Background
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How many of the 24 CCs in the intervention arms achieved implementation fidelity?
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What level of IPB implementation did CCs achieve?
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What factors influenced implementation?
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Did the IPB facilitate implementation in this context?
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What improvements can be made to the IPB?
Methods
IPB only | IPB+ |
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• Received the IPB document in the post | • Received the IPB and a training session covering IPB content and use delivered by the Child Accident Prevention Trust and KCS research team |
• Asked to use it as they would any other information | • Key content: Expected to deliver at least one session to participating families based on five key IPB fire prevention messages: |
▪ Importance of smoke alarms | |
▪ Having a fire escape plan | |
▪ Causes of house fires | |
▪ Children’s behaviour in a fire | |
▪ Following a bed time routine | |
• If unable to cover all five messages directed to focus on the following two essential ones: importance of smoke alarms and fire escape plans. | |
• KCS researcher facilitation contacts took place at one, three and eight months. These took the form of an interview about progress and discussion of alternative strategies and approaches. |
Ethics statement
Results
Numbers of children’s centres achieving implementation fidelity
Levels of implementation achieved
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‘Extended’ implementation included diverse delivery methods, wide coverage, key messages and content including additional information not presented in the IPB.
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‘Essential’ implementation - used minimum delivery methods and key content only (as described in the ‘The differences between IPB only and IPB+ intervention arms’ section).
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‘Minimal’ implementation - some recorded attempt at IPB related activity but insufficient to fulfil ‘essential implementation’ criteria.
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‘No implementation’ - CCs who did not implement any aspect of the IPB.
Level | Extended | Essential | Minimal | Non-implementation |
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Criteria
| • ≥ 2 delivery methods (e.g. group sessions, display boards, postal information, home visits, specific events) | • Delivered via at least one group session | • Recorded attempt at IPB related activity but insufficient to fulfil ‘Essential implementation’ criteria | • No evidence of any IPB related activity although may have provided usual fire safety activity |
• ≥2 messages1
| • 2 messages1
| |||
• Fully integrated into existing CCs health promotion activity | • Discrete delivery or limited integration into other CCs sessions | |||
• Active engagement with wide population of parents (beyond trial participants) | • Engaged with trial parents and/or passive involvement of wider community | |||
• Use of IPB and additional information or content | • Used IPB information | |||
• Delivered to more than 1 group | • Delivery to one group of parents | |||
No. of CCs
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10
|
8
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5
|
1
|
Level | Participant description |
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Extended
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‘We had boards and things up … we put up photographs after the events…. The fire safety in the home booklet pages photocopied out of books and stuck up …and we … encouraged people to come along to the workshops … slotting activities into a session, that’s already running … we’ve tried to do it …. in different ways … we set up the large training room with … hair straighteners on the floor … to try and make it a bit more interactive ….we watched the fancy a cuppa DVD which is from the child action prevention people… So we tried doing a lot of different things to make it a bit more interesting.’ (Site B: IPB+) |
Essential
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‘Initially we’d looked through the … IPB, to see exactly what it entailed … and decided that … we’d try and construct a lesson plan to give possibly two sessions at that point because I was obviously time constrained…it was just myself and the student social worker that provided the information … we just had to adapt to make the timings a lot shorter.’ (Site A: IPB+) |
Minimal
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‘We’d made… it wasn’t … official as such but we talked about how we were going to use it so we’d said that we’d would run workshops but … after contacting all the parents and not having the interest we didn’t go ahead if we had had the interest we would have gone ahead and made proper plans.’ (Site C: IPB only) |
Non-implementation
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‘We never had the briefing the injury prevention briefing book so … I think right from the beginning we have been at a misunderstanding. Also our manager at that time, two of the staff that set it up have left, our strategic manager … has also been on long term sick, the manager of our team has retired and we are going through a management of change so we have been short staffed… I don’t really know what IPB is.’ (Site C: IPB only) |
Factors influencing IPB implementation
KCS Moderators
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Universal Moderators
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Specific Moderators
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IFF Moderators
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Delivery factors
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Intervention factors
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Delivery factors
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4. Intervention Complexity
| KCS trial processes | IPB Complexity | |
5. Facilitation Strategies
| KCS facilitation | ||
External Agency Support | |||
6. Quality of Delivery
| Adaptability and flexibility | ||
7. Participant Responsiveness
| Organisational change, time and resources | Staff engagement and training | |
Working with hard to engage groups | Staff continuity | ||
Conflicting Priorities |
IPB only | IPB+ |
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• ‘I think if someone had come in and … explained … what it was that you were doing and things then it probably would have… possibly would have made it so more got done.’ (Site C: IPB only) | • ‘The training at the start was … brilliant and it made it really … easy to follow the IPB and gave us the background knowledge that we needed to be able to speak to the parents about the things.’ (Site B: IPB+)
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• ‘I think in terms of facilitating well the university has kick started us into it we wouldn’t have done it otherwise.’ (Site C: IPB+)
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• ‘You’ve actually been very good at geeing me up to … you know because otherwise I have to admit … under the circumstances I think that’s exactly what we needed was the nagging … it gave us opportunities to … ask you anything.’ (Site D: IPB+)
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• Some felt facilitation was pivotal in enabling them to overcome the difficulties in engaging parents and of organisational change:
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• ‘I think without it [facilitation] you wouldn’t get any results.’ (Site C: IPB+)
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IPB complexity and effects on implementation in the CC context
IPB +
| • ‘I think it’s the materials … have been really helpful… they are easy to use and … to understand … they’re usable across different groups of parents like … teenage parents and with older parents. They were understandable and clear they get the message really pretty clearly.’ (Site B: IPB+)
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• ‘I think the value of the material is that it’s fairly straightforward to use it’s all there together, bound in a book … we would not have been delivering anything around fire safety … without having an accessible tool like this.’ (Site C: IPB+)
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• ‘We used the IPB and we had the fire safety little booklet as well so we had a lot of information, and so we came across as we knew what we were talking about.’ (Site B: IPB+)
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IPB only
| • ‘The fact that the activity was there and there was … a session outline … how you could do this… so when you have got somebody who is … carrying two workloads … that kind of helped with the planning.’ (Site B: IPB only)
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• ‘For us there was one …outstanding piece of work really that came from it …there was a real safety issue that was flagged up with one of the parents …she’d mentioned several things about wires being openly exposed in the walls … the fire station officers… made an appointment to go out that afternoon … and to put everything right for her.’ (Site A: IPB only)
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• ‘I had a parent just last week … who had been to one… with the fire engine … she had someone come and check her house last week and you know they’ve done a safety plan.’ (Site D: IPB only)
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What improvements can be made to the IPB?
Improvement | No. CC |
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Simplification of content | 7 |
Tailoring content to specific groups (different cultures, accommodation types, learning styles and abilities) | 7 |
Increasing visual appeal | 7 |
Including detachable resources for reproduction (or use during home visits) | 6 |
Providing more interactive strategies (particularly those including activities for children) | 4 |
Providing ‘sound bite’ materials for rapid delivery of key messages | 3 |
Increasing local/parental relevance (through local fire related injury statistics and causes e.g. hair straighteners) | 3 |
Parental and staff response to successful IPB implementation
Discussion
Key findings:
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1. | The considerable challenges of engaging with this audience and of frequent organisational change should not be underestimated |
2. | The IPB design methodology produced a tool aiding CC staff to deliver fire safety messages which: |
• was accessible to a broad range of staff | |
• was adaptable to different audiences and simple to use | |
• was a source of useful legitimate evidence | |
• motivated staff to have a go | |
• inspired future fire safety activity | |
• generated parental discussion and interest | |
• and initiated parental behaviour change | |
3. | While the IPB alone could not overcome all the challenges to implementation in this context combining it with external facilitation was extremely successful in improving: |
• Staff engagement | |
• Adaptability and flexibility and in mitigating effects of: | |
• Staff changes | |
• Lack of other agency support | |
• Conflicting priorities and targets | |
Implications for policy practice and research:
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1. | Future children’s centre injury prevention interventions need to address the difficulties posed by organisational change and audience engagement. |
2. | Their design should ensure conditions for successful implementation are promoted through incorporating contextual knowledge and facilitation. |
3. | They should provide supporting evidence of local need and be accompanied by policy directives to enable CC staff to prioritise them. |
4. | Facilitation should include: |
• Internal facilitation: A named member of staff who is responsible for leading this strand of work and monitoring the impact. | |
• External facilitation: possibly drawing on the expertise of local injury prevention teams; especially the local FRS to answer queries, share concerns and raise confidence levels. | |
• Consistent involvement of external agencies including local Fire and Rescue Services is also important. | |
5. | IPBs are a potentially promising intervention for use by children’s centres, but they require evaluation in terms of safety behaviours and injury outcomes. |
6. | Possibilities for expanding the methodology for IPB development to other public health areas should be explored through further research |
7. | Further changes in CCs organisation, funding, and priorities should consider the impact this has on effective delivery of services. |
Study strengths and limitations
Conclusion
Appendix 1 Example interview questions
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For fire safety message (a), how long did this take? Was it by a formal or informal session? Please describe what you did and/or who was involved.
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How complex did you feel the fire safety messages were? Did you feel they were too complex, about right or too straightforward?
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Can you tell me why?
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You said there were some factors that affected the way in which the fire safety messages were promoted.
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What were these?
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Did these have any effect on how your Centre promoted the fire safety messages?