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Towards improved understanding of injury prevention program sustainability
Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0001-6049-5402
Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
2005 (English)In: Safety Science, ISSN 0925-7535, Vol. 43, no 10, 815-833 p.Article in journal (Refereed) Published
Abstract [en]

As policy makers and funders have become more concerned with allocating scarce resources effectively, attention to the sustainability of health intervention programs has increased. However, the empirical knowledge base about factors facilitating or working against sustainability remains at an early stage. The aim of this study was to contribute to improved understanding of the conditions under which community-based injury prevention programs are most likely to attain sustainability. Ten Swedish community-based injury prevention programs were analysed with respect to factors that contribute to or detract from program sustainability. All the programs are integrated within existing municipality structures. Data were collected by means of semi-structured telephone interviews with key informants.

The results suggested that different factors are interrelated, with no one factor being either primary or by itself sufficient for program sustainability. Financial, human, and relational resources lay the groundwork for the long-term operation of a program. The “integrated” program model appears to facilitate sustainability, but program intensity is vulnerable to changes in the financial status of the municipality and the priority-setting by municipality political decision makers. Sustainability may be compromised if a program becomes too dependent on a few key individuals. In contrast to financial, human, and relational resources, structural resources (e.g., injury surveillance and goals) appeared to have limited influence on sustainability. The programs were sustained with little evidence of effectiveness, resulting in limited feedback about how to improve a program in order to achieve and maintain long-term effectiveness.

Place, publisher, year, edition, pages
2005. Vol. 43, no 10, 815-833 p.
Keyword [en]
Sustainability; Resources; Activities; Effects; Context
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13875DOI: 10.1016/j.ssci.2005.08.015OAI: oai:DiVA.org:liu-13875DiVA: diva2:22088
Available from: 2006-06-26 Created: 2006-06-26 Last updated: 2013-09-05
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, PerTimpka, ToomasNordenfelt, LennartLindqvist, Kent

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