age and other socio-demographic factors or according to the quality and nature of the risk?
5.4 To what extent – and how – does children and young people's behaviour alter when their environment is made safer? How does children and young people's (and their parents' and carers') perception of risk impact on the amount and type of physical activity undertaken by children and young people?
5.5 What is the differential effectiveness and cost effectiveness of legislation, regulation, policies and standards to prevent unintentional injuries in the UK? Studies should consider the process and cost of development, promotion, implementation and enforcement. They should collect baseline data prior to any change and for a meaningful length of time afterwards on:
home safety assessments, thermostatic mixing valves (TMVs), smoke alarms (hard-wired and 10-year battery-operated), carbon monoxide alarms and window restrictors
water safety initiatives, sports rules and regulations, cycling skills training for children and young people and cycle helmet use
road safety knowledge and skills, road user behaviour, different types of road signage, differential effectiveness of speed enforcement (networked, targeted or mixed approaches) in rural and residential areas.
5.6 How effective and cost effective are social marketing and mass-media campaigns in support of legislation, regulation, policy and standards to reduce unintentional injuries among children and young people in the home, on the road and during outdoor play and leisure?
5.7 What is the impact of injury prevention training and development initiatives on those involved in preventing injuries in terms of their level of knowledge and degree of competency? What impact do such initiatives have on the scope and quality of preventive activities? Examples of training and developmental initiatives include: training people to undertake home risk assessments and educating representatives of community partnerships and private landlords about the Housing Health and Safety Rating System (HHSRS).
5.8 What prevents and what encourages children and young people to comply with legislation, regulation and standards to prevent unintentional injuries in the home, on the road and during outdoor play and leisure?
5.9 What prevents and what encourages delivery and implementation of policies/strategies to prevent unintentional injuries among children and young people in the home, on the road and during outdoor play and leisure? (These are outlined, for example, in white and green papers and policy briefings.)
5.10 How do the following factors influence the effectiveness and cost effectiveness of interventions to prevent unintentional injury in the home, on the road and during outdoor play and leisure:
method of delivery (for example, session format, learning materials)
frequency and duration of follow-ups
demographic characteristics of the participants (for example, gender, age, race/ethnicity, socioeconomic status and disability)?
5.11 What are the most effective and cost-effective ways of providing under-15s, their parents and carers with information, advice and education about safety and hazards in the home, on the road and in outdoor play and leisure environments?
5.12 To what extent do interventions to prevent unintentional injuries among under-15s in the home, on the road and during outdoor play and leisure impact on the household's safety knowledge and behaviour? What role do family members and carers (fathers, mothers, grandparents and extended family units) play in preventing unintentional injuries?
5.13 To what extent do interventions to reduce speed and prevent unintentional injuries on the road among under-15s influence people's attitude, knowledge and behaviour towards road safety (both drivers and the general public)? How can interventions be designed to maximise this effect?
5.14 How can systematic methods, combining health and engineering research, be developed to:
assess the effectiveness and cost effectiveness of injury prevention interventions outside the health sector (for example, within education and employment)
identify wider public health outcomes as a standard part of research into engineering measures to reduce speed and unintentional injuries (including co-benefits and unintended consequences, such as the impact on physical activity and air quality)?
5.15 How effective and cost effective are home safety interventions (including combined interventions) in preventing unintentional injuries among different population groups? For example, how effective are they in relation to participants' gender, age, race/ethnicity, socioeconomic status, disability, or other characteristics? To what extent does effectiveness and cost effectiveness vary according to the type of injury being prevented?
5.16 To what extent does the provision of safety information, advice and education during a home safety intervention contribute to its effectiveness and cost effectiveness? (For example, does it reduce the number – and severity – of unintentional injuries in the home among under-15s?)
5.17 How effective and cost effective are the different methods used to deliver safety information, advice and education? To what extent do effectiveness and cost effectiveness vary with different types of injury prevention activity?
5.18 To what extent does exposure to risk during outdoor play and leisure affect children and young people's risk-management skills in the setting where the hazard was encountered, other designated play areas, non-designated play areas and non-play settings?
More detail on the gaps in the evidence identified during development of this guidance is provided in appendix D.