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Evaluation of the effectiveness, implementation and cost-effectiveness of the Stay One Step Ahead home safety promotion intervention for pre-school children: a study protocol
  1. Elizabeth Orton1,
  2. Michael Craig Watson2,
  3. Mike Hayes3,
  4. Tina Patel1,
  5. Matthew Jones1,
  6. Carol Coupland1,
  7. Clare Timblin1,
  8. Hannah Carpenter1,
  9. Denise Kendrick1
  1. 1 Division of Primary Care, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, Nottingham, UK
  2. 2 Institute of Health Promotion and Education, Litchfield, UK
  3. 3 Child Accident Prevention Trust, London, UK
  1. Correspondence to Dr Elizabeth Orton, Division of Primary Care, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, Nottingham, UK; elizabeth.orton{at}


Background Unintentional injuries in children under the age of 5 years commonly occur in the home and disproportionately affect those living in disadvantaged circumstances. Targeted home safety promotion should be offered to families most at risk but there is a paucity of standardised evidence-based resources available for use across family-support practitioners.

Objective To assess the effectiveness, implementation and cost-effectiveness of a 2-year home safety programme (Stay One Step Ahead) developed by parents, practitioners and researchers, and delivered by a range of family support providers in inner-city localities, compared with usual care in matched control localities.

Methods Parents of children aged 0 to 7 months will be recruited to a controlled before and after observational study. The primary outcome is home safety assessed by the proportion of families with a fitted and working smoke alarm, safety gate on stairs (where applicable) and poisons stored out of reach, assessed using parent-administered questionnaires at baseline, 12 and 24 months.

Secondary outcomes include: the impact on other parent-reported safety behaviours, medically-attended injuries, self-efficacy for home safety and knowledge of child development and injury risk using questionnaires and emergency department attendance data; implementation (reach, acceptability, barriers, facilitators) of home safety promotion assessed through interviews and observations; and cost-effectiveness using medically-attended injury costs ascertained from healthcare records.

Conclusion If shown to be effective and cost-effective this study will provide a practical resource to underpin national guidance. The study could inform public health prevention strategies to reduce home injury in children most at risk, while delivering cost savings to health and care services.

Trial registration number ISRCTN31210493; Pre result.

  • behavior change
  • health education
  • public health
  • program evaluation
  • child
  • home

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  • Contributors EO, DK, MW, MH, MJ, CC and HC designed the main study methods, data analysis plan and data collection tools. MJ led the design of the economic study and its data collection tools with input from all other authors. CT and HC prepared documentation for the ethics committee. EO, DK and MW drafted the manuscript with revisions additionally from MH, MJ, CC, CT, TP and HC. EO is the guarantor of the manuscript.

  • Funding This project was funded by grant SSBC002 from Small Steps Big Changes, part of the National Lottery Community Fund’s A Better Start programme.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval This study has received ethical approval from East Midlands - Leicester Central Research Ethics Committee, reference 17/EM/0240.

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

  • Data availability statement Data sharing not applicable as this is a study protocol and no data sets have been generated and/or analysed.