An investigation of factors contributing to the sustainability of home safety equipment schemes in communities at higher risk of injury: a multiple case study based on a national programme in England

Errington, Gail (2015) An investigation of factors contributing to the sustainability of home safety equipment schemes in communities at higher risk of injury: a multiple case study based on a national programme in England. PhD thesis, University of Nottingham.

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Unintentional injury in the home setting is the leading cause of mortality and morbidity among pre-school children in the UK. Multi-component, community-based intervention programmes are a recommended means of addressing injury. England operated a national home safety programme based on this approach from 2009 to 2011. The programme was targeted at high risk families and supported through national government funding.

Little is currently known about the sustainability of injury prevention programmes, despite its relevance to public health planners and policy makers. Studies of programme sustainability in the global public health literature reveal an over-reliance on self-reported data from a single source and often under represent the target group perspective.

Aim and setting of the current study

The current study aims to explore influences on the sustainability of a multi-component injury prevention programme targeted at high risk communities in England.

Study design

The multiple case study design used qualitative methods to explore programme and contextual influences on sustainability in five sites. Multiple perspectives were considered including those of families in the target group and professionals involved in scheme delivery. Local, national and global public health policy documents were reviewed to understand the wider context for scheme sustainability and to corroborate research findings. Interviews with stakeholders in injury prevention policy at national and international level were undertaken to explore the conceptualisation of sustainability.

Framework analysis was conducted within-case and to identify cross-case over-arching themes. The analytic framework, display matrices and production of case study profiles documented the analysis stages. ‘Thick description’ assists the consideration of transferability of findings to other settings.

Principal findings

Little consensus was apparent in the conceptualisation of sustainability among policy makers. Although programme sustainability was seen as relevant to those agencies influential in policy development, this was not reflected in policy documents.

Funding availability and a supportive local context for scheme delivery were identified as the two main conditions required for sustainability. Ongoing change within the national political and economic context in England challenged sustainability efforts of local schemes. Three key strategies to actively encourage sustainability were identified: programme adaptation; presence of a co-ordinator or champion and extending collaborative networks. The adoption of these varied in response to contextual changes over time.

Ongoing benefits of the scheme were identified in all sites. These included improved safety practices reported by the target group and increased access to harder-to-engage families for scheme professionals. Programme components displayed differential levels of fidelity between and within sites over time.

Based on the study findings, a conceptual framework for promoting the sustainability of community-based child injury prevention programmes is presented.


This is the first study to comprehensively explore the sustainability of a community-based injury prevention programme in England. It has identified influences on sustainability that contribute to and support findings from other areas of public health. The proposal of a conceptual framework to promote sustainability within community-based child injury prevention programmes makes an original contribution to the field. Potential transferability of study findings suggests that public health gain may be increased by sharing the knowledge base between topics.

The study identified considerable challenges to sustaining local public health initiatives amidst ongoing change in the wider political and economic environments. Educating practitioners and policy makers could improve understanding of sustainability and enhance the future prospects for local initiatives. It is therefore recommended that sustainability should form an integral part of the programme planning cycle for public health initiatives.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Watson, Michael
Evans, Catrin
Keywords: Prevention of children's accidents, Community-based intervention, Public health initiatives, Programme planning cycle
Subjects: W Medicine and related subjects (NLM Classification) > WA Public health
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Health Sciences
Item ID: 30881
Depositing User: Errington, Gail
Date Deposited: 22 Feb 2016 09:39
Last Modified: 16 Dec 2017 10:10

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