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What makes community based injury prevention work?: In search of evidence of effectiveness
Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
2004 (English)In: Injury Prevention, ISSN 1353-8047, Vol. 10, no 5, 268-274 p.Article in journal (Refereed) Published
Abstract [en]

Community based injury prevention work has become a widely accepted strategy among safety promotion specialists. Hundreds of community based injury prevention programs have been implemented since the mid-1970s, but relatively few have been evaluated rigorously, resulting in a lack of consensus regarding the effectiveness of this approach. This study sought to identify key components that contribute to the effectiveness of these programs. The objective was to gain a better understanding of the community based model for injury prevention. The study was performed as a structured review of existing evaluations of injury prevention programs that employed multiple strategies to target different age groups, environments, and situations.

The results of this study suggested that there are complex relationships between the outcome and the context, structure, and process of community-wide injury prevention programs. The interconnectedness of these variables made it difficult to provide solid evidence to prioritise in terms of program effectiveness. The evaluations of multifaceted community oriented injury prevention programs were found to have many shortcomings. Meagre descriptions of community characteristics and conditions, insufficient assessment of structural program components, and failure to establish process-outcome relationships contributed to the difficulty of identifying key success factors of the programs.

Place, publisher, year, edition, pages
2004. Vol. 10, no 5, 268-274 p.
Keyword [en]
community based injury prevention, evidence of effectiveness
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13873DOI: 10.1136/ip.2004.005744OAI: diva2:22086
Available from: 2006-06-26 Created: 2006-06-26 Last updated: 2009-05-28
In thesis
1. Opening the Black Box of Community-Based Injury Prevention Programmes: Towards Improved Understanding of Factors that Influence Programme Effectiveness
Open this publication in new window or tab >>Opening the Black Box of Community-Based Injury Prevention Programmes: Towards Improved Understanding of Factors that Influence Programme Effectiveness
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Despite wide application of community-based programmes to prevent injuries and promote health over the last 25 years, there is a paucity of evaluations from which to obtain evidence regarding the effectiveness and critical factors contributing to achieving effectiveness of these programmes. Research on community-based injury prevention programmes thus far has been driven by the question “does it work?” However, merely establishing whether a programme works or not provides insufficient information to generate new knowledge about these programmes. Many programme evaluations have been characterised as “black box” evaluations, with inadequate information about the intervening and contextual factors that mediate the relationship between the programme and its effects. Opening the black box is essential to developing the best evidence in relation to community-based programmes.

Keeping the question “does it work?” in mind as a departure point, the seven studies of this thesis address different aspects of the questions “why does it work?” and “how does it work?” The aim is to aid in the understanding of factors that influence the operation and effectiveness of community-based injury prevention programmes.

The findings from the studies support a number of conclusions with regard to the three research questions posed. There is limited evidence for the effectiveness of communitybased injury prevention programmes. Some of the problems of providing convincing evidence are due to the methodological difficulties of evaluating these programs.

Contextual conditions and the amount of financial resources available to a programme are key factors associated with the effectiveness of community-based injury prevention programmes. There is inconclusive evidence regarding the importance of some of the socalled success factors described in the scientific literature for achieving effectiveness. While many programmes have access to locally collected injury data, they devote limited time to the analysis of this ssembled data. When selecting interventions, many programmes rely upon tuitive and subjective methods, e.g. discussions in networks, feedback from the general public, and experiences gained in their own work. This style of decision making is “experience-based” rather than evidence-based.

The theoretical underpinning of the community-based approach has certain shortcomings, which could explain some of the difficulties in demonstrating effectiveness seen with many of these programmes. Programmes overwhelmingly define geographical units as communities. However, these entities can be highly heterogeneous and characterised by a weak sense of community, which can yield insufficient community member participation and intersectoral collaboration, as well as inadequate reach for many programmes. At the same time, none of the most plausible assumptions of the community-based approach appears to be fully or widely applied in programme practice. The implication is that many community-based programmes do not function at an optimum level.

Place, publisher, year, edition, pages
Institutionen för hälsa och samhälle, 2006
Linköping University Medical Dissertations, ISSN 0345-0082 ; 948
Community-based, injury prevention, programmes, evaluation, effectiveness, Samhällsbaserad, skadeprevention, program, utvärdering, effektivitet
National Category
Public Health, Global Health, Social Medicine and Epidemiology
urn:nbn:se:liu:diva-7001 (URN)91-85497-85-1 (ISBN)
Public defence
2006-06-07, Aulan, Hälsans hus, Hälsouniversitet, Linköping, 13:00 (English)
Available from: 2006-06-26 Created: 2006-06-26 Last updated: 2013-09-05

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