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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 7: Injury Hospitilization

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Strategy. Training + Equipment Upgrades to Increase Playground Safety

Approach. Provide staff training + upgrades to playground equipment to reduce falls and increase playground safety.

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Overview. Although playgrounds are the ideal place for children in engage in motor, cognitive, and social skill development especially during school hours, playground injuries remain a major source of unintentional injuries for children under the age of 14 in the U.S.1-6

Evidence. Moderate. Research indicates that educational interventions show value in addressing fall-risk behaviors on playgrounds and ultimately reducing injury rates. Further, upgrading outdated, unsafe playgrounds using safety standards can reduce injury rates and may also help diminish the gap in socioeconomic status associated with playground injuries. Programs based on this strategy are likely to work. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. School staff/Community.

Outcome. Reduction of childhood injury caused by falls. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the “Intervention Results” for each study.

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM. You may also want to look at evidence that supports educational programs in other NPM topic areas that can be translated to this specific topic area.

Sample ESMs. Using the approach “Provide staff training + upgrades to playground equipment to reduce falls and increase playground safety,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework:

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of staff who received training on addressing fall-risk behaviors on playgrounds.
  • Number of playgrounds that received/installed upgraded equipment.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of staff who received training on addressing fall-risk behaviors on playgrounds.
  • Percent of playgrounds that received/installed upgraded equipment.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of staff who reported increased levels of knowledge about how to reduce falls in playground areas.
  • Number of staff who reported increased confidence in how to identify fall-risk behaviors on playgrounds.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of staff who reported increased levels of knowledge about how to reduce falls in playground areas.
  • Percent of playgrounds with updated equipment reporting reduced number of falls.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


References:

1 Chelvakumar G, Sheehan K, Hill AL, Lowe D, Mandich N, Schwebel DC. The stamp-in-safety programme, an intervention to promote better supervision of children on child care centre playgrounds: an evaluation in an urban setting. Injury Prevention 2010; 16(5): 352–354.

2 Howard AW, Macarthur C, Rothman L, Willan A, Macpherson, AK. School playground surfacing and arm fractures in children: a cluster randomized trial comparing sand to wood chip surfaces. PLoS Medicine 2009; 6(12):e1000195–e1000195.

3 Macpherson AK, Jones J, Rothman L, Macarthur C, Howard AW. Safety standards and socioeconomic disparities in school playground injuries: a retrospective cohort study. BMC Public Health 2010; 10: 542–542.

4 Morrongiello BA, Kane A. An evaluation of the Cool 2 Be Safeprogram: an evidence-based community disseminated program to positively impact children’s beliefs about injury risk on playgrounds. Prevention Science 2015; 16(1): 61–69.

5 Morrongiello BA, Mark L. Practice what you preach: induced hypocrisy as an intervention strategy to reduce children’s intentions to risk take on playgrounds. Journal of Pediatric Psychology 2008; 33(10): 1117–1128.

6 Olsen H, Hudson S, Thompson D. Strategies for playground injury prevention: an overview of a playground project. American Journal of Health Education 2010; 41, 187–192.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.