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Effectiveness of the 'WHO Safe Communities' model to prevent injury in
whole populations: a Cochrane Systematic
Review
Anneliese Spinks, Rod McClure, Cathy Turner, Jim Nixon
Rationale – Why a WHO Safe Communities
Systematic Review?
• WHO Safe Communities formally initiated in 1989
• At least 80 communities world-wide have been designated, with many more under preparation
Rationale – cont.
Given the global interest and effort being afforded the Safe Community concept, it is of public health interest to determine to what degree the model is successful, i.e.
Are injury rates reduced in the communities to which it is applied?
•Web-accessed database of peer-reviewed systematic reviews
•Entails a rigorous methodology that provides a framework for high quality assessment of interventions
Objectives
To conduct a Cochrane Systematic review to determine the effectiveness of the 'Safe Communities' model to prevent injury in whole populations, or targeted sub-groups of populations.
Searching for Evidence – Inclusion Criteria
1. Designated WHO Safe Community
2. Appropriate control community 3. Objective injury outcomes 4. Original data
Studies Located
61 studies written about Safe Communities
41 reported intervention outcomes
16 met the inclusion criteria 8 Individual Safe Communities
Included communities - Scandinavia
FalkopingFalunLidkopingMotalaHarstad
Included communities - Australasia
La TrobeShire of BullaWaitakere
Summary of Results• Mainly “positive”• 11 studies (4 communities) report
significant decrease in injuries compared to control communities
• 2 studies report ‘no change’ while injury rates in control areas rose
• 1 study reports no overall change but decrease in pediatric sub-group
• 2 studies report no significant effect
1983 1984
1989
Community 1
1987 1991/92
1995/96
Community 2
Limitations to Validity
Arbitrary base-line / follow-up periods (particularly for those of short duration in small communities)
Limitations to Validity cont.
• Reliance on administrative databases to ascertain injury rates
• Not always taking pre-existing trends into account
• Publication bias
• Only small number of communities evaluated to date
Conclusions
• Cochrane methodology provides a framework to evaluate the Safe Communities Model
• There is evidence that Safe Communities model does reduce injuries in whole populations
• Not many communities have been formally evaluated
• Limitations in evaluation methodology
Review available at:
http://www.cochrane.org/index0.htm