Conclusion: Indications for effectiveness
Lister-Sharp et al. (1999) conducted a systematic review of existing reviews on the effectiveness of health promoting interventions in schools in the following areas: nutrition, exercise, safety, psychological aspects of health, sexual health, substance use, personal hygiene, environmental issues and family life education. They found that almost all the interventions, for which this outcome was reported, demonstrated improved health knowledge. The impact of interventions on attitudes, health-related behaviour and health was much less reliable. Interventions to promote healthy eating and fitness, prevent injuries and abuse, and promote mental health were found the most likely to be effective and those to prevent substance misuse, promote safe sex and oral hygiene the least effective.
Most interventions Lister-Sharp et al. (1999) found in their review, have used classroom (curriculum) approaches only. Some interventions combined a classroom approach with changes to the school ethos and environment or with family and community involvement. Interventions which included environmental approaches were more likely to be effective than those which did not. Interventions incorporating the involvement of family were more likely to be successful than those that did not. Furthermore, from the very limited evidence available there are indications that programmes based on social learning theory and social influences are the most effective.
Three reviews found by Lister-Sharp et al. were specifically on accident prevention (Klassen et al., 1995; Towner et al., 1995); Speller et al., 1995), on which is concluded that school-based accident prevention interventions might benefit from including resistance skills or self-efficacy development components. One of the reviews included in the review by Lister-Sharp et al. was specifically aimed at injury prevention (Klassen et al., 1995), on which was concluded that education interventions within the school setting targeted at young children are effective in improving safety bahaviour and in some cases actually injury rates.
Inman et al. (2011) performed a systematic review to identify evidence-based, peer-reviewed programs of school health education programs designed to reduce health risk for children. This review found two evidence-based effective programs of injury prevention in school settings aimed at children:
- The Think First for Kids (6-9 years). Adresses multiple injury and safety issues.The program increased knowledge about safety and injury prevention
- The Children's Traffic Safety Program (5-18 years). Adresses vehicle safety. The program increased safety restraint use (only in low-income school with good program implementation)
Recommendations (for research & practice)
For practice
Inman et al. (2011) recommend: 'Without following the developers' guidelines and ensuring fidelity of the program, an evidence-based program often will not produce the intended results.'
Dusenbury et al. (2005) found that teachers varied in adherence and quality of program delivery. All teachers made adaptations to the program. Program developers need to anticipate how and when teachers will modify programs and develop guidelines and recommendations to ensure program goals are met.
A controlled trial (Frederickson et al, 2000) found benefits of a combination of school didactic and hospital experiental learning on injury prevention (road safety, accidents in the home, fire, electricity, poisons, and waterways) knowledge, attitudes, and behaviours.
A controlled trial by Cook et al. (2006) found that using the teachable moment associated with an injured classmate, can contribute to retention of injury prevention education in school-aged children one month after the educational moment.
A controlled trial by Collard et al. (2010) found that an intervention program that targeted physical activity injuries was most effective in the reduction of injuries in children in the low active group.
For further research
Assessment of the effectiveness of different components was limited by inadequate reporting of intervention content. Ensure that process evaluation which describes the way in which programmes have been implemented is undertaken and reported in all studies of health promotion in schools (Lister-Sharp et al, 1999).
Dusenbury et al. ( 2005) note that a key variable thought to influence effectiveness of programs in school settings is quality of implementation. Their study proposes a methodology for measuring quality of implementation in school settings and presents data from a pilot study to test several of the proposed components. Their results suggest that quality of implementation can be measured through observation and interview.
Review Date: 04/03/2011
Version: 1.0
Status: Publish
Procedure
Articles (reviews) and reports were included that were published between 1990 and 2010, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute.
Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute and after this a more thorough search was performed by the documentation centre of CSI (Catalog CenV, Pubmed, Injury lit, Google, Websites, 'Grey' literature). Results of each search were compared on differences and potential missed studies were added. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).
The outcomes of the study were reviewed by an expert in the field of child safety in 2011.
Background documents
An evaluation of the effectiveness of the Injury Minimization Programme for Schools (IMPS) (version 1.1)
Katrina Frederick, Elizabeth Bixby, Marie-Noelle Orzel, ...[et al.] (2000)
Quality of implementation : developing measures crucial to understanding the diffusion of preventive interventions (version 1.0)
Linda Dusenbury, Rosalind Brannigan, William B. Hansen...[et al] (2005)
Effect of safety education on classmates of injured children : a prospective clinical trial (version 1.0)
B.S. Cook, C.D. Ricketts, R.L. Brown (2006)
Health promoting schools and health promotion in schools : two systematic reviews (version 1.0)
D. Lister-Sharp, S. Chapman, S. Stewart-Brown ... [et al.] (1999)
Evidence-based health promotion programs for schools and communities (version 1.0)
Dianna D. Inman, Karen M. van Bakergem, Angela C. LaRosa ...[et al.] (2011)
Process evaluation of a school based physical activity related injury prevention programme using the RE-AIM framework (version 1.0)
Dorine C.M. Collard, Mai J.M. Chinapaw, Evert A.L.M. Verhagen ...[et al] (2010)