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- Peter Elton (11 August 1998)
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Peter Elton
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The results of the study by Clamp and Kendrick (1) were convincing but it would be dangerous to overgeneralise their results. Two linked studies of health visitor interventions in the North West of England failed to demonstrate that such interventions improved home safety(2). In one study, the health visitors designed a checklist, for a home visit at 3 months, to use as a basis of giving health safety advice and supporting leaflets. From matched pairs of primary health care teams, teams were randomly allocated to the intervention or control group. There were 261 families in the served by health visitors from the primary health care teams in the intervention group and 415 families in the control group. In analysing for the presence of stairgates, socket covers, functioning smoke detectors and protection for glass, it was found that, although the overall provision of safety equipment had increased, there was little difference between the trial and the control groups. In the other study in a neighbouring borough, health visitors designed two, more detailed interventions, one around the installation of smoke detectors and the other around car safety seats for the primary visit (10-21 days) supported by information sheets. In this study , the unit of randomisation was the health visitor, with a health visitor intervening for one of the safety measures and acting as a control for the other safety measure. There were 311 families seen by health visitors in the smoke detector group and 376 families in the car seat group. There was no significant difference in the proportion with working smoke detectors or car seats at the 6-8 week visit. The difference between these studies and Clamp and Kendrick may be explained by the nature of the intervention. The provision of subsidised safety equipment may not only have made purchase easier but it might also have sent out a message about the importance that the health professionals were giving to home safety. It may also be that the general practitioner giving the safety advice gave that advice extra weight. The evidence should be used not only to indicate whether it is worthwhile to give home safety advice but also how that advice should be given. Peter Elton, Director of Public Health Wigan and Bolton Health Authority Wigan WN1 1AH 1 Clamp M, Kendrick D, A randomised controlled trial of general practitioner safety advice for families with children under 5 years. BMJ 1998;316;1576-9 2 Tiler C, Sandys, Maxson P, Evaluating the effectiveness of health visitor interventions to improve home safety, Public Health Resource Centre, Bury, Rochdale and West Pennine Health Authorities 1996 |
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