title: Promoting child safety in primary care: a cluster randomised controlled trial to reduce baby walker use.
abstract: BACKGROUND
  Baby walkers are commonly used items of nursery equipment, but cause more than 3000 injuries each year in the UK. There is currently little evidence regarding the effectiveness of interventions in primary care to reduce walker use.
  
  
  OBJECTIVE
  To evaluate the effectiveness of an educational package provided by midwives and health visitors to reduce baby walker possession and use.
  
  
  METHODS
  Cluster randomised controlled trial.
  
  
  METHODS
  Sixty-four general practices in Nottingham and North Nottinghamshire, UK.
  
  
  METHODS
  An educational package aimed at discouraging mothers-to-be from obtaining and using a walker was delivered by midwives and health visitors to 1174 mothers-to-be of at least 28 weeks gestation. The control arm received usual care. Primary outcome measures were the possession and use of a walker. Secondary outcome measures included the frequency and duration of walker use, knowledge and attitudes towards walkers, plans to use a walker with future children, recommending a walker to a friend, and use of stair gates and fire guards.
  
  
  RESULTS
  Intervention arm participants were significantly less likely to own (odds ratio [OR] = 0.63, 95% confidence interval [CI] = 0.43 to 0.93) or to use a walker (OR = 0.26, 95% CI = 0.08 to 0.84). They were significantly less likely to plan to use a walker with their next child (OR = 0.52, 95% CI = 0.31 to 0.86) or to agree that walkers keep children safe (OR = 0.35, 95% CI = 0.16 to 0.78). There was some evidence that they were less likely to recommend a walker to a friend (OR = 0.51, 95% CI = 0.28 to 0.91) or to agree that they help children to walk more quickly (OR = 0.53, 95% CI = 0.29 to 0.95).
  
  
  CONCLUSIONS
  An educational package delivered by midwives and health visitors was effective in reducing baby walker possession and use. Providers of primary healthcare services should include baby walker education in their injury prevention strategy and child health promotion programme.
authors.affiliation: Department of Health Public Health Career Scientist, Trent Institute for Health Services Research, University of Nottingham, Nottingham. denise.kendrick@nottingham.ac.uk
authors.forename: Denise
authors.initials: D
authors.lastname: Kendrick
authors.forename: Rachel
authors.initials: R
authors.lastname: Illingworth
authors.forename: Amanda
authors.initials: A
authors.lastname: Woods
authors.forename: Kim
authors.initials: K
authors.lastname: Watts
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Collier
authors.forename: Michael
authors.initials: M
authors.lastname: Dewey
authors.forename: Rhydian
authors.initials: R
authors.lastname: Hapgood
authors.forename: Chih-Mei
authors.initials: CM
authors.lastname: Chen
mesh_terms: D000056:Accident Prevention / Q000379:methods*; D000328:Adult; D001294:Attitude to Health; D002662:Child Health Services / Q000458:organization & administration; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D007223:Infant; D015370:Infant Equipment / Q000706:statistics & numerical data*; D009035:Mothers / Q000523:psychology*; D010353:Patient Education as Topic / Q000379:methods*; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration; D011314:Preventive Health Services / Q000458:organization & administration; D011795:Surveys and Questionnaires