Developing an educational intervention for parents to promote preschool child safety in Nepal

Injuries are a leading cause of preventable death and lifelong disability among pre-school children in Nepal. Child injuries place major pressures on household income (due to associated care costs) and have implications for parents' ability to work (due to providing care for an injured child). Such injuries can therefore have an impact on individuals, communities and societies.

It's common for injuries to be seen as unavoidable and prevention is rarely considered. As with many diseases, most unintentional child injuries are caused by events that are predictable, and therefore preventable. Injuries to preschool children usually happen in the home and with their parents close by.

Therefore, parents and other family caregivers have the greatest opportunity to keep young children safe. Currently, there are no research-based programmes in Nepal to support parents to keep their children safe at home. This project will be conducted in Sunkoshi rural municipality, in Sindhupalchowk district of Nepal.

Our study aims to develop an intervention to improve the knowledge and skills of parents in rural Nepal to reduce injury hazards in and around their homes. To explore the social, cultural and health education systems that influence how parents make decisions about safety, we will work with families and stakeholders who are interested in child health and development to co-produce the intervention.

Such stakeholders include Female Community Health Volunteers (FCHVs) who are frontline practitioners working directly with parents to improve maternal and child health in their local communities. FCHVs often deliver community health programmes and could deliver our intervention if shown to be effective. In rural Nepal, groups of mothers meet monthly to discuss health issues, facilitated by leaders and FCHVs.

These 'Mother's Groups' occur across Nepal. We will work with mother's groups to identify parents of preschool children and explore whether these groups are an appropriate way to engage parents in the intervention. We will involve other community stakeholders to develop the intervention including health coordinators, schoolteachers, health-post staff, local leaders, municipality representatives and ward chairs.

Once the intervention has been agreed and prepared, we will run a small project to test the possibility of evaluating the intervention in a later, bigger study. In this small test, we will engage six mothers' groups and their FCHVs across two wards. In one, the FCHVs will be trained to deliver the intervention to mothers, in the other an activity not related to injury prevention will be offered.

We will explore whether it is possible to deliver the intervention and the alternative activity and engage parents in completing baseline and follow-up assessments. Through this process, we will learn if any modifications are needed for the intervention and subsequent study.

Potential beneficiaries include parents empowered to reduce injury risks at home, protecting their children from injury and reducing avoidable economic hardship. Children may benefit by reduced exposure to injury hazards and reduced injuries. Hazard identification and mitigation may improve injury risk in village communal areas and benefit wider groups.

FCHVs may benefit by improved knowledge of how to support parents and promote safety in the communities they support. Health facilities may experience fewer visits due to reduced injuries, lessening the load on healthcare practitioners. Government authorities could make informed decisions on child safety policies.

Researchers has the potential to contribute to the evidence base of effective child injury prevention strategies.