“I don’t feel any danger because I am in my own community”: a photovoice study on adolescents’ perceived community safety

Purpose A safe environment is critical for adolescents’ well-being. The purpose of this photovoice study is to explore reasons that make adolescents feel safe in their community. Design/methodology/approach This study was conducted in Florida through both online and in-person recruitment. After a training session on the ethical and technical use of cameras and a brief introduction of the photovoice methodology, six adolescents took photos (n = 66) in their community and discussed their photos guided by the revised SHOWeD framework. Abridged transcripts were used to match photos with corresponding discussions. Thematic analysis was conducted by the research team. Findings This study identified four main themes related to adolescents’ safe perceptions, including community protective factors (n = 22 photos) such as safe physical environments and community cohesion; family protective factors (n = 14 photos) including safe home and caring parents; traffic safety (n = 14 photos), such as proper road signs, seat belts for car safety and helmets and locks for bicycle safety; and public safety (n = 8 photos), such as emergency numbers, fire departments and police cars and officers. Research limitations/implications Due to the limited number of participants, this study did not compare the similarities and differences of safety perceptions between adolescents living in high crime areas (urban communities) and those in low crime areas (suburban and rural communities). Future photovoice studies are recommended to further explore the influential factors associated with adolescents’ perceived community safety in urban and rural areas with different levels of crime rates to provide more evidence on targeted strategies for community safety promotion in each area. Practical implications By exploring the reasons for adolescents’ safe feelings in their community using photovoice, this study provides insights for future intervention programs to promote community safety for children and adolescents from the community, family, traffic and societal perspectives. Social implications This photovoice study not only empowers adolescents to identify community assets related to their safe perceptions but also illustrates valuable insights for researchers and public health professionals for safety promotion. Originality/value This study has used a broad research question to explore the reasons that make adolescents feel safe, providing them the opportunities to express their opinions by photo taking and photo discussions. Moreover, rich information at the community, family and societal levels has been collected as related to factors contributing to adolescents’ safe perceptions, adding to the literature on community safety. In addition, this photovoice study has offered both in-person and online participation. Such combination not only provides adolescents with an opportunity to choose a participation method that works best for them but also adds to the photovoice methodology by extending the data collection from in-person to online.

Study protocol for a type III hybrid effectiveness-implementation trial of strategies to implement firearm safety promotion as a universal suicide prevention strategy in pediatric primary care

Background Insights from behavioral economics, or how individuals’ decisions and behaviors are shaped by finite cognitive resources (e.g., time, attention) and mental heuristics, have been underutilized in efforts to increase the use of evidence-based practices in implementation science. Using the example of firearm safety promotion in pediatric primary care, which addresses an evidence-to-practice gap in universal suicide prevention, we aim to determine: is a less costly and more scalable behavioral economic-informed implementation strategy (i.e., “Nudge”) powerful enough to change clinician behavior or is a more intensive and expensive facilitation strategy needed to overcome implementation barriers? Methods The Adolescent and child Suicide Prevention in Routine clinical Encounters (ASPIRE) hybrid type III effectiveness-implementation trial uses a longitudinal cluster randomized design. We will test the comparative effectiveness of two implementation strategies to support clinicians’ use of an evidence-based firearm safety practice, S.A.F.E. Firearm, in 32 pediatric practices across two health systems. All pediatric practices in the two health systems will receive S.A.F.E. Firearm materials, including training and cable locks. Half of the practices (k = 16) will be randomized to receive Nudge; the other half (k = 16) will be randomized to receive Nudge plus 1 year of facilitation to target additional practice and clinician implementation barriers (Nudge+). The primary implementation outcome is parent-reported clinician fidelity to the S.A.F.E Firearm program. Secondary implementation outcomes include reach and cost. To understand how the implementation strategies work, the primary mechanism to be tested is practice adaptive reserve, a self-report practice-level measure that includes relationship infrastructure, facilitative leadership, sense-making, teamwork, work environment, and culture of learning. Discussion The ASPIRE trial will integrate implementation science and behavioral economic approaches to advance our understanding of methods for implementing evidence-based firearm safety promotion practices in pediatric primary care. The study answers a question at the heart of many practice change efforts: which strategies are sufficient to support change, and why? Results of the trial will offer valuable insights into how best to implement evidence-based practices that address sensitive health matters in pediatric primary care. Trial registration ClinicalTrials.gov, NCT04844021. Registered 14 April 2021.

Evaluation of the effectiveness, implementation and cost-effectiveness of the Stay One Step Ahead home safety promotion intervention for pre-school children: a study protocol

BackgroundUnintentional injuries in children under the age of 5 years commonly occur in the home and disproportionately affect those living in disadvantaged circumstances. Targeted home safety promotion should be offered to families most at risk but there is a paucity of standardised evidence-based resources available for use across family-support practitioners.ObjectiveTo assess the effectiveness, implementation and cost-effectiveness of a 2-year home safety programme (Stay One Step Ahead) developed by parents, practitioners and researchers, and delivered by a range of family support providers in inner-city localities, compared with usual care in matched control localities.MethodsParents of children aged 0 to 7 months will be recruited to a controlled before and after observational study. The primary outcome is home safety assessed by the proportion of families with a fitted and working smoke alarm, safety gate on stairs (where applicable) and poisons stored out of reach, assessed using parent-administered questionnaires at baseline, 12 and 24 months.Secondary outcomes include: the impact on other parent-reported safety behaviours, medically-attended injuries, self-efficacy for home safety and knowledge of child development and injury risk using questionnaires and emergency department attendance data; implementation (reach, acceptability, barriers, facilitators) of home safety promotion assessed through interviews and observations; and cost-effectiveness using medically-attended injury costs ascertained from healthcare records.ConclusionIf shown to be effective and cost-effective this study will provide a practical resource to underpin national guidance. The study could inform public health prevention strategies to reduce home injury in children most at risk, while delivering cost savings to health and care services.Trial registration numberISRCTN31210493; Pre result.

The Impact of Children's Temperament on How Parents Resolve Safety Disagreements During Preadolescence

Objectives Parents play an important role in keeping their children safe. However, this becomes more difficult during preadolescence as children seek greater autonomy away from the direct supervision of adults. The current study focused on preadolescent youth (10–13 years) and examined parent–child disagreements about safety, with a focus on determining if child temperament attributes moderate the relation between how parents learn of these and resolve these disagreements. Methods A short-term longitudinal design was used. Parents and children retrospectively recalled safety disagreements together and then independently completed questionnaires about these. Parents then tracked disagreements over 1 month. Results The behavioral attributes of inhibitory control and risk-taking propensity both moderated the relationships between parental source of knowledge of safety disagreements and subsequent methods of resolution. Conclusion Safety-promotion messaging for parents of preadolescents may need to be tailored based on child attributes to maximize effectiveness.