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Developing drowning prevention strategies for rivers through the use of a modified Delphi process
  1. Amy E Peden1,2,
  2. Richard C Franklin1,2,
  3. Peter A Leggat2,3
  1. 1 Royal Life Saving Society - Australia, Broadway, New South Wales, Australia
  2. 2 College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
  3. 3 School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
  1. Correspondence to Amy E Peden, Royal Life Saving Society - Australia, Broadway, New South Wales 2007, Australia; apeden{at}


Introduction Internationally, rivers are a leading drowning location, yet little evidence exists evaluating river drowning prevention strategies. This study aims to use expert opinion to identify strategies more likely to be effective.

Methods Using a modified Delphi process, a virtual panel of 30 experts from 12 countries considered, grouped and prioritised strategies for river drowning prevention. Proposed strategies were assessed against known evidence and suitability in high-income countries (HICs) as well as low-income and middle-income countries (LMICs) using expert opinion. The final phase consolidated a list of strategies whose effectiveness was assessed against 10 evidence-based river drowning scenarios.

Results An initial list of 424 prevention strategies was refined to 22. After being assessed against the 10 scenarios, a final list of 13 strategies was derived. Strategies addressed alcohol consumption around rivers, flood mitigation, improving child supervision, learning to swim, increased lifejacket wear and achieving community-wide resuscitation skills.

Discussion While all 13 strategies were assessed as being effective in both LMICs and HICs by at least 60% of the respondents, further work is required to define river drowning at a country level and therefore allow for effective solutions to be developed, particularly in LMICs. No strategy will be effective in isolation and must be implemented alongside policy and behaviour change, public awareness and education. Evaluation should be incorporated as part of any future implementation of strategies.

Conclusion This Delphi process identified 13 drowning prevention strategies for rivers. Further research is required to validate the efficacy of these findings through implementation and evaluation.

  • drowning
  • methodology
  • behavior change
  • public health
  • education
  • enforcement

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  • Contributors AEP and RCF conceptualised the study. AEP and RCF identified the experts, and AEP invited them to participate. AEP and RCF designed the surveys. AEP collated the data and conducted the analysis. RCF provided assistance and advice on data analysis. AEP drafted the manuscript. RCF reviewed and revised the manuscript. PAL reviewed and revised the manuscript.

  • Funding This research is supported by the Royal Life Saving Society – Australia to aid in the reduction of drowning. Research at the Royal Life Saving Society – Australia is supported by the Australian Government. Lead author AEP’s doctoral studies are supported through an Australian Government Research Training Program Scholarship.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by James Cook University Human Research Ethics Committee (HREC) (H7166).

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

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