Creating safe spaces to prevent unintentional childhood injuries among the Bedouins in southern Israel: A hybrid model comprising positive deviance, community-based participatory research, and entertainment-education

Background Despite several intervention programs, the Bedouin population living in the Southern District of Israel has the highest mortality rate among children and adolescents from unintentional injuries. Our research questions asked: (1) How does increasing the involvement and participation of Bedouin community members influence the issue of unintentional injuries among children? (2) How does reframing of the technical issue of safety into security influence community involvement and cooperation? Objectives 1) To identify effective and efficacious positive deviance practices through community-based participatory research with adults, children, and professionals in the Bedouin community. 2) To create wider and deeper connections and cohesion between and among diverse Bedouin communities by seeding and sparking opportunities for social networking and cross-learning. Methods The study used a qualitative multi-method approach to generate a hybrid intervention model for reducing unintentional childhood injuries among the Bedouins. To frame the issue of unintentional injuries from the lived perspective of the Bedouins, we employed the Positive Deviance (PD) and Community Based Participatory Research (CBPR) approach. Drawing upon theatrical traditions, entertainment-education (EE), was employed as a way to narratively engage and persuade the Bedouins. Results Our research resulted in: (1) the emergence of several PD ideas and practices for preventing and avoiding children’s injuries; (2) the actual creation of a safe and secure playroom for children at a neighborhood mosque; and (3) the creation of cascading and cross-learning social networks between and among members of the Bedouin community spread across various locations. Conclusion This study helped in reframing the technical issue of accidents and safety into the notion of sacredness and security, enhanced the association between emotions and cognition by means of experiential and EE methods, and stimulated creative thinking and the emergence of new culturally and contextually relevant ideas and practices through the PD process. It demonstrated the synergistic power of using a hybrid model that combined the rigor and vigor of different health communication approaches to address a significant disparity in the burden of child accidents faced by the Bedouins. Our study generated solutions that emerged from, and directly benefitted, Bedouin children—those, who face overwhelming risk of injury and death from preventable accidents.

A Mixed Method Study to Assess the Effect of Training of Adolescents on Perception and Practices regarding Unintentional Childhood Injuries

Background: Adolescents are the future citizens of any society, who can be trained to become responsible members and also function as change agents in the community to improve children’s health. Child-To-Child Approach is an innovative technique which was used in the present study to improve perception and practices regarding unintentional childhood injuries, by training the adolescent population. Methodology: An intervention study was conducted in two villages of Delhi from April 2017 to July 2019, to test the Child-To-Child Approach in preventing childhood injuries, by training the eldest adolescent in each family of intervention area and encouraging them to disseminate the knowledge to other family members. Present study is a part of the main study and analyses improvement in Perception and Practice (PP) regarding injuries after intervention, as assessed from PP scores of adolescents eligible for training, other adolescents and adult women. Focus group discussions (FGD) for assessing perception were also conducted with adolescents and adult women, at the beginning and end of study. Results: During pre-intervention period, PP scores of all three groups of subjects showed no significant difference between the two areas. Statistically significant improvement was observed in PP scores of all three groups of subjects in the intervention area during the post-intervention phase, in comparison to pre-intervention phase as well as in comparison to scores of control area in post-intervention phase. Findings from the FGD showed that perception of both groups regarding types and reasons of injuries was low in the beginning, but increased markedly in the second FGD in both the groups, compared to the first FGD. Conclusion: These findings indicate that training adolescents and encouraging them to disseminate messages to their siblings and to the adult women of their families, which is the essence of Child-To-Child Approach, is effective in improving the perception and practices regarding unintentional childhood injuries.

Perception and awareness of unintentional childhood injuries among primary caregivers of children in Vellore, South India: a community-based cross-sectional study using photo-elicitation method

Objective We studied the primary caregivers’ perception, and further, their awareness of unintentional childhood injuries in south India. Methods A cross-sectional study was conducted in the rural block of Kaniyambadi, Vellore, among 300 primary caregivers of children aged between 0 and 14 years. A semi-structured interview was conducted with the primary caregivers using a photo-elicitation method, with a visual depiction of ten injury risky scenarios for a child. Scoring was done to assess the perception of environmental hazards in these scenarios, and further, knowledge on the prevention of these injuries. An independent ‘t’ test was done to elicit differences in mean scores and a multivariate regression analysis was applied to ascertain factors independently associated with the scores. Results Primary caregivers had adequate perception regarding risks posed to children in scenarios such as climbing trees (96.2%), playing near construction sites (96%), firecrackers (96.4%) and crossing unmanned roads with no traffic signals (94%). Knowledge of prevention was poor however, in the following scenarios: a woman riding a bicycle without safety features, with child pillion sitting behind bare foot and legs hanging by one side (72.6%); a child playing near a construction site (85.9%); and a child playing with plastic bags (88.3%). Overall, educational status of the primary caregiver and socioeconomic status were associated with poorer perception of risks and knowledge about unintentional childhood injuries and their prevention. Conclusions Pragmatic community-based childhood interventions incorporated into existing programs, with a special focus on road traffic injuries, burns and suffocation need to be implemented in high-risk settings of rural populations in South India.