Shalev Ligat, Rudolf Mary C J, Spitzer Sivan
Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
Front Health Serv. 2022 Sep 2;2:944367. doi: 10.3389/frhs.2022.944367. eCollection 2022.
Child home injuries prevention interventions have rarely been implemented in hospitals. The SHABI program ("Keeping our Children Safe"; in Hebrew: "SHomrim Al BetIchut Yeladenu") recruits at-risk families arriving with child injury to the Emergency Department. Medical/nursing students conduct two home visits four months apart, providing safety equipment and guidance. One hundred thirty-five families had a first visit and 98 completed the second. Fifty percentage of families were ultra-Orthodox Jews, 11% Arab, and 28% had ≥3 preschool children. We investigated SHABI's implementation using the Consolidated Framework for Implementation Research (CFIR).
Between May 2018 and March 2021 SHABI was implemented in the Emergency Department of a hospital in Israel's northern periphery, an area with high child injury rates. The Implementation process was examined through Emergency Department medical records and tracking registries, hospital management, nurses', and home visitors' meetings notes ( = 9), and a research diary. Hospital's inner setting and SHABI's characteristics were evaluated through interviews with hospital management, nurses, and home visitors 8 months after baseline ( = 18). Home visitors' characteristics were evaluated through interviews, post-visit questionnaire on challenges encountered ( = 233), families' perceptions of SHABI and home visitors' skills through telephone interviews ( = 212); and home visitors awareness of dangers at home ( = 8) baseline and 8 months later. Qualitative data were analyzed through explanatory content analysis according to CFIR constructs. Quantitative data were analyzed using X2 and Wilcoxon test for dependent subgroups.
Despite alignment between SHABI and the hospital's mission, structural hospital-community disconnect prevented implementation as planned, requiring adaptation and collaboration with the medical school to overcome this barrier. Recruitment was included in the initial patient triage process but was only partially successful. Medical/nursing students were recruited as home visitors, and following training proved competent. Children were a distraction during the visits, but home visitors developed strategies to overcome this.
Injury prevention programs in hospitals have significant benefits. Identifying implementation barriers and facilitators allowed implementers to make adaptations and cope with the innovative implementation setting. Models of cooperation between hospital, community and other clinical settings should be further examined.
儿童家庭伤害预防干预措施在医院中很少实施。SHABI项目（“保护我们的孩子安全”；希伯来语：“SHomrim Al BetIchut Yeladenu”）招募因儿童受伤而前往急诊科的高危家庭。医学/护理专业学生每隔四个月进行两次家访，提供安全设备并给予指导。135个家庭接受了首次家访，98个家庭完成了第二次家访。50%的家庭是极端正统派犹太人，11%是阿拉伯人，28%的家庭有≥3名学龄前儿童。我们使用实施研究综合框架（CFIR）对SHABI项目的实施情况进行了调查。
2018年5月至2021年3月期间，SHABI项目在以色列北部边缘地区一家医院的急诊科实施，该地区儿童伤害率较高。通过急诊科病历和跟踪登记、医院管理、护士及家访人员的会议记录（n = 9）以及一本研究日记来考察实施过程。在基线后8个月（n = 18），通过对医院管理层、护士和家访人员的访谈来评估医院的内部环境和SHABI项目的特点。通过访谈、关于所遇到挑战的访后问卷（n = 233）来评估家访人员的特点，通过电话访谈（n = 212）来评估家庭对SHABI项目的看法以及家访人员的技能；并在基线时和8个月后通过访谈（n = 8）来评估家访人员对家庭危险的认知。根据CFIR构建，通过解释性内容分析对定性数据进行分析。使用卡方检验和威尔科克森检验对相关亚组的定量数据进行分析。
尽管SHABI项目与医院的使命一致，但医院与社区之间的结构性脱节阻碍了按计划实施，需要与医学院进行调整和合作以克服这一障碍。招募工作纳入了最初的患者分诊过程，但仅取得部分成功。招募医学/护理专业学生作为家访人员，培训后证明他们能够胜任。家访期间儿童会分散注意力，但家访人员制定了克服这一问题的策略。
医院的伤害预防项目有显著益处。识别实施障碍和促进因素使实施者能够进行调整并应对创新的实施环境。医院、社区和其他临床环境之间的合作模式应进一步研究。
