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Preventing unintentional injuries to children under 15 years in the outdoors: a systematic review of the effectiveness of educational programs
  1. Mark Pearson,
  2. Harriet Hunt,
  3. Ruth Garside,
  4. Tiffany Moxham,
  5. Jaime Peters,
  6. Rob Anderson
  1. Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, University of Exeter, Exeter, UK
  1. Correspondence to Mark Pearson, Peninsula Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, UK; mark.pearson{at}


Introduction Unintentional injuries to children in the outdoors have a significant impact on child mortality, development and healthcare costs. This paper presents the findings of a systematic review about the effectiveness of programs that provided information, advice or education about the prevention of unintentional injuries to children under 15 years during outdoor play and leisure.

Methods A structured search strategy was conducted in a range of databases. All report titles and abstracts were screened using pre-defined criteria. Included reports were quality appraised using a modified Graphical Appraisal Tool for Epidemiological studies (GATE) tool. All quality appraisals and data extraction were checked by a second reviewer. If not provided in the original reports, ORs and mean differences were calculated, where sufficient data were available.

Results Twenty-three studies met the inclusion criteria. There was a paucity of robust study designs. The majority of studies only reported a short-term follow-up of intermediate outcome measures. Only two studies measured injury rates; both reported a reduction, but both studies also had considerable methodological weaknesses. The five studies that measured the use of protective equipment reported mixed results, although there is some evidence that suggests that more extensive educational programs (such as health fairs and media campaigns) increase their use. The 20 studies that measured behaviour, attitude or knowledge outcomes reported highly mixed results.

Discussion Methodological weaknesses of the included studies limit support for a particular course of action. To better inform policy and practice, future research should (1) use robust study designs and (2) not rely on short-term proxy outcome measures.

  • Health education
  • systematic review
  • child
  • adolescent
  • public health
  • qualitative research
  • health services

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  • Funding This review was part of a series of reviews on the prevention of unintentional injuries to children commissioned by the Centre for Public Health Excellence, National Institute for Health and Clinical Excellence (UK). The views expressed here are those of the authors and do not necessarily represent those of the National Institute for Health and Clinical Excellence.

  • Competing interests None.

  • Patient consent No human subjects were involved in this study (a systematic review).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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