Table 2

Main themes emerging in synthesis of nine articles on barriers to, and facilitators of, prevention of unintentional injury to children in the home

LevelType of barrierMain barriers identifiedMain facilitators identified
1. External: legal, policy or organisationalLegal/policy/health services
  • Weak legislation.

  • Absence of policy drivers influencing resources

  • Policy drivers and legislation.

  • Multi-agency partnerships, linking with other health messages or initiatives

Information and communication with householdsLack of appropriate information to parents/households about legislation and policies
  • Good communication between organisations and target audiences.

  • Involving local people (eg, mothers) to be trained in health initiatives.

  • Targeting of population (eg, schoolchildren) to share information

Socioeconomic circumstancesDisempowering effects of living in rented or overcrowded living conditions
2. Physical or environmentalHousingPractical barriers due to poor quality (often rented) housing
  • Stable and child-friendly accommodation.

  • Control/ownership of home environment

Equipment and maintenanceLack of maintenance of smoke alarms
  • Landlords' attention to safety issues.

  • Provision of appropriate and durable equipment.

  • Maintenance of and confidence in other safety devices

TrainingTraining in installation and equipment use/replacement
  • Cost of installing safety devices.

  • Costs of accessing treatment

3. IndividualUnderstanding of risk
  • Lack of awareness of risk.

  • Fatalism about nature of injuries

Awareness of risk
Mothers' safeguarding work
  • Mothers' work in safeguarding children.

  • Mothers' commitment to vigilance.

  • Teaching children about safety

Cultural background
  • Cultural differences in experiences and expectations.

  • Cultural practices in different cultural context.

  • Language barriers

Culturally sensitive information and advice systems
  • Relationship with partner.

  • Mistrust of officials.

  • Fear of being accused of abuse or neglect.

  • Not trusting neighbours/non-family to look after child

  • Social connectedness rather than isolation.

  • Building trust in officials via peer education