Objective: To examine the utilisation-related outcomes associated with visiting the Johns Hopkins CareS (Children are Safe) Mobile Safety Center (MSC), a 40-foot vehicle designed to deliver effective injury prevention interventions and education to low-income urban families.
Design and setting: Utilisation-related data were collected when the MSC was accessible at a community health centre and at community events from August 2004 to July 2006 in Baltimore City.
Subjects: Adults bringing their child for well child care at a community health centre and MSC visitors at community events.
Interventions: Low-cost safety products and free personalised educational services are provided on the MSC, which replicates a home environment and contains interactive exhibits.
Main outcome measures: Perceived benefits of visiting the MSC; products and services received.
Results: MSC visitors (n = 83) and non-visitors (n = 127) did not differ in sociodemographic and injury-related characteristics; 96% of visitors reported learning something new as a result of their visit and 98% would recommend the MSC. During the first 2 years of operation, the MSC made 273 appearances, serving 6086 people. Home child safety products accounted for 71% of the 559 products distributed; educational materials made up 87% of the 7982 services received. Car safety seats accounted for 23% of the products distributed; installations made up 4% of the services received.
Conclusions: This approach to disseminating injury prevention interventions holds promise for enhancing the appeal of safety information and increasing the protection of children.
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Unintentional injuries remain the leading cause of death for children and young people in the USA.1 Childhood injuries disproportionately affect the poor and certain minority populations, which is thought to be due to living in hazardous urban environments and a host of social disparities.2–4 Disseminating known effective injury prevention interventions such as smoke alarms and car safety seats to low-income urban families remains a challenge. Access barriers, including lack of availability in convenient locations and high costs of some safety products, along with structural design challenges in homes, are particular problems for these families.56 Bringing low-cost safety products and personalised education directly to families may help to address the needs of low-income urban families. Programmes that have been evaluated across a spectrum of populations and with mixed results include physician advice accompanied by product distribution, car seat checks, a hospital-based safety centre and home visiting programmes.7–11
Another possible approach is the delivery of services through a mobile unit, as has been done for asthma and dental healthcare in urban communities.1213 Mobile units have the potential advantage of being able to serve multiple clinic and community settings rather than being restricted to one site. The Home Safety Council’s Great Safety Adventure14 and the Jungle Mobile Project of the Kiwanis Pediatric Trauma Institute at the Children’s Hospital Trauma Services15 are mobile units that provide safety education targeted directly to children. In addition, many fire departments have safety vehicles that provide fire and life safety education at schools and community events. However, we could find no published evaluations of such programmes. Given their utility for other urban health problems, it is reasonable to think that a mobile unit may be effective for the delivery of injury prevention interventions as well.
We created and evaluated the Johns Hopkins CareS (Children are Safe) Mobile Safety Center (MSC) a 40-foot vehicle designed to deliver effective injury prevention interventions and education to low-income urban families. The MSC has delivered products and services in Baltimore in two different contexts: at a community health centre and at a variety of community events. The specific objectives of this paper are to: (1) compare characteristics of MSC visitors with those of non-visitors; (2) describe the perceived benefits reported by MSC visitors; (3) describe and compare the types of products and services disseminated by the MSC in the two different contexts.
This MSC is a 40-foot “house on wheels” that contains interactive educational exhibits focused on common childhood injury topics such as burns/scalds, fires, drowning, falls, choking and motor vehicle and pedestrian injuries (fig 1). The project is a partnership between the Johns Hopkins Bloomberg School of Public Health (SPH), the Baltimore City Fire Department (BCFD) and several other local organisations (Johns Hopkins Children’s Safety Center, Maryland Science Center, Maryland Institute College of Art, Johns Hopkins Community Physicians, Injury Free Coalition for Kids/Baltimore and Johns Hopkins Pediatric Trauma Service). The conceptualisation and creation of the MSC was based on prior research demonstrating the benefits of a hospital-based children’s safety centre,16–18 and after completion of a needs assessment indicating that community health clinics wanted the services of a safety resource centre, but had neither the space nor the resources to open one (unpublished work). Funding was provided by a variety of public and private sources as well as in-kind contributions from community partners. The BCFD provides the routine operating expenses for the vehicle. More detailed descriptions of the partnership that created and implemented the MSC are available from the authors.
The safety education curriculum developed by the authors was based on information from national safety organisations and agencies, as well as materials previously created and used in the hospital-based children’s safety centre.16–18 Input was also obtained from parents recruited through East Baltimore community organisations. All public education professionals from BCFD and SPH health educators who staff the MSC received training from the authors in use of the curriculum.
Although the curriculum is comprehensive, educators tailored the material to each MSC visitor or group of visitors on the basis of their needs (eg, age of their children, time available). The visits could last from 15 to 40 minutes and included demonstrations of various safety products and hands-on opportunities for visitors to practise using specific products. Print materials appropriate for a low-literacy audience were also distributed. Safety products were sold at below retail costs, such as safety gates (US$11.50–27.00), cabinet locks (US$1.10–2.00), bike helmets (US$10) and car seats (US$10–60). Services such as free car seat installations and referrals to the BCFD’s free smoke alarm installation programme were also offered. Both the curriculum and the safety products were chosen to be responsive to the most important hazards for children in Baltimore according to injury data examined during the planning stages.
The study period for this analysis covers the first 2 years of MSC operation, from August 2004 through July 2006. During that period, the MSC visited a community health centre approximately 2 days a week to serve low-income families being seen in their paediatric clinic. In addition to the trial described below, the MSC was widely advertised and its services open to anyone in the clinic. When not at the health centre, the MSC made appearances at community events throughout the city, such as health fairs, bike rodeo and school and community events.
For the first two study objectives, we use data collected for a randomised trial of the MSC conducted at the community health centre.19 Briefly, on the days when the MSC was at the health centre, the study recruiter randomly assigned families to one of two intervention groups. The prescribed group (n = 69) was told that, as part of the study, they needed to visit the MSC after their physician visit. The optional group (n = 70) was simply informed by the recruiter that the MSC was available and they were encouraged to visit. The comparison group (n = 71) was made up of families enrolled on days when the MSC was not at the health centre, who were given a schedule of MSC appearances. Participants were parents or guardians of children younger than 7 years; 91% were the child’s mother. Enrolment interviews collected information on sociodemographic and injury-related characteristics. Follow-up interviews were conducted in participants’ homes 2 weeks and 4 months after enrolment. Of the 210 families who completed the evaluation, a total of 47 from the prescribed group, 29 from the optional group and seven from the comparison group had visited the MSC by the time of their first follow-up interview. These families form the sample used in the present analysis comparing visitors (n = 83) and non-visitors (n = 127) and reporting on visitors’ perceived benefits of the MSC.
For the third objective, to examine the dissemination of products and services, we used administrative data routinely collected on the MSC to monitor utilisation. From August 2004 through July 2006, the MSC attended 76 community events, in addition to being at the community health centre for a total of 197 days. Data collected on number and age of visitors and the products and services that they received are used in this analysis.
The study was approved by the institutional review boards of the Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Community Physicians, which oversees the participating community health centre.
From the health centre interview data, we obtained sociodemographic (age, education, employment status, income, ethnicity, number of children) and injury-related characteristics (prior child injury, no working smoke alarm, no car safety seat, no locked place to store poisons). Those who visited the MSC were asked about their perceived benefits of visiting: (1) what they learned from their visit (learned nothing new, learned a little, learned a lot); (2) if they would recommend the MSC to a friend or family member. From the MSC administrative data, we collected products and services received: car seats; bicycle safety products (helmets, pads); child home safety products (locks/latches, knob covers, electric outlet covers, bath safety products); referral to BCFD free smoke alarm programme; bicycle helmet fitting; car seat installation/check; educational handouts.
Sociodemographic and injury-related characteristics of MSC visitors and non-visitors at the health centre are compared using contingency tables with χ2 tests. Simple frequencies are then presented to describe perceived benefits to MSC visitors at the health centre. Finally, frequencies of products and services received by visitors at the health centre and at community events are presented.
Characteristics of MSC visitors and non-visitors
There were no significant differences in sociodemographic or injury-related characteristics between those who visited the MSC and those who did not (table 1). At enrolment, more than one-quarter of families reported having no working smoke alarm, more than one-third had no locked place for poisons, and almost one-half of the families reported not having the correct car seat for their child.
Perceived benefits of visiting the MSC
Virtually all visitors reported learning something new during their visit (96%) and that they would recommend the MSC to a friend or family member (98%) (table 1).
Safety products and services provided to MSC visitors
Table 2 displays the numbers of adults and children reached when the MSC was at the health centre and at community events as well as the products and services provided. In total, 6086 people (22.3 per appearance) were served on the MSC during the first 2 years of operation. On a per appearance basis, the community events yielded 13.6 adults with 1.7 safety products distributed and 48.2 services provided, whereas the health centre yielded 5.0 adults with 2.2 safety products distributed and 21.9 services provided. Children were reached in larger numbers at community events (43.3 per appearance) relative to the health centre (3.9 per appearance).
Home child safety products represented the largest proportion of products distributed (71%), with car safety seats representing another 23%. Car safety seat products and services represented a large proportion of the activity at the health centre (28% of the products and 7% of the services), whereas bike safety products and services represented a large proportion of the activity at community events (12% of the products and 14% of the services). The largest proportion of services in both settings was the distribution of educational handouts (91% at the health centre and 82% at the community events).
The central goal of this work was to examine the utilisation-related outcomes and perceived benefits associated with visiting a mobile safety centre. To our knowledge, these results provide the first evidence that such a mobile unit can be an effective dissemination vehicle for injury prevention services and safety products. At the health centre, we could not detect any differences between persons who visited the MSC and those who did not in terms of sociodemographic or injury-related characteristics, suggesting that this type of resource may be useful for urban families with a range of backgrounds and safety needs. In fact, the MSC was extremely well received by visitors, with virtually all reporting that they would recommend it to a friend and that they learned something new from their visit.
What is already known on this topic
Childhood injuries are a significant threat to families living in low-income urban environments.
Finding effective ways to disseminate known effective injury prevention interventions such as smoke alarms and car safety seats to low-income urban families remains a challenge.
Mobile units have been used effectively to deliver health-related services to urban populations, but they have not been evaluated for their potential in injury prevention.
What this study adds
A mobile safety centre can address access and affordability barriers by bringing injury prevention information and life-saving interventions directly to families.
Visiting a mobile safety centre in conjunction with well child care and at community events was well received by families and offers a new approach to disseminating injury prevention interventions.
Partnerships among multiple stakeholders such as fire safety professionals, paediatric healthcare providers, public health professionals and others made the creation and implementation of a mobile safety centre feasible.
The health centre and community event settings appeared to have somewhat different utilisation indicators. For instance, we reached more adults and children per appearance through community events, and we distributed more educational materials. However, we were able to provide more in-depth car seat installation services at the health centre and more bike safety products and helmet fittings at community events. Thus, both venues offer opportunities for potential benefits: increased awareness among large numbers at community events and more focused attention on time-consuming car seat issues at the health centre providing well child care.
These findings support the idea that a mobile safety centre can be an effective community resource for distributing safety products and services in high-need urban settings and educating families in ways that they enjoy. The importance of continuing to seek effective ways of disseminating safety products to low-income urban families is underscored by our findings that more than one-quarter of families reported having no working smoke alarm, more than one-third had no locked place for poisons, and almost one-half of the families reported not having the correct car seat for their child.
Limitations and lessons learned
This descriptive study is limited in its generalisability given that we collected data in only one health centre and from community events in a single city. We are also limited to self-reported uptake of safety products, and we cannot comment on the extent to which those families who obtained products properly installed or used them over time. However, the data presented here capture the full range of activities of a new community resource during its first 2 years in the field and offer insights for practitioners and future research. We are encouraged by the findings that a community resource such as the mobile safety centre was appealing to a large number of families and well received by those who visited. The reported knowledge gains and uptake of safety products by visitors bodes well for this approach to enhancing the appeal of child safety information and increasing dissemination of proven effective safety products.
The ability to offer safety products at reduced costs may be particularly important for use of this model in a low-income community. Although launching a mobile unit is initially resource intensive, the partnerships and collaborations that were essential for implementation also allowed the costs to be shared among the multiple participating organisations. Future evaluations of the longer-term impact of this approach and the programme’s cost-effectiveness are warranted.
IMPLICATIONS FOR PREVENTION
Diverse stakeholders such as fire safety professionals, paediatric healthcare providers and public health professionals are concerned with preventing injuries to children. The MSC provided an opportunity for multiple disciplines to combine forces to create a unique dissemination vehicle for injury prevention interventions. The positive response to the MSC in terms of utilisation and visitor feedback suggest that mobile units may be as appropriate for injury prevention as they have been for other health conditions. This method of resource delivery is especially important for families living in low-income urban environments where there is high risk of injury and limited access to proven effective interventions.
Funding for this research was provided by the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Grants No R49/CCR322401 and R49/CE00027. We gratefully acknowledge the considerable assistance of members of the partnership who contributed to the creation and implementation of the Mobile Safety Center: Bernard Caniffe, Manjit Goldberg, Richard Lipscher, Charles Paidus, Theodore Saunders, Kevin Williams, Dawona Young and Susan Ziegfeld. We also extend our sincere appreciation to others who made this research possible: Pasquale Bernardi, Dan Bitzel, Paul Colombani, Robert Doedderlein, Jeanne McCauley, Ben Selassi, Rosemary Nabaweesi and Mei Cheng Wang.
The CareS (Children are Safe) Mobile Safety Center Partnership consists of Johns Hopkins Center for Injury Research and Policy, Baltimore City Fire Department, Maryland Science Center, Maryland Institute College of Art, Johns Hopkins Community Physicians, Johns Hopkins Pediatric Trauma Service, Johns Hopkins Children’s Safety Center and Injury Free Coalition for Kids/Baltimore
Competing interests: None.
Ethics approval: Obtained.
Patient consent: Obtained.
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