title: Preventing unintentional injuries to children under 15 years in the outdoors: a systematic review of the effectiveness of educational programs.
abstract: BACKGROUND
  Unintentional injuries to children in the outdoors have a significant impact on child mortality, development and healthcare costs. This paper presents the findings of a systematic review about the effectiveness of programs that provided information, advice or education about the prevention of unintentional injuries to children under 15 years during outdoor play and leisure.
  
  
  METHODS
  A structured search strategy was conducted in a range of databases. All report titles and abstracts were screened using pre-defined criteria. Included reports were quality appraised using a modified Graphical Appraisal Tool for Epidemiological studies (GATE) tool. All quality appraisals and data extraction were checked by a second reviewer. If not provided in the original reports, ORs and mean differences were calculated, where sufficient data were available.
  
  
  RESULTS
  Twenty-three studies met the inclusion criteria. There was a paucity of robust study designs. The majority of studies only reported a short-term follow-up of intermediate outcome measures. Only two studies measured injury rates; both reported a reduction, but both studies also had considerable methodological weaknesses. The five studies that measured the use of protective equipment reported mixed results, although there is some evidence that suggests that more extensive educational programs (such as health fairs and media campaigns) increase their use. The 20 studies that measured behaviour, attitude or knowledge outcomes reported highly mixed results.
  
  
  CONCLUSIONS
  Methodological weaknesses of the included studies limit support for a particular course of action. To better inform policy and practice, future research should (1) use robust study designs and (2) not rely on short-term proxy outcome measures.
authors: Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, University of Exeter, Exeter, UK. mark.pearson@pms.ac.uk
authors: Mark
authors: M
authors: Pearson
authors: Harriet
authors: H
authors: Hunt
authors: Ruth
authors: R
authors: Garside
authors: Tiffany
authors: T
authors: Moxham
authors: Jaime
authors: J
authors: Peters
authors: Rob
authors: R
authors: Anderson
mesh_terms: D000056:Accident Prevention / Q000379:methods*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006266:Health Education / Q000592:standards*; D006801:Humans; D007223:Infant; D007899:Leisure Activities; D008297:Male; D014947:Wounds and Injuries / Q000517:prevention & control*