Step One: Collect and Analyze the Data
The first step in any injury prevention program is to examine data on injury deaths and hospitalizations. Looking at actual numbers will help you figure out who is dying and becoming disabled and the cause. With this data, you should be able to create a list of who is most likely to be injured and what types of injuries are most common. It can also reveal injuries that are likely to necessitate hospitalization and those that frequently result in death.
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Injuries on school playgrounds are common but rarely result in death or permanent disability. Instead, there are numerous scrapes, bruises, and occasional broken bones. Your decision to launch a playground injury prevention program will be based on careful consideration of the answers to the questions “How many children are being hurt, how badly, and what can be done to reduce those injuries?” and “Are there other injury problems causing more death and disability that we should focus our energy and resources on?”
Your resources and the required information determine the extent of your data search. Your requirement will be shaped by how narrowly you want to define the target injury and population. The amount of data required may be determined by the credibility and convincing required to obtain resources and implement a program. Special studies and requests are frequently accommodated by local organizations such as your community hospital, university or college, or the state or local health department.
Data on Nonfatal Injuries
Your state might collect injury data using E-coded hospital discharge databases. On the patient’s hospital discharge record, these codes indicate the external cause of injury. This is an effective source to evaluate state or county injury when used uniformly by all hospitals. For access to this system, contact your state’s department of health.
The state highway patrol may have the car, pedestrian, and bicycle accident information.
Data may also be available from Emergency Medical Services systems. While it may not be collected and coded in the same way by all services within a state, it could be helpful for a particular community.
Local police and fire department data may also be helpful.
Data from phone calls is available at regional poison control centers.
Data on Fatalities
The vital statistics department in your state will have information from death certificates.
The county coroner and the state highway patrol may also be able to help.
Other nonfatal and fatal injury data sources include the state department of health and local or state trauma registries.
Data from your community will make a stronger case for an injury prevention project than national data.
Injury trends do not vary significantly yearly, so you should not be concerned if your data is a few years old.
The figures you receive from various sources may not match. The criteria for coding deaths vary by organization.
What Comes Next? ……
The first component of your prevention program is data collection and analysis. But don’t let it be the only one. Too often, people get stuck in the data phase, delaying prevention because they use the search for more data to avoid making decisions. You may only be able to obtain some of the information you would prefer, but there will be enough to provide a picture of the injury situation and a clear direction of what needs to be done. It would help if you were satisfied that your data was sufficient to tell you where and how to begin. Then proceed to Step 2.
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Step 2: Determine the Injury and Population.
Selecting a targeted injury and population will assist you in focusing your prevention efforts. Remember that having a well-defined injury prevention goal and target population will make program planning and evaluation much easier. Example: Imagine the program loosely shaped by the warning, “Be careful,” as compared to a program molded by the phrase, “Wear your seat belt.”
After identifying injuries that cause a significant number of deaths or disabilities, other factors can help you narrow your choice:
To what extent do the injuries cause death or severe injury or disability?
How frequently does the injury occur, and how many people are affected? Injury data should be examined across all age groups. The number of lives saved and disabilities reduced must be balanced against the frequency of occurrence. The most vulnerable people must be identified. Example: Bicycle accidents killed approximately 800 people in the United States in 1994. Approximately 175 deaths occurred in children aged 10 to 15, although this age group represented only about 9% of the national population.
Method of Prevention
Is there a viable strategy for reducing the frequency and severity of the injury? Many injuries continue to lack effective prevention measures, even though their high mortality rate makes them obvious targets for prevention. Bicycle accidents are common among school-aged children. A properly fitted helmet can help to prevent serious head injuries. Pedestrian injuries are the leading cause of death in this age group. Still, no low-cost, readily available strategies have been shown to reduce the frequency or severity of these injuries.
Take into account…
Are monetary and human resources available?
Consider the program’s price. Consider whether educational materials for the program are already available in-house or if they could be easily developed. Is there a willing employee who could be trained to handle the problem? If the problem is large enough and the community is dedicated, resources can usually be found to address it.
Is the community concerned about the issue?
Consider whether the community is aware of and concerned about the issue. While it is possible to educate the community about a serious problem, mobilizing people will be easier if the community is already interested in the injury topic. Remember that some injuries are seasonal, and your community may be more interested in a specific injury, such as drowning, at different times of the year.
Existing programs in your organization or another local organization to address the issue?
Print materials may already exist if this is the case and present a natural opportunity to collaborate with another agency. In contrast, you should consider whether your community’s injury problem is already being addressed effectively. Duplicating another agency’s efforts would be a good use of your time and resources.
What Comes Next… Once you’ve decided on the injury you want to prevent and the population you want to reach, the next step is to figure out how to reduce death and disability. Many factors contribute to an injury occurring. Strategies for addressing as many of these factors as possible can be developed.
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Step 3: Develop Intervention Strategies
An investigation into the factors involved in a specific injury
After identifying a targeted injury, you should spend time considering the numerous factors contributing to the injury’s occurrence. These factors will assist you in determining how the injury could be avoided. The factors are classified into three categories: the individual, the causes of injury, and the environmental conditions surrounding the event. Consider what happens in each of these major areas before the injury and what you might do to prevent those events, and you’ll be well on your way to deciding on an intervention strategy. Example: Consider automobile accidents. Alcohol intoxication, poor vision, fatigue, and a lack of driving experience may all occur during the drive. Brakes, tires, and travel speed are all potential causes of injury. Wet roads, nights, and poor road signage are examples of environmental conditions. There are numerous other factors to consider.
A combination of passive and active methods will be used in successful interventions. Passive strategies occur automatically and thus do not necessitate a conscious decision by the individual. A seat belt, for example, protects you in a car accident. Active interventions necessitate “action” on the individual’s part. For example, a seat belt must be fastened to protect in a collision. Individual decision-making strategies will be more difficult to implement because they require someone to make a conscious decision to change their behavior and, in many cases, repeat this new behavior repeatedly.
Consider New Year’s resolutions to understand the difficulty of behavior change. How many of us make good intentions to change our lives only to have them fall by the wayside? As a result, developing intervention strategies that combine passive and active methods are ideal.
Some examples will show how passive and active strategies are intertwined. Consider the use of smoke detectors. First, a smoke detector must be purchased (active). They must install it (active). The smoke detector will alert the individual in the event of a fire (passive).
Bicycle helmets are another example. A helmet must be purchased (active). They must remember to wear a helmet whenever they ride (active). In a collision, the helmet protects the head (passive).
Education, legislation, and technology are three areas where passive and active methods are frequently used. Personal interaction with others, media, and printed materials are all used to disseminate information in education. Legislation is a law or policy that individuals or organizations must follow.
Airbags, smoke detectors, seat belts, and bike helmets are technological interventions that protect people.
For example, you could choose to promote bicycle helmets. You could create educational materials and hold a bicycle rodeo to promote bicycle safety (education). As part of the program, you could get a law passed in your area requiring bicycle helmets (legislation). Bicycle helmets could be considered a technological solution in and of themselves. These are just examples of possible pieces: you don’t have to use all three strategies in your program, but the more you use them, the more likely you are to succeed.
For example, combining different strategies allows you to address the target injury in the long and short term. Consider wearing a life jacket. They are only useful if they are worn. You may choose education as a short-term solution to increase their use. If the community supports it, legislation mandating their use could be a long-term and very effective goal.
Consider the following factors as you examine the various factors involved in an injury occurrence to help you identify the strategies you may want to employ:
1. Think about who will carry out the strategy.
The prevention strategy and specific technique chosen to accomplish it may be determined by who in the community will do it. For instance, schools are likely to implement educational techniques such as a pedestrian safety curriculum if the goal is to improve pedestrian safety. To improve a dangerous street crossing, city engineers may install a walking signal and crosswalk (technology), and police may choose to enforce speed limits in school zones (legislation) strictly.
2. Keep in mind to target your message.
Your interventions should be tailored to the specific population and need. For example, bathers must be educated about surfing and undertowing in Hawaii. Because there are so many Japanese tourists in Hawaii, warning signs must be in Japanese and English. When writing educational material for the elderly, use a larger font to make the piece easier to read. A fast-paced video may be more appealing to adolescents than a brochure.
3. The intended audience must accept the strategy.
You’ll want to ensure you’re promoting something reasonable and useful to your target audience. Promoting something so ridiculous is pointless that no one would ever do it. Consider if you want to reduce injuries in car accidents. One approach could be to encourage drivers to wear helmets while driving. While wearing helmets may reduce/avoid injury, it is unrealistic to expect the general public to support this idea.
What Comes Next?… Once you’ve determined the strategies to prevent your target injury and have decided on the interventions and techniques to use, you’re ready to move on to the next stage of your program: developing an implementation plan.
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Step 4: Create an Implementation Strategy
The implementation plan outlines how you intend to carry out your objectives. Your target injury, target population, and intervention strategies determine your selection.
Declare Your Objective – Be Specific!
The objective should be stated clearly and in measurable terms. It must be specific regarding what you intend to do, for whom, and when. The more specific and focused the goal, the more directly it will provide for program implementation and evaluation measurement.
The goal of “reducing injury” provides few hints as to what to do, for whom, and most importantly, how. It is a recipe for failure because changing the death and injury statistics will take years and difficult to attribute to your program. Try this instead: “Reduce childhood death and hospitalization due to head injury by increasing the wearing of bicycle helmets by 30% among children 5 – 12 years in Spokane County over the next five years”. It is clear who, what, and how.
Make a list of your goals.
Objectives tell you how you are going to go about accomplishing your goal. Again, remember that the more focused the program, the more easily it is accomplished. Example: Using bicycle helmets for children again, the following objectives might be some of those utilized to reach the above goal:
Educate parents that their children can be seriously injured from bicycle crashes.
Educate parents that bicycle helmets can reduce serious injuries.
Reduce peer pressure to encourage children to wear helmets.
Ensure the availability of low-cost helmets.
Increase general community awareness of the problem of bicycle-related head injuries.
Develop Program Ideas
The above objectives are clear, aim at the goal, and are measurable. Each objective needs specific actions on your part to accomplish it. This is where coalition members start participating (See Step 5). Programming might include participation in a health fair, hosting a bike rodeo, or conducting school assemblies. Think about events in the community throughout the year where your program theme would fit in well. For example, a local hospital might have a fair in which you could participate.
You will want to choose an implementation strategy already designed and evaluated for efficacy. Your role will shape and tailor this strategy to fit your community’s resources and needs. For example, you may need more resources to do the program parts. Instead, you can prioritize and choose the most fitting pieces for your community. You may want to narrow the focus of the target audience. For example, a strategy may be designed for the general population, and you want to focus on adolescents. This tailoring will make an intervention strategy work best for you and provides a sense of ownership.
Make a Timeline
A timeline is an excellent organizing tool for the overall project and community activities. It Is a good idea to put both timelines in written form so that the project staff and community agencies can see where their commitment to an activity falls in the grand scheme and when they must perform it. This also helps ensure that the task gets done. Activities are often keyed to community events, and a timeline ensures forethought so as not to miss these opportunities. Example: For a community scald prevention program, the annual hospital health fair in October may display hot water gauges, bathtub thermometers, stop-hot decals, scald burn prevention posters and temperature charts, anti-tip mugs, and a video that shows the prevention of scald bums.
…. Before considering methods more thoroughly, you must choose who in your community should be involved in your program. These groups will help to shape the activities, but they first must be chosen for a clear connection to the objectives.
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Step Five: Identity, Select and Commit Community Agencies to Implement the Program
You and your agency can only do part of the injury prevention program yourself. A coalition of community agencies can achieve more because of the opportunity it provides to pool resources and draw from the skills of many people.
A coalition is a loosely organized group of individuals representing agencies and organizations that work toward a common goal. Each member contributes knowledge, expertise, and action appropriate to their field of interest. Three elements are essential for an effective coalition.
The lead agency takes responsibility and leadership for the injury prevention program. Within the lead agency, there should be a designated coordinator. This is preferably a paid position or a percentage of a staff job.
The coordinator is responsible for planning the goal and objectives of the project and ensuring that they are accomplished. The coordinator may consult their lead agency or a consultant for assistance, direction, and advice. The coordinator plans and leads meetings as a communications hub for the coalition members, motivates the members to perform activities and moves the project toward completion.
Enthusiastic and committed members are vital to the project. They are the individuals who will disseminate information and conduct activities. As the lead agency, you will already have developed the program objectives and framework. Lay those out for them, get them to agree and thus buy into the program, and then move right into the methods – what they will actively do.
Locating Potential Coalition Members
Consider the following as you search for coalition members:
Agencies should have a mission consistent with that the program’s goal. Example: If you are implementing a bike helmet program, there may be better additions to your coalition than bike shops. Bike shops want to make money. This is not the same goal as saving lives. Although bike shops are an important piece in a helmet program, having them in a planning role with the coalition may be disruptive. It may be better to ask for their cooperation later and tell them how they can help.
Members who represent an agency have the buy-in and backup of their agency to accomplish tasks and for the program’s credibility. Individuals may not have this kind of support.
Consider all aspects of the injury problem and all the interventions you may employ to insure that you have the mix of professions and disciplines that will facilitate your goals.
Non-traditional agencies and groups should be considered. Example: Insurance companies are beginning to play a role in injury prevention. Those offering auto insurance may be interested in joining traffic safety efforts.
Consider what resources you need, and ensure you include members who can help supply those resources.
Remember that the number of coalition members is not important, but the quality. A few energetic people can accomplish a great deal!
Public and private organizations should be contacted to find those who will join the coalition and contribute. Fewer will join than are asked, and fewer will continue as members and do activities than will come to the first meeting. It is best to start with a long list of agencies because it will dwindle. Another reason for this is that it is far better to include groups than exclude and possibly anger those that were not contacted.
It is also important that groups that are important for their influence be asked to join, even if they will not directly participate in conducting activities. Example: Political invitees may do nothing but can lend valuable, influential support. A media representative may not be an active coalition member but could sponsor the program. Example: A newspaper could take on the prevention effort as an editorial agenda item. Editorials would be published periodically. They, like most organizations, want their name on the efforts.
Agencies, organizations, and groups can be found by brainstorming, looking through local listings such as the Yellow Pages, and asking local people. It is best to contact the most important agencies by telephone or in person. This way, you can assess their level of interest and ask them for suggestions from other organizations. Send a letter to the entire list of potential members that states the community’s concern with the injury problem and announces the formation of a coalition to address the concern.
… The next step gives the coalition members tools to accomplish the objectives in Step Four. It is time to create a plan to achieve the program goal.
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Step Six: Develop an Action Plan
While the coordinator should develop the goal and objectives, activities to accomplish the objectives are the responsibility of the coalition members. Developing an action plan will formalize each member’s commitment to specific activities and how they will contribute. Duties can be selected and assigned based on the activities. Coalition members must be able to choose activities they are accustomed to and have the resources and skills to accomplish.
Your action plan will vary depending on the strategy or strategies that you have selected.
Many programs rely heavily on education as a technique. The most effective educational efforts couple personal interaction with printed educational materials and a media campaign. The more ways and places a person sees and hears the injury prevention message, the more likely it will produce an effect.
Printed materials such as posters, brochures, flyers, curriculums, or guides will help in education.
Public information through the media can effectively complement your other strategies and allow you to get your message out to many people.
Personal interaction is the most effective educational tool and must be used in addition to printed materials and media messages. Assembly programs in schools, presentations at meetings, and counseling by healthcare providers are ways to relay a personal message to many people.
See the appendix under “Choosing Materials” for more information on this subject.
Legislation is very effective once enacted but requires extensive planning, and usually, long-term work is required to influence the legislative process. The following specific tools are helpful:
A packet designed for legislators that presents the facts, costs, and sides of the injury issue and the legislation being proposed as an intervention. Ideas about how this legislation could be enforced should be included.
Convincing data. Often the economic argument is more persuasive than death statistics. Example: At the major trauma center in the state of Washington, 63% of the cost of motorcycle injuries is paid for by public funds. This was an influential fact in the passage of the 1989 legislation requiring motorcycle helmets.
One or more legislators will sponsor the bill. They can work to influence other legislators and will appear before the media to reach the public.
Close contact with a legislative staff person and the services of an organizational lobbyist, such as that of a state medical association, can be invaluable.
Grassroots involvement. Legislators need to hear that their constituents want the bill. A coalition can brainstorm for organizations and individuals to contact. Every coalition member must contact their stakeholders to explain the legislation and encourage letters and telephone calls to legislators. This final step must be done quickly and efficiently as the bill comes before the legislature.
There are two vital steps to technological strategies. One step is to develop and produce the technological method, and the second is to market it. Development and production of the technological device may be beyond the capabilities of your community coalition. However, a community-based program can be extremely effective in the distribution of the item and promotion of its use once it has been developed. Example: Life jackets are now attractive and comfortable to wear. The boating public needs to know and be educated about the importance of buying and using life jackets. Creating a demand can also lower the cost, which would be an additional benefit to the public.
Incorporating a coupon discount plan into your prevention program may increase the program’s success. You can work with a manufacturer or distributor to negotiate a discount.
The coalition may also want to raise funds to buy prevention items like bike helmets or smoke detectors. A bulk purchase such as this often makes the item less expensive, meaning you can sell the item to the public for a nominal charge.
What Next?… With the above tools for program implementation, your coalition members can go forward to activate the injury prevention plan. But first, you will want to ensure that your members are knowledgeable and ready for the upcoming activities.
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Step Seven: Orient and Train Agencies/Individuals Implementing the Intervention Plan
The orientation and training of those implementing the program help ensure they understand their role. It is also helpful for the coalition members to understand the scope of the program and how it addresses the need for injury prevention and fits into the larger picture – at least a picture as large as your state’s efforts for injury prevention. Although knowledge of the philosophy of injury prevention is not necessary for community people, it can be helpful because everyone working on the program is an ambassador for injury prevention. They will interact with others and represent the program, so the better they understand, the more they may influence others. As the project continues and grows, new members will also need to be trained.
This step also implies open and two-way communication between those working on the program. As people begin their tasks, they must know what is expected of them and how to do their activities. They can bring feedback to the group regarding the workability of the methods, the effectiveness of the tools, and the reaction from the community. They can contribute ideas and suggestions for changes.