Promoting child safety in primary care: a cluster randomised controlled trial to reduce baby walker use.
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.
Kendrick
Denise
D
Department of Health Public Health Career Scientist, Trent Institute for Health Services Research, University of Nottingham, Nottingham. denise.kendrick@nottingham.ac.uk
Illingworth
Rachel
R
Woods
Amanda
A
Watts
Kim
K
Collier
Jacqueline
J
Dewey
Michael
M
Hapgood
Rhydian
R
Chen
Chih-Mei
CM
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