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Facilitators and barriers for the adoption, implementation and monitoring of child safety interventions: a multinational qualitative analysis
  1. Beatrice Scholtes1,2,
  2. Peter Schröder-Bäck1,3,
  3. J Morag MacKay4,
  4. Joanne Vincenten1,
  5. Katharina Förster1,
  6. Helmut Brand1
  1. 1Faculty of Health, Medicine and Life Sciences, CAPHRI School of Public Health and Primary Care, Department of International Health, Maastricht University, Maastricht, The Netherlands
  2. 2Bureau de Projets, Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman, Liège, Belgium
  3. 3Faculty for Human and Health Sciences, University of Bremen, Bremen, Germany
  4. 4SafeKids Worldwide, Washington DC, USA
  1. Correspondence to Beatrice Scholtes, Faculty of Health, Medicine and Life Sciences, Department of International Health, School of Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Beatrice.scholtes{at}


The efficiency and effectiveness of child safety interventions are determined by the quality of the implementation process. This multinational European study aimed to identify facilitators and barriers for the three phases of implementation: adoption, implementation and monitoring (AIM process). Twenty-seven participants from across the WHO European Region were invited to provide case studies of child safety interventions from their country. Cases were selected by the authors to ensure broad coverage of injury issues, age groups and governance level of implementation (eg, national, regional or local). Each participant presented their case and provided a written account according to a standardised template. Presentations and question and answer sessions were recorded. The presentation slides, written accounts and the notes taken during the workshops were analysed using thematic content analysis to elicit facilitators and barriers. Twenty-six cases (from 26 different countries) were presented and analysed. Facilitators and barriers were identified within eight general themes, applicable across the AIM process: management and collaboration; resources; leadership; nature of the intervention; political, social and cultural environment; visibility; nature of the injury problem and analysis and interpretation. The importance of the quality of the implementation process for intervention effectiveness, coupled with limited resources for child safety makes it more difficult to achieve successful actions. The findings of this study, divided by phase of the AIM process, provide practitioners with practical suggestions, where proactive planning might help increase the likelihood of effective implementation.

  • Interventions

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  • Contributors BS, PS-B, JMM, JV and HB were all involved in the design of the study. Data collection and analysis was conducted by BS, PS-B, JMM, JV and KF. All authors were involved in revision of the manuscript.

  • Funding European Commission under the EU Health Programme 2008–2013 project number 20101212.

  • Competing interests None.

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

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