Abstract

Preventing children's thermal injuries requires changes to both the home environment and the behaviour of family members. Two pilot studies were undertaken of a school-based programme that taught children aged 7–11 years about burns and scalds hazards, and encouraged changes to the home environment and family practices through a take-home exercise. Both studies took place at ethnically diverse schools from low/middle-income areas of Waitakere City, New Zealand. Study 1 involved 55 children who received the programme, and Study 2 involved 64 children who received the programme and 71 children from a control school. The children's ability to identify the burns and scalds hazards illustrated in a series of pictures was measured before and after the programme. Children who received the programme showed considerable improvement in hazard identification at the post-test, while children at the control school showed minimal improvement. The take-home exercise was completed by 85% of the children and their families in Study 1, and 61% of the participants from the intervention school in Study 2. In both studies families reported positive safety changes as a result of the programme. The programme appeared equally effective with all the ethnic groups involved. Future development of the programme is discussed.

Introduction

Burns and scalds are a major threat to the health of children in New Zealand and other industrialized countries. In the period from 1984–1993, 5034 New Zealand children aged 0–14 years were hospitalized as a result of scalds and 821 children were hospitalized with burns (Injury Prevention Research Unit, 1996). These injuries can result in long periods of hospitalization and life-long scarring.

One approach to preventing children's thermal injuries is to advocate for safer household equipment and home structures. For example, building codes in New Zealand now require a tempering valve to be installed on new hot water cylinders, which is an important move towards reducing the risk posed by excessively hot tap water. `Passive' interventions, such as these, have the advantage of not requiring ongoing behaviour change that may be difficult to bring about and sustain. However, many of the burns and scalds sustained by children will only be prevented by changing the behaviour of people within the home (Dershewitz and Christophersen, 1984; Carey and McNeil, 1992). Simple behaviours such as the placement of hot drinks are critical to the scald risk faced by a young child (Ytterstad and Søgaard, 1995).

A common target for behaviour change has been the parents of young children. Interventions aimed at this group cannot only encourage safer habits, but may also lead to environmental changes in the home if a parent is given the appropriate advice and resources. The traditional route for this type of approach has been education delivered by health professionals. A number of trials have been conducted on injury prevention counselling to parents through routine paediatric visits and several of these have reported some improvements to home safety as a result (Kelly et al., 1987; Guyer et al., 1989; Bass et al., 1993; Miller and Galbraith, 1995).

However, counselling by doctors may not be the most appropriate way of effectively reaching parents from all sectors of the community. In New Zealand, low-income families and indigenous Maori are less likely to receive adequate primary health care than other groups (Malcolm, 1996). Cultural and language barriers that may inhibit successful interactions with health care professionals have also been found in minority groups elsewhere (Eckerman and Dowd, 1992; Mikhail, 1994; Taylor, 1994).

The project described in this paper began with the development of a burns and scalds prevention kit designed to overcome some of the problems with delivering education to parents through traditional health providers. The kit was developed by Safe Waitakere, a community injury prevention project based in Waitakere City. The city is ethnically diverse, with 141 900 people, from mainly low/middle-income families. In order to provide an environment in which parents could freely discuss the safety practices and needs of their household, the kit was delivered to groups of parents through the community organizations they belonged to, such as support groups, playgroups and the church. Kit sessions were facilitated by a community worker in the first language of the group, and encouraged participants to choose from a number of possible safety changes they could make to their homes and practices. An outline of the programme and an evaluation of its effectiveness has been reported elsewhere (Harré and Polzer-Debruyne, 1998). While the programme appeared effective in bringing about some positive changes in the safety practices of parents, community workers reported considerable difficulties in gathering together groups of parents for the purposes of running the two sessions. There were various reasons for these difficulties, many of which indicated a breakdown in community networks.

It therefore seemed desirable to explore other approaches to burns and scalds prevention in homes with young children. In discussions of a working group on injuries to children coordinated by Safe Waitakere, it became apparent that schoolchildren might be a suitable target for such interventions, as school nurses in the group reported that children were using many household objects that carried a burn or scald risk. In order to further investigate children's involvement, a survey of 421 children aged 7–13 was carried out (Harré et al., 1998). The results of this survey suggested that the majority of children of all ages were involved in activities such as preparing hot drinks, running their own baths and using a microwave. Children with younger siblings were often involved in bathing them. This was of particular concern as children under 2 years of age are at high risk of scalds in New Zealand and elsewhere (Herd et al., 1986, Waller et al., 1993).

Not only were children found to be using household objects that may put them or their siblings at risk of a thermal injury, but it was also reasoned that children are eager to learn and that they are in the process of developing habits that could be influenced by an intervention. The accessibility of schools, which are attended by virtually all New Zealand children, was also appealing, given earlier difficulties with accessing parents. Finally, it was hoped that children could take home messages about burns prevention that would influence the behaviour of other family members.

To date, the results of only a small number of school-based burns prevention educational programmes have been published. These have focused on the effects and treatment of burns (Morrison et al., 1988), integrating burns prevention messages into aspects of the school curriculum (Grant et al., 1992), lectures on the causes and treatment of burns (Eckelt et al., 1985; Lewis et al., 1994), and using a robot and cartoons to deliver burns prevention messages (Varas et al., 1988). Evaluations that have been carried out on some of these programmes have suggested that they are successful in improving children's knowledge (Eckelt et al., 1985; Varas et al., 1988; Lewis et al., 1994). However, none of these evaluations attempted to measure if any behaviour change had occurred as a result of the education or whether a school-based approach has the potential to reach parents as well as children.

The value of involving parents in bringing about behaviour change in children has been recognized in areas as diverse as smoking (Oei and Baldwin, 1992), sun protection (Pion, 1996), child abuse prevention skills (Briggs and Hawkins, 1994) and cycle helmet wearing (Johnson et al., 1991). Parental involvement is also a key component of the health-promoting schools approach (Young, 1992). There has been rather less emphasis on developing programmes in which children can potentially influence their parents. Two recent programmes in the area of cardiovascular health (Resincow et al., 1993; Hooper et al., 1996) have been piloted, in an attempt to promote healthy eating and exercise in the families of children who were the direct recipients of the programme. In the injury prevention area, one study brought about increases in seat-belt usage amongst elementary school children and their parents by rewarding children if all the passengers in the car in which they were travelling were appropriately restrained (Roberts and Fanurik, 1986). This had the interesting effect of encouraging adult compliance through reminders to buckle up from their children.

Therefore a school-based burns and scalds `education and action' programme was developed with a dual purpose. The first purpose was to teach children about burns and scalds hazards in the home and how to reduce these, and the second was to reach other family members with a take-home exercise that would encourage safe practices. The original kit designed for groups of parents and caregivers was used as a starting point for the development of the school kit. The practices that were focused on were those that children had indicated high levels of involvement in when surveyed. As with the original kit, the school-based kit was pictorially based so that it would be easy for school nurses and teachers to deliver, and could be readily understood by primary school children and families with English as a second language. In order to make the take-home exercise achievable by all families, most of the resources needed to make changes were supplied to the children. An initial pilot study was conducted, followed by a second study that simplified and improved the kit, and included a comparison group for evaluation purposes. A basic outline of the programme will be described first and then the results of the two studies.

Outline of the programme

Classroom teaching

The classroom teaching involved two sessions taken by the public health nurse attached to the schools. The first of these took approximately 45 min, and began with the nurse explaining that she wanted to help the class learn to keep themselves and their little brothers/sisters safe from getting burnt or scalded. The class was asked if they had any experiences of burns and scalds that they would like to share. A flipchart was then used to present the key ideas of the programme through illustrations. The first picture illustrated how many children are injured from burns and scalds, and how the majority of these happen in the home. The children were asked where they think these injuries happen in the home and what causes them.

The remainder of the flipchart illustrated different burn and scald hazards that could be found around the home. The children were shown one picture containing an unsafe practice and were asked to try to identify what was unsafe. They were then shown a picture of a safe alternative. For example, the unsafe picture of an electric jug showed the cord hanging over the edge of the bench and the jug placed at the front of the bench. The safe picture showed the cord hanging up on a hook and the jug moved to the back of the bench. A full description of the hazards illustrated in each study can be seen on Table I. After the pictures were discussed the public health nurse gave out and explained the homework exercise, encouraging children to do this with their parents.

Each class was given a chart with all the children's names on, to encourage the return of the homework exercises. When the children handed in their exercise, they put a smiley face sticker next to their name. The following week there was a follow-up session in which the homework exercises were discussed and the health nurse asked the children for feedback on the programme. All the children who had handed in their homework exercise also received a family participation certificate in this session.

The homework exercise

Each child received a package of five activities to take home related to the hazards discussed in class (see Table I). They were also provided with small items to help carry out the activities they had been given. The items available included a hook for their household's electric jug cord, a hot water measuring card, instruction leaflets on how to lower hot water temperature and how to obtain and install a smoke alarm, power point protectors, and stickers to mark the windows to be used in the event of a fire. The activities involved the child and a parent identifying whether the item and their household practices concerning the item were as safe as possible by examining the item and/or discussing what they usually did, and ticking the appropriate box on the sheet provided. If their practice was unsafe, the children and parents were asked if they would make changes. If they were not able or prepared to make the changes, they were asked to comment on their reasons for this. There was a space for a parent to sign the exercise.

Evaluation procedure

All the children received a letter to take home to their parents informing them of the study and offering them the chance to withdraw their child. No parents did so in either study. In order to evaluate the success of the programme, the ability of children to identify the target hazards was measured before and after the teaching had taken place. Each child was individually shown the pictures of unsafe practices and asked to say what was unsafe. When the child made a correct identification this was noted on a checklist. Each of the classes was also observed being taught the programme. Of particular interest was how the public health nurse delivered the programme and how the class responded to the teaching. The homework exercises were collected for analysis.

In Study 1, 10 randomly selected parents who indicated on the homework exercise a willingness to be interviewed were contacted. In Study 2, a parent questionnaire was attached to the homework exercise. The questionnaire asked who had participated in the exercise and the amount of time taken to complete it. There was also a question about whether the respondent felt it had improved their child's level of safety awareness. A list of possible opinions about the programme was given, with the instruction to circle all those that applied. The list consisted of: enjoyable for the parent, enjoyable for the child, interesting, intrusive, boring, waste of time, confusing, good information. There was also a space for parents to write down any comments or problems with the exercise.

Study 1—The Safe Waitakere burns and scalds education kit

The first study involved two classes (55 children in total) from an ethnically diverse primary school in Waitakere City. The children received teaching on 12 burn and scald hazards commonly found at home. Each child also took home an individually tailored homework exercise that covered five activities relevant to their household (e.g. children who had siblings under 3 years of age received the activity about power point protectors; children who indicated they did not have a smoke alarm at home received this activity).

In the pre-testing phase of the study the mean number of hazards (out of a possible 13) identified by the children when shown the pictures of unsafe practices was 5.0 (SD 2.7) with 10.8 (SD 1.7) hazards identified on the post-test. A related samples t-test confirmed that the difference in the pre- and post-test means was significant (t[44] = 17.08, P < 00005). The return rate of the homework exercises was 82%. Thirty-seven out of the 45 returned had been signed by a parent. The homework exercises had all been correctly completed, with under 3% of all the questions asked missed out by the respondents. Of the practices asked about in the homework exercise, 67% of responses indicated that the family already engaged in the safe practice recommended. A further 22% of responses indicated the family had implemented a safety change as a result of the exercise.

The observations that were carried out of the teaching and the parent interviews suggested an extremely positive response to the programme from the participants. The children were very enthusiastic, and parents in the interviews commented that it was fun and that they had learnt about hazards they were unaware of. Two fathers specifically mentioned that their sons had noticed pot handles jutting out from the stove and were quick to point out this was not safe.

While the programme was clearly highly successful in increasing children's hazard identification and the homework exercise largely appeared to have reached its target audience of children and their parents, it was felt that the administration of the programme in its current form with each child receiving a different combination of activities to take home was too complex. For a number of reasons it was decided to revise the kit with a focus on scalds. First, the survey of children's practices (Harré et al., 1998) indicated that children started to use hot water earlier than they started to use most cooking equipment and objects such as irons and matches. Second, one of the most effective burn prevention measures is the installation of a smoke alarm. As we were unable to give the children a free smoke alarm, including this as a recommendation meant the first version of the kit was not fully self-contained. Finally, the New Zealand fire service already routinely teach schoolchildren about safety in the event of fire, whereas there is no routine education given about scalds prevention.

The second version therefore focused on five potential scald hazards that would be relevant to the great majority of children's homes. It was also decided to include a control school, to check the validity of the pre-post hazard identification test.

Study 2—The Safe Waitakere scalds education and action kit

An intervention and control school were chosen with similar demographic profiles. On a socio-economic indicator developed by the Ministry of Education which ranks schools from decile 1 (low)–10 (high) both schools were decile 3. At the intervention school a Year 2 class (n = 21), a Year 4 class (n = 22) and a Year 6 class (n = 21) participated in the programme and evaluation. At the control school, a Year 2 class (n = 22) a Year 4 class (n = 22) and a Year 6 class (n = 27) participated in the pre-post hazard identification exercise. In the control school there were 38 boys and 33 girls, and in the intervention school there were 31 boys and 32 girls. The age range at both schools was 5–11 years. Overall, 40% of the participants were of European descent, 26% were indigenous Maori, 22% were of Pacific Island descent, 8% were of Asian descent and 3% were of other ethnic origins.

Results

Pre-post hazard identification test

In this study, children from both the intervention and control schools were shown four pictures that illustrated a total of 10 hazards. They were asked to identify these hazards before and after the intervention children received the teaching. The children were also asked the safe temperature for hot water (with the correct answer being anything between 50 and 55°C).

Table II shows the mean number of hazards identified by the children in each class at the pre- and post-tests. Repeated measures analysis of variance was used to test for school, year level, ethnic and gender differences in the pre- and post-test scores. As gender and ethnicity had no significant main effects or interaction effects with the two time intervals, these were removed from the analysis. The results of the second repeated measures ANOVA that examined school and year level effects showed that the children at the teaching school improved significantly more than the children at the control school F[1,128] = 507.435, P < 0.0005. On average the children at the teaching school could identify six more hazards at the post-test than the children at the control school. The children in the higher year levels at both schools also improved significantly more over time than the children in the lower year levels. F[1,128] = 9.148, P < 0.0005. The differences in the improvement made by each year group were particularly noticeable at the teaching school, with the Year 2 children recognizing 5.8 more hazards at post-test than pre-test, and the Year 4 and 6 children recognizing 6.7 and 8.1 more hazards, respectively.

Homework exercises

The return rate of the homework exercises, the number signed and the number of parent questionnaires completed can be seen on Table III. Overall, 51 out of 83 exercises (61%) were returned. Year 6 had the best return rate with 19 out of 27 (70%) returned. Eighty-eight percent of exercises that were returned were signed, with 90% of the parent questionnaires on the returned exercises being completed. The exercises appeared to have been filled out carefully, with less than 2% of the possible responses missing. Chi-square analyses indicated that gender and ethnicity did not appear to relate to whether or not a child returned the homework exercise.

The percentage of families at the teaching school who reported safety changes as a result of the programme can be seen on Table IV. It can be seen from this table that for all items except those that related to the temperature of the hot water cylinder, the majority of families reported that they already had safe practices. When the family reported that their practice was not safe, the majority of the time they responded that they had made the recommended change. The practice that appeared the most readily amenable to change was keeping pot handles turned in on the stove. The most problematic recommendation was to turn down the temperature on the hot water cylinder if it exceeded 55°C.

Parent questionnaire

The responses to the parent questionnaire indicated that 73% of the exercises were done by the child and parent together, with another 10% completed by the child and either an older sibling or other relative. The median amount of time taken to complete the exercise was 10 min, with the maximum being 45 min. Forty-four out of the 46 respondents (96%) indicated that the exercise had improved their child's awareness. Overall, 55% of the respondents circled that the exercise was enjoyable for themselves and 80% circled that it was enjoyable for the child. Only one respondent circled that the exercise was `boring' and `a waste of time'. The generally very positive opinions were also confirmed by the written responses of some of the parents who wrote comments such as: `It was a great exercise' and `I found this exercise to be very interesting and important'.

Classroom observations

All the children appeared to be very responsive to the teaching. The public health nurse was able to hold the children's attention, and they seemed to enjoy participating by sharing their stories about scalds and trying to identify the hazards in the pictures. The teachers also had favourable opinions and, in informal discussions carried out after the programme, they said that the children were excited about the homework exercise. One teacher said that she also went home and measured her hot water temperature with one of the cards provided.

Discussion

The burns and scalds prevention programme discussed in this paper was designed to have an impact on the safety knowledge and behaviour of primary school children and their parents. There were a number of indications that it had some success with each of these groups.

The results of both pilot studies showed very large increases in the number of burns and scalds hazards identified by children after receiving the programme. This supports the results of other school-based burns and scalds programmes that also demonstrated knowledge increases (Eckelt et al., 1985; Varas et al., 1988; Lewis et al., 1994). These knowledge gains suggest that the kit was appropriate for the age group concerned, both in terms of being interesting enough to gain their attention and being simple enough for the children to absorb the messages involved. An additional factor that may have helped the learning process was the excellent rapport observed between the children and the health nurse. The level of observed rapport between teachers and students has previously been found to correlate to health knowledge score achieved (Resincow et al., 1998).

Demonstrated knowledge gains have sometimes been seen as rather unimpressive in the health promotion literature. The main reason for this is the considerable body of evidence that suggests there is no automatic connection between improved knowledge and behaviour change [e.g. (Forman and Linney, 1991; O'Connor and Saunders, 1992)]. Knowledge exists on many levels of abstraction, however, and the mechanism by which it is supposed to bring about change differs across programmes. If a programme is relying on increased awareness about the possible negative effects of a behaviour to motivate people to change that behaviour, then it may be ineffective, given that many people continue to carry out unsafe behaviours in full awareness of the risks. Similarly, if a programme clearly outlines the healthy course of action, but the social context is such that this course of action is highly inconvenient, then behaviour change may not follow. This appeared to be the case in a recent study of a school-based cardiovascular exercise and nutrition programme, in which increased levels of cholesterol in the children that participated in the programme appeared to be due to the high cholesterol levels of the school lunch on the day of the post-test (Hooper et al., 1996). The knowledge gained by the children in the current study was, however, very practical and they were given the chance to immediately apply it, by checking their home environment for burns and scalds risks. The behaviour changes that were suggested were fairly undemanding and it was hoped these would take place on a family level, thereby leading to a social context in the home in which safe practices were reinforced.

In addition to providing children with practical knowledge about burns and scalds risks in the home, the programme also appeared to have reasonable success in reaching parents and other family members. This was measured most clearly by the return rate of the homework exercises. In Study 1, the return rate was 83% and in Study 2 it was 61%. A parent signed 82% of the returned homework exercises in Study 1 and 88% of those in Study 2. Responses to the parent questionnaire included with the exercise in Study 2, indicated that a child and another family member, most commonly a parent completed 83% of the returned exercises.

The difference in return rate between the two studies was quite considerable, with 22% more homework exercises returned in Study 1 than in Study 2. This is unlikely to be due to the demographic characteristics of the schools, as they were highly similar in this regard. One difference between the studies that may partly explain the discrepancy, was that an incentive, the possibility of winning two smoke alarms, was offered in Study 1 to parents who agreed to an interview by filling in a section at the back of the homework exercise. This incentive may have also encouraged families to complete the homework exercise itself. It is also possible that there were differences in the commitment and attitude of the teachers at the two schools. Teacher commitment has been found to be a major factor in the success of health education programmes in studies of seat belt promotion (Hazinski et al., 1995), sexual abuse prevention (Briggs and Hawkins, 1994), and encouraging the consumption of fruit and vegetables (Resincow et al., 1998). Whereas the same highly motivated health nurse conducted the teaching sessions at both schools, it was the responsibility of the teachers to collect the homework exercises and administer the chart on which children received stickers for returning their exercises.

The responses to the interviews conducted in Study 1 and the parent questionnaire conducted in Study 2 suggest that parents very positively received the programme. There were also indications that it led to environmental changes and safer practices in some homes and families. These results do need to be interpreted with some caution, as they were based on self-reported behaviour change and the circumstances in which the exercises were filled out were not controlled. However, they are a further indication that the programme appeared to have an impact beyond the classroom. One of the positive features of the homework exercise, that may have encouraged families to make changes, was that most of the resources needed to complete the activities were provided. This is vitally important as lack of availability and cost prevented the installation of safety devices amongst some of the participants in the parent version of the kit that was discussed earlier (Harré and Polzer-Debruyne, 1998). These factors have also been described as barriers to change in previous studies of injury prevention both in New Zealand (Podmore and Lealand, 1990) and elsewhere (Kelly et al., 1987; Gielen et al., 1995). Even the most demanding activity, turning down the hot water temperature at the cylinder if the temperature measured at the tap was greater than 55°C, appeared to have been attempted by many families. The inclusion of a detailed instruction sheet and modern cylinders in which it is easier to control the temperature may have made this recommendation more achievable.

Another positive feature of the programme was its apparent success with all the ethnic groups involved. While the numbers were small, ethnicity did not appear to relate to either the children's performance on the hazard identification test or to the return rate of the homework exercises. In both studies approximately half the children were Maori or of Pacific Island descent. As children from these groups are disproportionately at risk of thermal injuries in New Zealand (Pomare and de Boer, 1988), it is very encouraging that this programme appeared well received by these children and their parents.

There were indications in Study 2 that the amount of knowledge absorbed by the children was related to the year level they were in, with older children improving more than younger children. This may suggest that the programme is optimally aimed at children in their final years at primary school. However, the survey conducted as a preliminary investigation to the development of the programme found that the majority of children as young as 7 years were involved in activities that carry the risk of a scald (Harré et al., 1998). A compromise may be to aim the kit at children aged around 8–9 years.

Efforts are currently underway to secure sponsorship for 50 kits that will be presented to interested primary school teachers and public health nurses from Waitakere City. The focus on the five scald risks will be retained, but it is planned to introduce more `gimmicks' to accompany the activities. As well as receiving a hook for their jug cord and a hot water measuring card, it is hoped children can be given a coaster for hot drinks that states `Put your cup in the middle of the table', and stickers for the bath and stove to remind the family to run cold bath water before hot, use the back elements of the stove first and keep pot handles turned in. The extent to which the kit is used in schools will be monitored and feedback from the teachers and public health nurses involved will be gathered to ascertain how the well the kit is received.

It has been estimated that consistently enforced safety rules in the home may be effective in reducing childhood injuries by around one-third (Peterson and Saldana, 1996). Programmes such as the one described in this paper would appear to be of great value in encouraging families to adopt and enforce safety rules that are simple and convenient. Whereas parents are generally very effective at keeping their children safe, years of experience that indicate `accidents' are rare and a prevalent ideology that they are not usually preventable (Morrongiello and Dayler, 1996; Mulligan-Smith et al., 1998) may lead to some risky habits and unnecessary hazards. Sadly, it appears to be only after a burn or scald has occurred that the majority of parents are fully aware that the injury could have been avoided (Cronin et al., 1996).

Children, who are beginning to participate in household tasks, appear eager to carry out their newly learnt skills in the safest way possible. The combination of teaching children about safety and reminding parents of simple rules that will reduce the family's risk of injury would appear extremely valuable.

Table I.

Materials used in the programme trials

Item Unsafe picture Safe picture Homework exercise 
Items marked `a' used only in the first trial, items marked `b' used only in the second trial. 
Numbered items in the column describing the unsafe pictures correspond to the hazards children were asked to identify in the pre- and post-tests. 
Electric jug (1) Cord not hooked up Cord hooked up Check jug. Make jug safer by:  
 (2) Near front of bench Near back of bench Hooking cord up 
   Moving to safer place 
Pots (3) Handles over stove edge Handles facing in Discuss family practice.  
   Decision to: 
 (4) Pots on front elements Pots on back elements Keep handles facing in 
   Use front elements first 
Bath (5) Hot water running first Cold water running first Discuss family practice.  
   Decision to: 
 (6) Adult not watching small child Adult watching small child Run cold water first or use mixer tap to run both together 
Hot drinks Young child present with: Cup in middle of table Discuss family practice.  
   Decision to: 
 (7) Cup at edge of table No tablecloth Put hot drinks in middle of table 
 (8) Tablecloth on table No cup on floor Not use tablecloth with hot drinks and food 
 (9) Cup on floor Girl carrying cup on tray  
 (10) Girl carrying cup too fullb   
High hot water temperature No picture Tap with hot water running Measure hot water. If over 55°C: 
 (11) Asked safe temperature for hot waterb  Read flier on how to turn down cylinder 
   Turn down cylinder 
Power pointsa (10) Young child with fork near unprotected power pointa Young child near power point with safety plug Check power points. If any uncovered: 
   Insert safety plugs provided 
Microwavea (11) Not at eye levela At eye level Make microwave safer by: 
 (12) Person not using mittsa Person using mitts Moving to child's eye-level 
   Put out mitts or cloth for hot things 
Matches and lightersa (13) On table and floor in young child's reacha Matches and lighter high up in cupboarda Safe place chosen for putting matches and lighters out of reacha 
Heatersa No picture Heater with guarda No activity 
Irona No picture Iron in usea No activity 
Smoke alarmsa No picture Child asleep with smoke alarm on ceilinga If have smoke alarm, check battery; if do not have alarm, read attached leaflet on where to purchase and decide to purchasea 
Escape plana No picture House on fire; family escaping out windowa Family discussion on how to escape house fire; put stickers provided on fire-exit windows and doorsa 
Item Unsafe picture Safe picture Homework exercise 
Items marked `a' used only in the first trial, items marked `b' used only in the second trial. 
Numbered items in the column describing the unsafe pictures correspond to the hazards children were asked to identify in the pre- and post-tests. 
Electric jug (1) Cord not hooked up Cord hooked up Check jug. Make jug safer by:  
 (2) Near front of bench Near back of bench Hooking cord up 
   Moving to safer place 
Pots (3) Handles over stove edge Handles facing in Discuss family practice.  
   Decision to: 
 (4) Pots on front elements Pots on back elements Keep handles facing in 
   Use front elements first 
Bath (5) Hot water running first Cold water running first Discuss family practice.  
   Decision to: 
 (6) Adult not watching small child Adult watching small child Run cold water first or use mixer tap to run both together 
Hot drinks Young child present with: Cup in middle of table Discuss family practice.  
   Decision to: 
 (7) Cup at edge of table No tablecloth Put hot drinks in middle of table 
 (8) Tablecloth on table No cup on floor Not use tablecloth with hot drinks and food 
 (9) Cup on floor Girl carrying cup on tray  
 (10) Girl carrying cup too fullb   
High hot water temperature No picture Tap with hot water running Measure hot water. If over 55°C: 
 (11) Asked safe temperature for hot waterb  Read flier on how to turn down cylinder 
   Turn down cylinder 
Power pointsa (10) Young child with fork near unprotected power pointa Young child near power point with safety plug Check power points. If any uncovered: 
   Insert safety plugs provided 
Microwavea (11) Not at eye levela At eye level Make microwave safer by: 
 (12) Person not using mittsa Person using mitts Moving to child's eye-level 
   Put out mitts or cloth for hot things 
Matches and lightersa (13) On table and floor in young child's reacha Matches and lighter high up in cupboarda Safe place chosen for putting matches and lighters out of reacha 
Heatersa No picture Heater with guarda No activity 
Irona No picture Iron in usea No activity 
Smoke alarmsa No picture Child asleep with smoke alarm on ceilinga If have smoke alarm, check battery; if do not have alarm, read attached leaflet on where to purchase and decide to purchasea 
Escape plana No picture House on fire; family escaping out windowa Family discussion on how to escape house fire; put stickers provided on fire-exit windows and doorsa 
Table II.

Study 2—mean number of hazards identified (out of a possible 11) in pre- and post-tests

 Teaching school Control school 
 Year 2 (n = 21) Year 4 (n = 21) Year 6 (n = 21) Year 2 (n = 22) Year 4 (n = 22) Year 6 (n = 27) 
Pre-test       
mean 0.7 1.8 1.4 1.0 1.9 2.4 
SD 1.2 1.5 1.4 1.0 1.5 1.4 
Post-test       
mean 6.5 8.5 9.5 1.0 2.2 3.1 
SD 2.4 2.3 1.5 1.1 1.3 1.6 
Difference 5.8 6.7 8.1 0.3 0.7 
 Teaching school Control school 
 Year 2 (n = 21) Year 4 (n = 21) Year 6 (n = 21) Year 2 (n = 22) Year 4 (n = 22) Year 6 (n = 27) 
Pre-test       
mean 0.7 1.8 1.4 1.0 1.9 2.4 
SD 1.2 1.5 1.4 1.0 1.5 1.4 
Post-test       
mean 6.5 8.5 9.5 1.0 2.2 3.1 
SD 2.4 2.3 1.5 1.1 1.3 1.6 
Difference 5.8 6.7 8.1 0.3 0.7 
Table III.

Study 2—number of homework exercises and parent questionnaires returned and completed

 Exercises given out Exercises returned Exercises signed Parent questionnaires completed 
Year 2 27 16 13 15 
Year 4 29 16 14 15 
Year 6 27 19 18 16 
Total 83 51 45 46 
 Exercises given out Exercises returned Exercises signed Parent questionnaires completed 
Year 2 27 16 13 15 
Year 4 29 16 14 15 
Year 6 27 19 18 16 
Total 83 51 45 46 
Table IV.

Study 2—percentage of families (n = 51) who reported safety changes on the homework exercise

Suggested changes Already safe, change unnecessary (%) Did change (%) Did not change (%) 
aThe percentages who did not make this change is not applicable as the question regarding safety of the jug did not ask the participants to specify what aspect of their jug was unsafe, just if it met all the safety recommendations. 
Use cold water first in bath 80 14 
Turn pot handles in on stove 88 12 
Use back elements on stove 75 18 
Have read flier on hot water 47 47 
Have turned hot water cylinder down 47 35 18 
Have removed tablecloth 70 22 
Put drinks in middle of table 72 22 
Moved jug to safer place 82 10 NAa 
Hooked jug cord up 82 14 NAa 
Other jug change made 82 NAa 
Suggested changes Already safe, change unnecessary (%) Did change (%) Did not change (%) 
aThe percentages who did not make this change is not applicable as the question regarding safety of the jug did not ask the participants to specify what aspect of their jug was unsafe, just if it met all the safety recommendations. 
Use cold water first in bath 80 14 
Turn pot handles in on stove 88 12 
Use back elements on stove 75 18 
Have read flier on hot water 47 47 
Have turned hot water cylinder down 47 35 18 
Have removed tablecloth 70 22 
Put drinks in middle of table 72 22 
Moved jug to safer place 82 10 NAa 
Hooked jug cord up 82 14 NAa 
Other jug change made 82 NAa 

Anne Sisam is gratefully acknowledged for her role in the development and teaching of the programme. The input of the Safe Waitakere Working Group on Injuries to Children was also invaluable. The Child Accident Prevention Foundation of New Zealand helped fund the research. We wish to thank the schools that participated.

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