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Effectiveness of Community-Based Injury Prevention: Injury Rate Levels, Changes, and Trends for 14 Swedish WHO-Designated Safe Communities
Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
Karolinska Institute, Department of Public Health Science, Division of Social Medicine, Stockholm, Sweden.
Karolinska Institute, Department of Public Health Science, Division of Social Medicine, Stockholm, Sweden.
Swedish Rescue Services Agency, National Centre for Learning from Incidents and Accidents (NCO), Karlskoga, Sweden.
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2007 (English)In: Accident Analysis and Prevention, ISSN 0001-4575, Vol. 39, no 2, 267-273 p.Article in journal (Refereed) Published
Abstract [en]

This study investigates the injury rate levels, changes, and trends between 1987 and 2002 for the 14 Swedish municipalities designated as WHO Safe Communities. The injury rate was defined as the number of injured patients discharged from hospital per 1000 persons. Injury rates were age standardised. Each municipality was compared with its respective municipality group, according to a classification of Sweden's 288 municipalities into nine groups based on numerous structural parameters.

The average injury rate levels for the 14 WHO-designated Safe Community municipalities ranged from 11.54 to 19.09 per 1000 population during the study period, which was defined as the time period during which a municipality's injury prevention program has been operational. Eleven of 14 municipalities had higher levels than their corresponding municipality groups. Five of the 14 municipalities “outperformed” their respective municipality groups and achieved a greater relative injury rate decrease during the study period. The trends for the 14 municipalities in relation to their municipality groups showed an inconsistent pattern, with only four municipalities exhibiting overall favourable trends for the study period.

Place, publisher, year, edition, pages
2007. Vol. 39, no 2, 267-273 p.
Keyword [en]
Intervention effectiveness, Community-based, Injury prevention, WHO Safe Community
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13874DOI: 10.1016/j.aap.2006.07.007OAI: oai:DiVA.org:liu-13874DiVA: diva2:22087
Available from: 2006-06-26 Created: 2006-06-26 Last updated: 2009-05-08
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
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 948
Keyword
Community-based, injury prevention, programmes, evaluation, effectiveness, Samhällsbaserad, skadeprevention, program, utvärdering, effektivitet
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
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)
Opponent
Supervisors
Available from: 2006-06-26 Created: 2006-06-26 Last updated: 2013-09-05

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Nilsen, PerLindqvist, Kent

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