title: Effect of a multi-level education intervention model on knowledge and attitudes of accidental injuries in rural children in Zunyi, Southwest China.
abstract: OBJECTIVE
  To explore the effect of a school-family-individual (SFI) multi-level education intervention model on knowledge and attitudes about accidental injuries among school-aged children to improve injury prevention strategies and reduce the incidence of pediatric injuries.
  
  
  METHODS
  The random sample of rural school-aged children were recruited by using a multistage, stratified, cluster sampling method in Zunyi, Southwest China from 2012 to 2014, and 2342 children were randomly divided into intervention and control groups. Then children answered a baseline survey to collect knowledge and attitude scores (KAS) of accidental injuries. In the intervention group, children, their parents/guardians and the school received a SFI multi-level education intervention, which included a children's injury-prevention poster at schools, an open letter about security instruction for parents/guardians and multiple-media health education (Microsoft PowerPoint lectures, videos, handbooks, etc.) to children. Children in the control group were given only handbook education. After 16 months, children answered a follow-up survey to collect data on accidental injury types and accidental injury-related KAS for comparing the intervention and control groups and baseline and follow-up data.
  
  
  RESULTS
  The distribution of gender was not significantly different while age was different between the baseline and follow-up survey. At baseline, the mean KAS was lower for the intervention than control group (15.37 ± 3.40 and 18.35 ± 5.01; p < 0.001). At follow-up, the mean KAS was higher for the intervention than control group (21.16 ± 3.05 and 20.02 ± 3.40; p < 0.001). The increase in KAS in the intervention and control groups was significant (p < 0.001; KAS: 5.79 vs. 1.67) and suggested that children's injury-related KAS improved in the intervention group. Moreover, the KAS between the groups differed for most subtypes of incidental injuries (based on International Classification of Diseases 10, ICD-10) (p < 0.05). Before intervention, 350 children had reported their accident injury episodes, while after intervention 237 children had reported their accidental injury episodes in the follow-up survey.
  
  
  CONCLUSIONS
  SFI multi-level education intervention could significantly increase KAS for accidental injuries, which should improve children's prevention-related knowledge and attitudes about such injuries. It should help children change their risk behaviors and reduce the incidence of accidental injuries. Our results highlight a new intervention model of injury prevention among school-aged children.
authors: Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi 563099, China. shuannimeng@163.com.
authors: Bo-Ling
authors: BL
authors: Cao
authors: Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi 563099, China. xqshi@zmc.edu.cn.
authors: Xiu-Quan
authors: XQ
authors: Shi
authors: Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi 563099, China. qyhwanan@yeah.net.
authors: Yong-Hong
authors: YH
authors: Qi
authors: Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi 563099, China. vinald1988@126.com.
authors: Ya
authors: Y
authors: Hui
authors: Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi 563099, China. yanghuajun0201@163.com.
authors: Hua-Jun
authors: HJ
authors: Yang
authors: Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi 563099, China. shangpengss@163.com.
authors: Shang-Peng
authors: SP
authors: Shi
authors: Affiliated Hospital of Zunyi Medical University, Zunyi 563099, China. zylirongluo@163.com.
authors: Li-Rong
authors: LR
authors: Luo
authors: Affiliated Hospital of Zunyi Medical University, Zunyi 563099, China. zhanghong19861208@163.com.
authors: Hong
authors: H
authors: Zhang
authors: Affiliated Hospital of Zunyi Medical University, Zunyi 563099, China. xwang@zmc.edu.cn.
authors: Xin
authors: X
authors: Wang
authors: School of Management, Zunyi Medical University, Zunyi 563099, China. ypyang57@126.com.
authors: Ying-Ping
authors: YP
authors: Yang
mesh_terms: D000056:Accident Prevention / Q000379:methods*; D000293:Adolescent; D002648:Child; D002681:China; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D011897:Random Allocation; D012424:Rural Population; D014947:Wounds and Injuries / Q000523:psychology*