Abstract:

Accidents in childhood have a high morbidity and mortality rate and are often preventable, which reinforces the importance of educational measures to prevent unintentional injuries. This study aimed to identify and describe useful educational strategies for preventing childhood accidents in communities. This systematic review was guided by PRISMA (2020) and registered on the PROSPERO platform (ID: CRD42024500956). A search strategy was developed by combining the descriptors “Accident Prevention”, “Child”, and “Health Education” with the Boolean operator AND, applied to the PubMed/MEDLINE, Web of Science, LILACS, and SciELO databases. A total of 5,037 studies were located, including observational articles published from 2018 to 2023, with children aged 0-12 years and/or their parents/caregivers. The quality of the studies was assessed based on the Qualitative Studies Checklist and the Research Triangle Institute Item Bank instruments. The bibliographic sample consisted of 30 articles, mostly classified as high quality, with a population of 4,510 adults and 54,190 children from various countries. Educational strategies for accident prevention were described, aimed at parents and guardians, children, and both. This review, addressing innovative educational strategies for preventing childhood accidents, highlights playful approaches for children and visual methods for caregivers. Implementation faces challenges related to evaluation and socioeconomic factors, making rigorous criteria and prolonged follow-ups important for continuous effectiveness.

Keywords:
Accident Prevention; Child; Health Education; Health Promotion; Pediatrics

Resumo:

Acidentes na infância têm uma alta taxa de morbidade e mortalidade e, muitas vezes, podem ser evitados, o que reforça a importância de medidas educacionais para evitar lesões não intencionais. O objetivo foi identificar e descrever estratégias educacionais úteis para a prevenção de acidentes infantis no contexto da comunidade. Essa revisão sistemática foi orientada pelo PRISMA (2020) e registrada na plataforma PROSPERO (ID: CRD42024500956). Uma estratégia de busca foi desenvolvida combinando os descritores “Accident Prevention” (prevenção de acidentes), “Child” (criança) e “Health Education” (educação em saúde) com o operador booleano AND, aplicado às bases de dados PubMed/MEDLINE, Web of Science, LILACS e SciELO. Foram localizados 5.037 estudos, incluindo artigos observacionais publicados entre 2018-2023, com crianças de 0 a 12 anos e/ou seus pais/cuidadores. A qualidade dos estudos foi avaliada considerando os critérios dos instrumentos Qualitative Studies Checklist e Research Triangle Institute Item Bank. A amostra bibliográfica consistiu em 30 artigos, em sua maioria classificados como de alta qualidade, com uma população de 4.510 adultos e 54.190 crianças de vários países. Foram descritas estratégias educacionais para a prevenção de acidentes, voltadas para pais e responsáveis, crianças e ambos. Esta revisão, que aborda estratégias educacionais inovadoras para a prevenção de acidentes infantis, destaca abordagens lúdicas para crianças e métodos visuais para cuidadores. A implementação enfrenta desafios relacionados à avaliação e a fatores socioeconômicos, tornando critérios rigorosos e acompanhamentos prolongados importantes para a eficácia contínua.

Palavras-chave:
Prevenção de Acidentes; Criança; Educação em Saúde; Promoção da Saúde; Pediatria

Resumen:

Los accidentes en la infancia tienen una alta tasa de morbimortalidad y, muchas veces, son prevenibles, por lo que refuerza la importancia de medidas educativas para prevenir lesiones no intencionales. El objetivo de estudio fue identificar y describir estrategias educativas útiles para la prevención de accidentes en la infancia en el contexto comunitario. Esta revisión sistemática fue guiada por PRISMA (2020) y registrada en la plataforma PROSPERO (ID: CRD42024500956). Se realizó una búsqueda combinando los descriptores “Accident Prevention” (prevención de accidentes), “Child” (niño) y “Health Education” (educación en salud) con el operador booleano AND, aplicado a las bases de datos PubMed/MEDLINE, Web of Science, LILACS y SciELO. Se encontraron 5.037 estudios, que incluye artículos observacionales publicados entre 2018-2023, con niños de 0 a 12 años y/o sus padres/cuidadores. La calidad de los estudios se evaluó considerando los criterios de los instrumentos Qualitative Studies Checklist y Research Triangle Institute Item Bank. La muestra bibliográfica consistió en 30 artículos, en su mayoría clasificados como de alta calidad, realizados con una población de 4.510 adultos y 54.190 niños de varios países. Se describieron estrategias educativas para la prevención de accidentes dirigidas a padres y tutores, niños o ambos. Esta revisión aborda estrategias educativas innovadoras para la prevención de accidentes en la infancia y destaca los enfoques lúdicos para los niños y las técnicas visuales para los cuidadores. La aplicación se enfrenta a desafíos relacionados con la evaluación y los factores socioeconómicos, por lo que los criterios estrictos y los seguimientos prolongados son importantes para mantener su eficacia.

Palabras-clave:
Prevención de Accidentes; Niño; Educación en Salud; Promoción de la Salud; Pediatría

Introduction

Accidents involving children are mostly unintentional and have high rates of morbidity and mortality, making them one of the leading causes of death among 5-14-year-olds. They can also have serious consequences, potential long-term impacts, and affect the individual’s quality of life. These unintentional injuries can result from traffic accidents, falls, drowning, burns, poisoning, asphyxiation, or sports practices. They affect children from all living conditions but are less frequent among families with higher economic status and levels of education. Developing countries show greater economic burden and mortality statistics due to these accidents ¹1. Beck B, Teague W, Cameron P, Gabbe BJ. Causes and characteristics of injury in pediatric major trauma and trends over time. Arch Dis Child 2019; 104:256-61.^,22. Greenham M, Botchway E, Knight S, Bonyhady B, Tavender E, Scheinberg A, et al. Predictors of participation and quality of life following major traumatic injuries in childhood: a systematic review. Disabil Rehabil 2022; 44:2591-607.^,33. Bou-Karroum L, El-Jardali F, Jabbour M, Harb A, Fadlallah R, Hemadi N, et al. Preventing unintentional injuries in school-aged children: a systematic review. Pediatrics 2022; 149 Suppl 5:e2021053852J..

Investing in prevention and improving these efforts is crucial to minimize preventable injuries. Multimodal educational interventions should prioritize children’s knowledge, attitudes, and safer behaviors ¹1. Beck B, Teague W, Cameron P, Gabbe BJ. Causes and characteristics of injury in pediatric major trauma and trends over time. Arch Dis Child 2019; 104:256-61.^,22. Greenham M, Botchway E, Knight S, Bonyhady B, Tavender E, Scheinberg A, et al. Predictors of participation and quality of life following major traumatic injuries in childhood: a systematic review. Disabil Rehabil 2022; 44:2591-607.^,33. Bou-Karroum L, El-Jardali F, Jabbour M, Harb A, Fadlallah R, Hemadi N, et al. Preventing unintentional injuries in school-aged children: a systematic review. Pediatrics 2022; 149 Suppl 5:e2021053852J.. These interventions can take the form of classroom teaching, family counseling, lectures, and educational materials such as posters, messages, stories, videos, games, virtual reality approaches, and more. However, there is a need for systematization and evaluations of the impact of these strategies, as the literature currently lacks such assessments ³3. Bou-Karroum L, El-Jardali F, Jabbour M, Harb A, Fadlallah R, Hemadi N, et al. Preventing unintentional injuries in school-aged children: a systematic review. Pediatrics 2022; 149 Suppl 5:e2021053852J.^,44. Azevedo SB, Vasconcelos CMR, Leal LP, Vasconcelos MGL. Intervenções educativas para prevenção de acidentes em pré-escolares: revisão integrativa. Rev Eletrônica Enferm 2018; 20:1-16..

Considering the impact of accidents in childhood, some systematic reviews have already been developed and have contributed to understanding injuries, quality of life impacts, environmental change strategies to prevent them in general, and some cause-specific prevention ²2. Greenham M, Botchway E, Knight S, Bonyhady B, Tavender E, Scheinberg A, et al. Predictors of participation and quality of life following major traumatic injuries in childhood: a systematic review. Disabil Rehabil 2022; 44:2591-607.^,33. Bou-Karroum L, El-Jardali F, Jabbour M, Harb A, Fadlallah R, Hemadi N, et al. Preventing unintentional injuries in school-aged children: a systematic review. Pediatrics 2022; 149 Suppl 5:e2021053852J.^,55. Bhatta S, Mytton J, Deave T. Environmental change interventions to prevent unintentional home injuries among children in low- and middle-income countries: a systematic review and meta-analysis. Child Care Health Dev 2020; 46:537-51.^,66. Gasteratos K, McCarthy M, Chatziathanasiou D, Vradeli G, Vlachopoulos N, Voitsidis P, et al. A systematic review of pediatric nonaccidental burns: protecting the children through knowledge, vigilance, and prevention. Ann Plast Surg 2023; 90:551-8.. This research aims to contribute to the theme by identifying and systematically describing useful educational strategies for preventing childhood accidents in the community context.

Methodology

This systematic review was guided by the research question: “What educational strategies (I) can be employed to prevent accidents in a community context (Co) during childhood (P)?”. The question was formulated according to the PICo strategy (Population, Interest/phenomenon of interest, and Context) ⁷7. Cardoso V, Trevisan I, Cicolella DA, Waterkemper R. Revisão sistemática de métodos mistos: método de pesquisa para a incorporação de evidências na enfermagem. Texto & Contexto Enferm 2019; 28:e20170279., due to its qualitative approach. For its development, the criteria of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) ⁸8. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372:n71. were followed, and a protocol for this review was registered on the PROSPERO platform (protocol n. CRD42024501952).

We searched for articles published from 2018 to 2023 that focused on educational strategies and intervention programs for accident prevention in community settings. We included studies involving children aged 0-12 years and/or their parents/caregivers, while excluding studies that did not meet the inclusion criteria, were incomplete, or did not address the research question. We excluded studies centered on patient safety in hospital settings rather than community settings and literature reviews. Language was not a criterion for exclusion. We accessed articles that were not fully available whenever possible, either via the institution of the authors of this research or directly from the authors of the studies.

The following descriptors were combined into a search strategy using the Boolean operator AND, and applied to the Web of Science, PubMed/MEDLINE, LILACS, and SciELO databases in January 2024: “Accident Prevention”, “Child”, and “Health Education”. For screening studies, initially through titles and abstracts, followed by full-text reading of eligible studies, the free web platform Rayyan (https://www.rayyan.ai/) was used. This stage was conducted by two independent and blinded evaluators (G.G.C.L. and A.L.F.G.), with disagreements resolved by consensus. The selected studies were managed for data extraction and analysis using Microsoft Excel (https://products.office.com/). The extracted data included author and year of publication, study design and location, sample size, key findings, and limitations.

The qualitative studies were evaluated using the Qualitative Studies Checklist⁹9. Critical Appraisal Skills Programme. CASP checklist: 10 questions to help you make sense of a qualitative research. https://casp-uk.net/checklists/casp-qualitative-studies-checklist-fillable.pdf (accessed on 03/Jan/2024).
https://casp-uk.net/checklists/casp-qual... , an instrument proposed by the Critical Appraisal Skills Programme (CASP). Articles were classified into the following categories: (i) high methodological rigor, for meeting at least nine out of 10 items on the checklist and (ii) moderate methodological rigor, for meeting five to eight items. Regarding quantitative studies, six criteria from the Research Triangle Institute Item Bank (RTI-Item Bank) ¹⁰10. Viswanathan M, Berkman ND. Item bank for assessment of risk of bias and precision for observational studies of interventions or exposures. https://www.ncbi.nlm.nih.gov/books/NBK82267/ (accessed on 12/Jan/2024).
https://www.ncbi.nlm.nih.gov/books/NBK82... were evaluated: (i) clearly defined inclusion and exclusion criteria; (ii) use of valid and reliable measures to assess inclusion and exclusion criteria; (iii) standardized recruitment strategy for study participants across all groups; (iv) appropriate sample selection; (v) results assessed using valid and reliable measures consistently implemented for all study participants; (vi) consideration of confounding and effect-modifying variables in the study design and/or data analysis. Articles were classified as: (i) high methodological rigor, for meeting five to six items of the criteria or (ii) moderate methodological rigor, for meeting three to four of them.

The quantitative information from the research was presented using descriptive statistics, including absolute numbers and percentages. Qualitative data were summarized in individual study synthesis figures.

Results

A total of 5,037 records were found in the searched databases. Out of these, 737 were published from 2018 to 2023 and were screened based on eligibility criteria. After applying the criteria, 30 articles were selected for analysis, as illustrated in Figure 1.

The following countries were represented among the studies: the United States (30%), Brazil (9.99%), Iran (6.66%), Saudi Arabia (6.66%), China (3.33%), South Korea (3.33%), Egypt (3.33%), Spain (6.66%), Australia (3.33%), Bangladesh (3.33%), Israel (3.33%), Pakistan (3.33%), the United Kingdom (3.33%), Thailand (6.66%), Turkey (3.33%), and Vietnam (3.33%). The studies consisted of 18 qualitative and 12 quantitative research. The study population included approximately 4,510 adults - parents and caregivers of children under 12 years old - and 53,987 children, aged from 3 months to 12 years old. Interventions for the prevention of various topics were included, with 11 studies focusing on accidents and unintentional injuries (33.66%), six on interventions for traffic safety (20%), five on home risk situations (16.66%), five on fall prevention (16.66%), five on correct car seat usage (16.66%), three on drowning prevention interventions (9.99%), three on fire prevention (9.99%), one on poisoning and intoxication prevention (3.33%), one on firearm accidents (3.33%), and one on injury identification (3.33%). It is important to note that some studies addressed more than one topic. Box 1 shows the study characterization.

Interventions aimed at caregivers

Most interventions were conducted by professionals with a background in Public Health and Pediatrics in a community setting, with only one conducted in a hospital context, despite the educational project focusing on the community setting ¹¹11. Macy ML, Kandasamy D, Resnicow K, Cunningham RM. Pilot trial of an emergency department-based intervention to promote child passenger safety best practices. Acad Emerg Med 2019; 26:770-83..

Some interventions used digital media through software, virtual sessions, and electronic content ¹²12. Choi Y, Ahn HY. Developing and evaluating a mobile-based parental education program for preventing unintentional injuries in early childhood: a randomized controlled trial. Asian Nurs Res 2021; 15:329-36.^,1313. Moridi E, Fazelniya Z, Yari A, Gholami T, Hasirini PA, Jeihooni AK. Effect of educational intervention based on health belief model on accident prevention behaviors in mothers of children under 5 years. BMC Womens Health 2021; 21:428.^,1414. Bakhurji EA, Alqahtani AM, Alwashmi EM, Husain MS, Gaffar BO. The effect of social media campaigns on parental knowledge, attitudes, and practices regarding the use of children's car seats in the Gulf region. BMC Public Health 2023; 23:1816.^,1515. Kendi S, Taylor MF, Thomas B, Khemraj UD, Mohamed MA, Macy ML, et al. Randomised feasibility trial of a virtual intervention to address infant car seat misuse. Inj Prev 2023; 29:29-34.. Creating virtual programs for preventable accidents with interactive quizzes led to increased safety practices. Sessions with videos, images, recommendations, and practical virtual demonstrations increased knowledge and awareness of the importance of traffic safety, ultimately enhancing the correct use of child seats regarding installation and positioning ¹²12. Choi Y, Ahn HY. Developing and evaluating a mobile-based parental education program for preventing unintentional injuries in early childhood: a randomized controlled trial. Asian Nurs Res 2021; 15:329-36.^,1414. Bakhurji EA, Alqahtani AM, Alwashmi EM, Husain MS, Gaffar BO. The effect of social media campaigns on parental knowledge, attitudes, and practices regarding the use of children's car seats in the Gulf region. BMC Public Health 2023; 23:1816.^,1515. Kendi S, Taylor MF, Thomas B, Khemraj UD, Mohamed MA, Macy ML, et al. Randomised feasibility trial of a virtual intervention to address infant car seat misuse. Inj Prev 2023; 29:29-34.. Conference-style presentations with practical sessions were also employed to address this topic ¹⁶16. Kuroiwa E, Ragar RL, Langlais CS, Baker A, Linnaus ME, Notrica DM. Car seat education: a randomized controlled trial of teaching methods. Injury 2018; 49:1272-7.^,1717. Budziszewski R, Thompson R, Lucido T, Walker J, Meyer LK, Arthur LG, et al. Measuring the effectiveness of a car seat program in an urban, level one pediatric trauma center. Inj Epidemiol 2021; 8 Suppl 1:19.. Content delivery primarily involved lectures directed at parents and caregivers of children ¹⁶16. Kuroiwa E, Ragar RL, Langlais CS, Baker A, Linnaus ME, Notrica DM. Car seat education: a randomized controlled trial of teaching methods. Injury 2018; 49:1272-7.^,1717. Budziszewski R, Thompson R, Lucido T, Walker J, Meyer LK, Arthur LG, et al. Measuring the effectiveness of a car seat program in an urban, level one pediatric trauma center. Inj Epidemiol 2021; 8 Suppl 1:19.^,1818. Furman L, Strotmeyer S, Vitale C, Gaines BA. Evaluation of a mobile safety center's impact on pediatric home safety behaviors. BMC Public Health 2021; 21:1095..

Behavioral approaches based on Social Cognitive Theory enabled the reorganization of habits, diminishing home safety issues and extending knowledge beyond the family context to encompass the community as a whole ¹⁹19. Machin AI, Ngamsuoy A, Pearson P. Collaborative child home injury prevention in Thailand: an action research study. Nurs Health Sci 2018; 20:206-13.^,2020. Wang Y, Gielen AC, Magder LS, Hager ER, Black MM. A randomised safety promotion intervention trial among low-income families with toddlers. Inj Prev 2018; 24:41-7.. An intervention based on the Health Belief Model, addressing participants’ perceptions of health-related risks, benefits of habit change, and barriers to habit change, resulted in reduced perceptible barriers and increased awareness, sensitivity, severity, and benefits related to habit change, measured using accident prevention questionnaires ¹³13. Moridi E, Fazelniya Z, Yari A, Gholami T, Hasirini PA, Jeihooni AK. Effect of educational intervention based on health belief model on accident prevention behaviors in mothers of children under 5 years. BMC Womens Health 2021; 21:428.^,2121. Estebsari F, Filabadi ZR, Matbouei M, Nasiri M. Application of a risk management program based on the health belief model for preventing home accidents. Iran J Nurs Midwifery Res 2023; 28:78-84..

The combination of intervention strategies such as presentations, group messaging apps, videos, brochures, practical sessions, and counseling sessions showed positive outcomes for increasing knowledge and safety practices in childhood, measured using pre- and post-test questionnaires, and led to a significant difference in identifying pediatric injuries and their risks ¹¹11. Macy ML, Kandasamy D, Resnicow K, Cunningham RM. Pilot trial of an emergency department-based intervention to promote child passenger safety best practices. Acad Emerg Med 2019; 26:770-83.^,1313. Moridi E, Fazelniya Z, Yari A, Gholami T, Hasirini PA, Jeihooni AK. Effect of educational intervention based on health belief model on accident prevention behaviors in mothers of children under 5 years. BMC Womens Health 2021; 21:428.^,2222. El Seifi OS, Mortada EM, Abdo NM. Effect of community-based intervention on knowledge, attitude, and self-efficacy toward home injuries among Egyptian rural mothers having preschool children. PLoS One 2018; 13:e0198964.^,2323. Kahriman IL, Karadeniz H. Effects of a safety-awareness-promoting program targeting mothers of children aged 0-6 years to prevent pediatric injuries in the home environment: implications for nurses. J Trauma Nurs 2018; 25:327-35..

The less frequent playful interventions for children’s caregivers, such as illustrated games related to childcare themes, improved knowledge indices immediately after the first intervention immediately after the intervention. However, in the second test, structured similarly to the first, applied five months post-intervention, there was a reduction in the number of mothers with optimal scores on the childhood accident prevention questionnaire ²⁴24. Silva FB, Gondim EC, Henrique NCP, Fonseca LMM, Mello DF. Intervenção educativa com mães jovens: aquisição de saberes sobre cuidados da criança. Acta Paul Enferm 2018; 31:32-8..

Group sessions, using triggering figures for discussion and meetings for skill development, as well as encouragement regarding children’s safety situations, increased the identification of childhood accident risk situations. Group dynamics on fire prevention, poison control, and car seat use facilitated community support and self-efficacy, being more effective for families with various home safety issues ²⁵25. Nascimento EN, Gimeniz-Paschoal SR, Sebastião LT. Prevention of domestic child accidents: an educational intervention conducted by speech therapy trainees in a family health care unit. Rev CEFAC 2019; 21:e17018.^,2626. Wang Y, Gielen AC, Magder LS, Hager ER, Black MM. Varying effect of a randomized toddler home safety promotion intervention trial by initial home safety problems. Matern Child Health J 2020; 24:432-8..

Educational and governmental accident risk training programs produced knowledge about childhood and adolescent safety, addressed by a significant increase in post-intervention perception of accident preventability. Additionally, caregivers reported the perceived effectiveness of campaigns in improving child safety ²¹21. Estebsari F, Filabadi ZR, Matbouei M, Nasiri M. Application of a risk management program based on the health belief model for preventing home accidents. Iran J Nurs Midwifery Res 2023; 28:78-84.^,2727. Temsah M-H, Aljamaan F, Alhaboob A, Almosned B, Alsebail R, Temsah R, et al. Enhancing parental knowledge of childhood and adolescence safety: an interventional educational campaign. Medicine (Baltimore) 2022; 101:e28649..

Interventions aimed at children

All interventions for this audience were implemented within schools, in some cases including both public and private institutions, by researchers with interests in health management ²⁸28. Ahmad H, Naeem R, Feroze A, Zia N, Shakoor A, Khan UR, et al. Teaching children road safety through storybooks: an approach to child health literacy in Pakistan. BMC Pediatr 2018; 18:31., educational assessment ²⁹29. DelCastillo-Andrés Ó, Toronjo-Hornillo L, Rodríguez-López M, Castañeda-Vázquez C, Campos-Mesa MC. Children's improvement of a motor response during backward falls through the implementation of a safe fall program. Int J Environ Res Public Health 2018; 15:2669.^,3030. DelCastillo-Andrés Ó, Toronjo-Hornillo L, Toronjo-Urquiza L. Effects of fall training program on automatization of safe motor responses during backwards falls in school-age children. Int J Environ Res Public Health 2019; 16:4078., applied health psychology ³¹31. Schwebel DC, Wu Y, Li P, Severson J, He Y, Xiang H, et al. Featured article: evaluating smartphone-based virtual reality to improve Chinese schoolchildren's pedestrian safety: a nonrandomized trial. J Pediatr Psychol 2018; 43:473-84., prevention ³²32. Ramos WD, Greenshields JT, Knee EN, Kreiti BK, Espirito KJ. Drowning prevention: assessment of a classroom-based water safety education program in Vietnam. Asian Pac J Public Health 2018; 30:470-8.^,3333. Teichman AL, Walls DO, Choron RL, Starace D, Mosier AS, Lissauer M, et al. Improving elementary students' knowledge and behavior to prevent traumatic injury: the impact of a behavioral skills training model delivered by aspirational role models. Eur J Pediatr 2023; 182:3275-80., and pediatric health education ³⁴34. Freitas CKAC, Rodrigues MA, Parreira PMSD, Santos ACFS, Lima SVMA, Fontes VS, et al. Educational program for the promotion of knowledge, attitudes and preventive practices for children about traffic accidents: experimental study. Rev Paul Pediatr 2019; 37:458-64.^,3535. McLaughlin CM, Barry WE, Barin EN, Mert M, Lowery C, Upperman JS, et al. Interactive education is associated with lower incidence of pedestrian-related injury in children. J Surg Res 2019; 244:57-62.^,3636. Kusol K, Phromphen C, Eksirinimit T. Effects of potential support program on drowning prevention among primary school students in Nakhon Si Thammarat Province, Thailand. Sustainability 2022; 14:11717..

Activities with practical components yielded positive results in increasing children’s knowledge about accident prevention. Simulating an urban traffic environment, for example, whether using virtual reality or immersive life-sized settings, showed that practical experiences in traffic were effective in increasing the likelihood that children would adopt responsible and preventive behaviors when crossing the street, as well as in identifying risk patterns and reducing the chance of accidents. Theoretical-practical educational sessions addressing the dangers of aquatic environments were able to increase knowledge about risk attitudes and water safety skills ³¹31. Schwebel DC, Wu Y, Li P, Severson J, He Y, Xiang H, et al. Featured article: evaluating smartphone-based virtual reality to improve Chinese schoolchildren's pedestrian safety: a nonrandomized trial. J Pediatr Psychol 2018; 43:473-84.^,3232. Ramos WD, Greenshields JT, Knee EN, Kreiti BK, Espirito KJ. Drowning prevention: assessment of a classroom-based water safety education program in Vietnam. Asian Pac J Public Health 2018; 30:470-8.^,3535. McLaughlin CM, Barry WE, Barin EN, Mert M, Lowery C, Upperman JS, et al. Interactive education is associated with lower incidence of pedestrian-related injury in children. J Surg Res 2019; 244:57-62.. In this regard, recognized programs such as Safe Fall also brought significant changes, reducing the risk of injury and increasing the adoption of safe positions in the event of a fall ²⁹29. DelCastillo-Andrés Ó, Toronjo-Hornillo L, Rodríguez-López M, Castañeda-Vázquez C, Campos-Mesa MC. Children's improvement of a motor response during backward falls through the implementation of a safe fall program. Int J Environ Res Public Health 2018; 15:2669.^,3030. DelCastillo-Andrés Ó, Toronjo-Hornillo L, Toronjo-Urquiza L. Effects of fall training program on automatization of safe motor responses during backwards falls in school-age children. Int J Environ Res Public Health 2019; 16:4078..

Interactive games, educational and playful resources, and the use of active methodologies were also crucial in acquiring new knowledge on unintentional injury prevention. Programs like the Safety Ambassador and the Drowning Prevention support program used creative approaches, educational materials, and manuals to effectively enhance student knowledge ²⁸28. Ahmad H, Naeem R, Feroze A, Zia N, Shakoor A, Khan UR, et al. Teaching children road safety through storybooks: an approach to child health literacy in Pakistan. BMC Pediatr 2018; 18:31.^,3333. Teichman AL, Walls DO, Choron RL, Starace D, Mosier AS, Lissauer M, et al. Improving elementary students' knowledge and behavior to prevent traumatic injury: the impact of a behavioral skills training model delivered by aspirational role models. Eur J Pediatr 2023; 182:3275-80.^,3434. Freitas CKAC, Rodrigues MA, Parreira PMSD, Santos ACFS, Lima SVMA, Fontes VS, et al. Educational program for the promotion of knowledge, attitudes and preventive practices for children about traffic accidents: experimental study. Rev Paul Pediatr 2019; 37:458-64.. Similarly, playful tools were used by a program that aimed to improve students’ knowledge, skills, and positive attitudes toward preventing aquatic accidents ³⁶36. Kusol K, Phromphen C, Eksirinimit T. Effects of potential support program on drowning prevention among primary school students in Nakhon Si Thammarat Province, Thailand. Sustainability 2022; 14:11717..

Interventions for mixed audiences

The interventions applied to both adults and children were predominantly conducted by professionals interested in health education and behavioral science ³⁷37. White C, Shanley DC, Zimmer-Gembeck MJ, Walsh K, Hawkins R, Lines K, et al. Promoting young children's interpersonal safety knowledge, intentions, confidence, and protective behavior skills: outcomes of a randomized controlled trial. Child Abuse Negl 2018; 82:144-55.^,3838. Foulds K, Peng D, Zaidi S. Play safe with Sisimpur: an evaluation of a child injury prevention intervention in Bangladesh. Int J Inj Contr Saf Promot 2021; 28:86-93.^,3939. Gesser-Edelsburg A, Alamour Y, Cohen R, Shahbari NAE, Hijazi R, Orr D, et al. Creating safe spaces to prevent unintentional childhood injuries among the Bedouins in southern Israel: a hybrid model comprising positive deviance, community-based participatory research, and entertainment-education. PLoS One 2021; 16:e0257696.^,4040. Taylor MJ, Orton E, Patel T, Timblin C, Clarke R, Watson MC, et al. Effectiveness of systematically delivered evidence-based home safety promotion to improve child home safety practices: a controlled before-and-after study. Inj Prev 2023; 29:227-33., primarily within a school setting, but with one instance in a healthcare and social assistance service ⁴⁰40. Taylor MJ, Orton E, Patel T, Timblin C, Clarke R, Watson MC, et al. Effectiveness of systematically delivered evidence-based home safety promotion to improve child home safety practices: a controlled before-and-after study. Inj Prev 2023; 29:227-33. and another involving focus groups from the studied community ³⁹39. Gesser-Edelsburg A, Alamour Y, Cohen R, Shahbari NAE, Hijazi R, Orr D, et al. Creating safe spaces to prevent unintentional childhood injuries among the Bedouins in southern Israel: a hybrid model comprising positive deviance, community-based participatory research, and entertainment-education. PLoS One 2021; 16:e0257696..

Television programs were designed/adapted to enhance knowledge among adults and children regarding injury prevention and risk behavior change, proving widely effective in improving understanding among children and adults on preventing and treating burns, electrocution, falls, household hazards, safe play, traffic injuries, as well as enhancing knowledge and skills in interpersonal safety ³⁷37. White C, Shanley DC, Zimmer-Gembeck MJ, Walsh K, Hawkins R, Lines K, et al. Promoting young children's interpersonal safety knowledge, intentions, confidence, and protective behavior skills: outcomes of a randomized controlled trial. Child Abuse Negl 2018; 82:144-55.^,3838. Foulds K, Peng D, Zaidi S. Play safe with Sisimpur: an evaluation of a child injury prevention intervention in Bangladesh. Int J Inj Contr Saf Promot 2021; 28:86-93..

Other actions were designed for implementation within the family context. Promotion of evidence-based home safety was implemented using various methods that addressed educational topics aimed at reducing the risk of common causes of injuries ⁴⁰40. Taylor MJ, Orton E, Patel T, Timblin C, Clarke R, Watson MC, et al. Effectiveness of systematically delivered evidence-based home safety promotion to improve child home safety practices: a controlled before-and-after study. Inj Prev 2023; 29:227-33.. Although the intended primary outcome and rates of medically attended injuries were not affected by the intervention, families were more inclined towards safety behaviors and practices. Cultural differences were also addressed using hybrid model interventions for unintentional injury reduction ³⁹39. Gesser-Edelsburg A, Alamour Y, Cohen R, Shahbari NAE, Hijazi R, Orr D, et al. Creating safe spaces to prevent unintentional childhood injuries among the Bedouins in southern Israel: a hybrid model comprising positive deviance, community-based participatory research, and entertainment-education. PLoS One 2021; 16:e0257696.. By incorporating traditional theatrical elements of the target ethnic group, the tools were able to generate ideas and positive diversion practices for injury prevention, as well as creating safe play spaces for children.

The quality assessment of the studies was conducted using the Qualitative Studies Checklist for qualitative studies and the RTI-Item Bank for quantitative studies. Among the studies, 22 (73.33%) were classified as high quality, and eight (26.66%) as moderate quality.

Discussion

This research highlights the growing demand for playful and interactive educational strategies aimed at preventing childhood accidents, which can be targeted at both caregivers or children, with varied approaches according to the context, skills, and specific needs of each target audience. Therefore, more playful and engaging approaches directed at children are described, such as stories and games designed to teach and reinforce learning, considering the specific cognitive abilities of each age group in the childhood cycle. Whereas, actions formulated for caregivers aimed to solidify more technical knowledge, predominantly visually, with group interactions, time-efficient activities, and methodologies involving lectures, quizzes, and administered questionnaires. The results also demonstrate difficulties in implementing these programs due to multiple factors related to the persistence of high rates of childhood accidents, such as the difficulty of maintaining and evaluating these actions in the long term, as well as issues related to parents’ level of education, socioeconomic vulnerabilities, and the geographical or cultural context in which some studies were conducted.

Educational technologies enable access to different intelligences and skills, incorporating both written and non-written language, resulting in greater engagement of users and professionals with the topics ⁴¹41. Costa CIA, Pacheco STA, Soeiro G, Adame DG, Peres PLP, Araújo BBM. Construção e validação de materiais educativos para criança com doença crônica: uma revisão integrativa. Rev Enferm UERJ 2018; 26:e34208.. Thus, the process of childhood teaching and learning allows for the educational development of children in orientation, structuring, motivation, problem-solving, and creativity perspectives. Therefore, playfulness in early childhood education allows for different possibilities of expression, analysis, and critical thinking of students, facilitating the understanding of adult reality from the child’s perspective and thereby stimulating autonomy and decision-making ability ⁴²42. Bertol SEE, Bertol CE, Bogo CSM, Silva E, Martins LA. A importância do lúdico na educação infantil o lúdico como facilitador do ensino aprendizagem. Revista Científica Semana Acadêmica 2018; (140). https://semanaacademica.org.br/artigo/importancia-do-ludico-na-educacao-infantil-o-ludico-como-facilitador-do-ensino-aprendizagem.
https://semanaacademica.org.br/artigo/im... . From this understanding, art is reaffirmed as an important tool for learning and for the development of long-term safer habits. Thus, it mobilizes affective and emotional aspects alongside theoretical knowledge to promote redefinitions and new interactions capable of fostering the prevention of various issues ⁴³43. Laguna GGC, Sousa GS, Marques BO, Gusmão ALF, Gusmão ABF, Azevedo KRM. Experimentações artísticas no pensar a construção de identidades a partir da infância e sua interface com a saúde mental. Saúde.com 2023; 19:3251-5..

The importance of storytelling during this period involves establishing an emotional bond between the story and the elements specific to the contexts experienced by children, being a psycho-pedagogical resource that amuses contrast to the monotony of the traditional teaching model ⁴⁴44. Caldeira MFSC. A criança e o lúdico: a arte de contar história na educação infantil. Revista ft 2023; 27(124). https://revistaft.com.br/a-crianca-e-o-ludico-a-arte-de-contar-historia-na-educacao-infantil/.
https://revistaft.com.br/a-crianca-e-o-l... . The use of a children’s storybook sparked a discussion among elementary school children about traffic accident prevention. It acted effectively toward this goal, as there was a statistically significant improvement in the average scores obtained by the children in tests administered immediately after the discussions and another conducted two months later. The latter showed a reduction in obtained values compared to the first post-intervention test, corroborating the need for continuous education to maintain the learning of safety measures ²⁸28. Ahmad H, Naeem R, Feroze A, Zia N, Shakoor A, Khan UR, et al. Teaching children road safety through storybooks: an approach to child health literacy in Pakistan. BMC Pediatr 2018; 18:31.. The article, featuring innovative modeling due to the didactic strategy applied by a pictorial storybook, employs a methodology based on a learning assumption during a primary school academic year to calculate the sample size, followed by thematic discussions grounded in this expected knowledge, which may be recognized as a factor of ambiguity. The use of an unvalidated questionnaire tends to elicit initial impressions that warrant further analysis for recognition. Furthermore, schools showed a statistically significant increase in average scores over time (p-value < 0.001) ¹³13. Moridi E, Fazelniya Z, Yari A, Gholami T, Hasirini PA, Jeihooni AK. Effect of educational intervention based on health belief model on accident prevention behaviors in mothers of children under 5 years. BMC Womens Health 2021; 21:428..

Prevention strategies based on traditional theoretical or theoretical-practical teaching methods, by cycles of classes, lectures, and workshops also proved effective in generating new knowledge and skills to recognize and deal with potentially dangerous situations for children. Knowledge of the location of possible accidents, circumstances, and mechanisms of injuries essential to prevent such events from occurring. Thus, changes in focus on dangers in domestic environments, for example, tend to reduce risks of falls, poisonings, and burns by taking precautions to make it difficult for infants to access toxic or harmful materials ⁴⁵45. Almeida LA, Torres BVS, Silva JS, Silva RCM, Vieria ACS. Prevenção de acidentes domésticos na primeira infância: uma revisão integrativa. Rev Urug Enferm 2023; 18:e2023v18n2a4.. From this perspective, providing guidance to caregivers, making adaptations to residential spaces, and identifying risk factors, especially considering the child’s developmental stage and common behavioral habits for the age group, are crucial to developing effective interventions ⁴⁶46. Barcelos RS, Del-Ponte B, Santos IS. Interventions to reduce accidents in childhood: a systematic review. J Pediatr (Rio J.) 2018; 94:351-67..

Various actions combine traditional teaching methodology with technological tools, such as explanatory videos, group discussions, video clips, apps, and quizzes, yielding positive outcomes in some studies, given the established statistical significance and feedback received ¹³13. Moridi E, Fazelniya Z, Yari A, Gholami T, Hasirini PA, Jeihooni AK. Effect of educational intervention based on health belief model on accident prevention behaviors in mothers of children under 5 years. BMC Womens Health 2021; 21:428.^,1717. Budziszewski R, Thompson R, Lucido T, Walker J, Meyer LK, Arthur LG, et al. Measuring the effectiveness of a car seat program in an urban, level one pediatric trauma center. Inj Epidemiol 2021; 8 Suppl 1:19.^,1919. Machin AI, Ngamsuoy A, Pearson P. Collaborative child home injury prevention in Thailand: an action research study. Nurs Health Sci 2018; 20:206-13.^,2222. El Seifi OS, Mortada EM, Abdo NM. Effect of community-based intervention on knowledge, attitude, and self-efficacy toward home injuries among Egyptian rural mothers having preschool children. PLoS One 2018; 13:e0198964.^,2323. Kahriman IL, Karadeniz H. Effects of a safety-awareness-promoting program targeting mothers of children aged 0-6 years to prevent pediatric injuries in the home environment: implications for nurses. J Trauma Nurs 2018; 25:327-35.. On the other hand, other studies demonstrate that the use of alternative techniques - employing novel tools - shows similar effectiveness to the traditional format. Short video lessons presenting car seats specifications and steps for their installation seem to be similarly well understood in the short digital teaching format. It tends to increase participant’s adherence and practicality for individuals can watch them on demand, investing less time and therefore making it easier to implement the acquired teachings later on ¹⁴14. Bakhurji EA, Alqahtani AM, Alwashmi EM, Husain MS, Gaffar BO. The effect of social media campaigns on parental knowledge, attitudes, and practices regarding the use of children's car seats in the Gulf region. BMC Public Health 2023; 23:1816.^,1616. Kuroiwa E, Ragar RL, Langlais CS, Baker A, Linnaus ME, Notrica DM. Car seat education: a randomized controlled trial of teaching methods. Injury 2018; 49:1272-7..

The integration of technology into intervention programs has yielded promising results, particularly in vehicle traffic safety. The strategy involving virtual demonstrations with certified child passenger safety technicians (CPSTs) and families for checking car seats resulted in fewer installation errors compared to the control group, which only participated in in-person demonstrations (control group: 7% ± 4; intervention group: 2% ± 3; p < 0.001) ¹⁵15. Kendi S, Taylor MF, Thomas B, Khemraj UD, Mohamed MA, Macy ML, et al. Randomised feasibility trial of a virtual intervention to address infant car seat misuse. Inj Prev 2023; 29:29-34.. Similar interventions had been previously conducted and discussed regarding their feasibility, applicability, and increased participant confidence in using car seats ⁴⁷47. Schwebel DC, Tillman MA, Crew M, Muller M, Johnston A. Using interactive virtual presence to support accurate installation of child restraints: efficacy and parental perceptions. J Safety Res 2017; 62 Suppl C:235-43..

Virtual reality (VR) has also proven to be an important strategy for reducing traffic accidents, particularly discussed in other studies as beneficial for reducing pedestrian accidents among children ⁴⁸48. Schwebel DC, McClure LA, Severson J. Teaching children to cross streets safely: a randomized controlled trial. Health Psychol 2014; 33:628-38.^,4949. Schwebel DC, Severson J, He Y. Using smartphone technology to deliver a virtual pedestrian environment: usability and validation. Virtual Real 2017; 21:145-52.. Although the study using VR showed weaker evidence compared to other studies in our review, the results described a reduced probability of accidents post-training and increased likelihood of checking traffic in both directions before crossing the first traffic lane ³¹31. Schwebel DC, Wu Y, Li P, Severson J, He Y, Xiang H, et al. Featured article: evaluating smartphone-based virtual reality to improve Chinese schoolchildren's pedestrian safety: a nonrandomized trial. J Pediatr Psychol 2018; 43:473-84.. This underscores the need for further trials validating the efficacy of VR.

Initiatives aimed at educating children about falling events, whether to prevent or reduce harm, are also important, as these events hold a high prevalence in childhood and cause pediatric unintentional emergencies and urgencies, representing a large part of hospitalizations, along with burns, drownings, and traffic accidents ⁵⁰50. Reis TS, Oliveira IS, Santos JMJ, Farre AGMC, Rodrigues IDCV, Leite AM, et al. Conhecimentos e atitudes de crianças escolares sobre prevenção de acidentes. Ciênc Saúde Colet 2021; 26:1077-84.. Among the most common accidents in childhood, falls were identified as the leading cause of hospitalization in all age groups from 0 to 15 years ⁵¹51. Gonçalves AC, Araújo MPB, Paiva KV, Menezes CSA, Silva AEMC, Santana GO, et al. Accidents in childhood: casuistry of a tertiary service in a medium-sized city in Brazil. Rev Col Bras Cir 2019; 46:e2104.. Given the above, interventions such as the Safe Fall program for promoting actions involving physical education classes, with the practice of games and exercises for the assimilation of safe positions, have achieved results that reduced the risk of injury and increased the adoption of safe positions in a fall event ²⁹29. DelCastillo-Andrés Ó, Toronjo-Hornillo L, Rodríguez-López M, Castañeda-Vázquez C, Campos-Mesa MC. Children's improvement of a motor response during backward falls through the implementation of a safe fall program. Int J Environ Res Public Health 2018; 15:2669.^,3030. DelCastillo-Andrés Ó, Toronjo-Hornillo L, Toronjo-Urquiza L. Effects of fall training program on automatization of safe motor responses during backwards falls in school-age children. Int J Environ Res Public Health 2019; 16:4078.. In children aged 6 to 12 years, the risk of injury, initially estimated at over 90%, was reduced to levels ranging from 8.7% to 18.3% due to the students’ natural responses to falls ³⁰30. DelCastillo-Andrés Ó, Toronjo-Hornillo L, Toronjo-Urquiza L. Effects of fall training program on automatization of safe motor responses during backwards falls in school-age children. Int J Environ Res Public Health 2019; 16:4078.. Similar strategies to the Safe Fall program, which focus on adopting proper body positions, have shown promising results in reducing fall events and their severity ⁵²52. Moon Y, Sosnoff JJ. Safe landing strategies during a fall: systematic review and meta-analysis. Arch Phys Med Rehabil 2017; 98:783-94.^,5353. Shi X, Wang T, Nie C, Wang H, Luo L, Qi Y, et al. Epidemiologic features and intervention effect of fall injury among rural school-aged children in southwest China: a short-term cohort study. Int J Inj Contr Saf Promot 2018; 25:439-42..

Therefore, the implementation of strategies for preventing childhood accidents is essential in promoting the health and well-being of this population, considering that external causes are among the leading causes of death in pediatrics. The applicability of some studies are limited to specific contexts and conditions of their samples, requiring critical reflection for the development of similar models, given the existence of cultural, socioeconomic, and geographical heterogeneity, for example.

Limitations

As this is a literature review, the limitations of the included studies may influence the outcomes of our research. The absence of control groups for result comparison is noted ¹¹11. Macy ML, Kandasamy D, Resnicow K, Cunningham RM. Pilot trial of an emergency department-based intervention to promote child passenger safety best practices. Acad Emerg Med 2019; 26:770-83.^,2828. Ahmad H, Naeem R, Feroze A, Zia N, Shakoor A, Khan UR, et al. Teaching children road safety through storybooks: an approach to child health literacy in Pakistan. BMC Pediatr 2018; 18:31.^,3131. Schwebel DC, Wu Y, Li P, Severson J, He Y, Xiang H, et al. Featured article: evaluating smartphone-based virtual reality to improve Chinese schoolchildren's pedestrian safety: a nonrandomized trial. J Pediatr Psychol 2018; 43:473-84.^,3333. Teichman AL, Walls DO, Choron RL, Starace D, Mosier AS, Lissauer M, et al. Improving elementary students' knowledge and behavior to prevent traumatic injury: the impact of a behavioral skills training model delivered by aspirational role models. Eur J Pediatr 2023; 182:3275-80.^,3838. Foulds K, Peng D, Zaidi S. Play safe with Sisimpur: an evaluation of a child injury prevention intervention in Bangladesh. Int J Inj Contr Saf Promot 2021; 28:86-93., as well as the lack of sample groups standardization, size, and rigor during the conduction of some studies ¹⁶16. Kuroiwa E, Ragar RL, Langlais CS, Baker A, Linnaus ME, Notrica DM. Car seat education: a randomized controlled trial of teaching methods. Injury 2018; 49:1272-7.^,1818. Furman L, Strotmeyer S, Vitale C, Gaines BA. Evaluation of a mobile safety center's impact on pediatric home safety behaviors. BMC Public Health 2021; 21:1095.^,2020. Wang Y, Gielen AC, Magder LS, Hager ER, Black MM. A randomised safety promotion intervention trial among low-income families with toddlers. Inj Prev 2018; 24:41-7.^,3333. Teichman AL, Walls DO, Choron RL, Starace D, Mosier AS, Lissauer M, et al. Improving elementary students' knowledge and behavior to prevent traumatic injury: the impact of a behavioral skills training model delivered by aspirational role models. Eur J Pediatr 2023; 182:3275-80.^,3636. Kusol K, Phromphen C, Eksirinimit T. Effects of potential support program on drowning prevention among primary school students in Nakhon Si Thammarat Province, Thailand. Sustainability 2022; 14:11717.^,4848. Schwebel DC, McClure LA, Severson J. Teaching children to cross streets safely: a randomized controlled trial. Health Psychol 2014; 33:628-38.^,5454. Alonso F, Esteban C, Useche S, Colomer N. Effect of road safety education on road risky behaviors of Spanish children and adolescents: findings from a national study. Int J Environ Res Public Health 2018; 15:2828.. Some studies relied on self-reported data collection from individuals, which may underestimate or overestimate the real results ¹²12. Choi Y, Ahn HY. Developing and evaluating a mobile-based parental education program for preventing unintentional injuries in early childhood: a randomized controlled trial. Asian Nurs Res 2021; 15:329-36.^,1414. Bakhurji EA, Alqahtani AM, Alwashmi EM, Husain MS, Gaffar BO. The effect of social media campaigns on parental knowledge, attitudes, and practices regarding the use of children's car seats in the Gulf region. BMC Public Health 2023; 23:1816.^,2121. Estebsari F, Filabadi ZR, Matbouei M, Nasiri M. Application of a risk management program based on the health belief model for preventing home accidents. Iran J Nurs Midwifery Res 2023; 28:78-84.^,2222. El Seifi OS, Mortada EM, Abdo NM. Effect of community-based intervention on knowledge, attitude, and self-efficacy toward home injuries among Egyptian rural mothers having preschool children. PLoS One 2018; 13:e0198964.^,2727. Temsah M-H, Aljamaan F, Alhaboob A, Almosned B, Alsebail R, Temsah R, et al. Enhancing parental knowledge of childhood and adolescence safety: an interventional educational campaign. Medicine (Baltimore) 2022; 101:e28649.^,3131. Schwebel DC, Wu Y, Li P, Severson J, He Y, Xiang H, et al. Featured article: evaluating smartphone-based virtual reality to improve Chinese schoolchildren's pedestrian safety: a nonrandomized trial. J Pediatr Psychol 2018; 43:473-84.^,4848. Schwebel DC, McClure LA, Severson J. Teaching children to cross streets safely: a randomized controlled trial. Health Psychol 2014; 33:628-38.^,5454. Alonso F, Esteban C, Useche S, Colomer N. Effect of road safety education on road risky behaviors of Spanish children and adolescents: findings from a national study. Int J Environ Res Public Health 2018; 15:2828.. The lack of a standardized, validated, or fully understood instrument by the research team is also a limiting factor ¹¹11. Macy ML, Kandasamy D, Resnicow K, Cunningham RM. Pilot trial of an emergency department-based intervention to promote child passenger safety best practices. Acad Emerg Med 2019; 26:770-83.^,1616. Kuroiwa E, Ragar RL, Langlais CS, Baker A, Linnaus ME, Notrica DM. Car seat education: a randomized controlled trial of teaching methods. Injury 2018; 49:1272-7.^,1717. Budziszewski R, Thompson R, Lucido T, Walker J, Meyer LK, Arthur LG, et al. Measuring the effectiveness of a car seat program in an urban, level one pediatric trauma center. Inj Epidemiol 2021; 8 Suppl 1:19.^,1818. Furman L, Strotmeyer S, Vitale C, Gaines BA. Evaluation of a mobile safety center's impact on pediatric home safety behaviors. BMC Public Health 2021; 21:1095.^,2424. Silva FB, Gondim EC, Henrique NCP, Fonseca LMM, Mello DF. Intervenção educativa com mães jovens: aquisição de saberes sobre cuidados da criança. Acta Paul Enferm 2018; 31:32-8.^,2525. Nascimento EN, Gimeniz-Paschoal SR, Sebastião LT. Prevention of domestic child accidents: an educational intervention conducted by speech therapy trainees in a family health care unit. Rev CEFAC 2019; 21:e17018.^,2828. Ahmad H, Naeem R, Feroze A, Zia N, Shakoor A, Khan UR, et al. Teaching children road safety through storybooks: an approach to child health literacy in Pakistan. BMC Pediatr 2018; 18:31.^,3232. Ramos WD, Greenshields JT, Knee EN, Kreiti BK, Espirito KJ. Drowning prevention: assessment of a classroom-based water safety education program in Vietnam. Asian Pac J Public Health 2018; 30:470-8.^,3333. Teichman AL, Walls DO, Choron RL, Starace D, Mosier AS, Lissauer M, et al. Improving elementary students' knowledge and behavior to prevent traumatic injury: the impact of a behavioral skills training model delivered by aspirational role models. Eur J Pediatr 2023; 182:3275-80.^,3535. McLaughlin CM, Barry WE, Barin EN, Mert M, Lowery C, Upperman JS, et al. Interactive education is associated with lower incidence of pedestrian-related injury in children. J Surg Res 2019; 244:57-62.^,3939. Gesser-Edelsburg A, Alamour Y, Cohen R, Shahbari NAE, Hijazi R, Orr D, et al. Creating safe spaces to prevent unintentional childhood injuries among the Bedouins in southern Israel: a hybrid model comprising positive deviance, community-based participatory research, and entertainment-education. PLoS One 2021; 16:e0257696.^,4848. Schwebel DC, McClure LA, Severson J. Teaching children to cross streets safely: a randomized controlled trial. Health Psychol 2014; 33:628-38.^,5454. Alonso F, Esteban C, Useche S, Colomer N. Effect of road safety education on road risky behaviors of Spanish children and adolescents: findings from a national study. Int J Environ Res Public Health 2018; 15:2828.. Other results have limitations that hinder generalization and replication in other populations due to their strong local cultural factors and socioeconomic bias ¹⁴14. Bakhurji EA, Alqahtani AM, Alwashmi EM, Husain MS, Gaffar BO. The effect of social media campaigns on parental knowledge, attitudes, and practices regarding the use of children's car seats in the Gulf region. BMC Public Health 2023; 23:1816.^,1515. Kendi S, Taylor MF, Thomas B, Khemraj UD, Mohamed MA, Macy ML, et al. Randomised feasibility trial of a virtual intervention to address infant car seat misuse. Inj Prev 2023; 29:29-34.^,1616. Kuroiwa E, Ragar RL, Langlais CS, Baker A, Linnaus ME, Notrica DM. Car seat education: a randomized controlled trial of teaching methods. Injury 2018; 49:1272-7.^,1919. Machin AI, Ngamsuoy A, Pearson P. Collaborative child home injury prevention in Thailand: an action research study. Nurs Health Sci 2018; 20:206-13.^,3737. White C, Shanley DC, Zimmer-Gembeck MJ, Walsh K, Hawkins R, Lines K, et al. Promoting young children's interpersonal safety knowledge, intentions, confidence, and protective behavior skills: outcomes of a randomized controlled trial. Child Abuse Negl 2018; 82:144-55.^,3939. Gesser-Edelsburg A, Alamour Y, Cohen R, Shahbari NAE, Hijazi R, Orr D, et al. Creating safe spaces to prevent unintentional childhood injuries among the Bedouins in southern Israel: a hybrid model comprising positive deviance, community-based participatory research, and entertainment-education. PLoS One 2021; 16:e0257696.. Some studies were conducted during the COVID-19 pandemic, limiting participant structure and follow-up ¹³13. Moridi E, Fazelniya Z, Yari A, Gholami T, Hasirini PA, Jeihooni AK. Effect of educational intervention based on health belief model on accident prevention behaviors in mothers of children under 5 years. BMC Womens Health 2021; 21:428.^,3636. Kusol K, Phromphen C, Eksirinimit T. Effects of potential support program on drowning prevention among primary school students in Nakhon Si Thammarat Province, Thailand. Sustainability 2022; 14:11717.^,4040. Taylor MJ, Orton E, Patel T, Timblin C, Clarke R, Watson MC, et al. Effectiveness of systematically delivered evidence-based home safety promotion to improve child home safety practices: a controlled before-and-after study. Inj Prev 2023; 29:227-33..

Conclusion

This systematic review synthesizes innovative and interactive educational strategies that have demonstrated effectiveness in preventing childhood accidents within the community context. Among the identified effective strategies are playful approaches aimed at children, such as the use of stories, games, and educational activities that respect the cognitive abilities of each age group. For caregivers, educational actions using visual and interactive methods stand out, including lectures, quizzes, and group activities focused on disseminating technical knowledge in an accessible and efficient manner.

The implementation and maintenance of these strategies face significant challenges, including long-term evaluation, parental educational attainment, socioeconomic vulnerabilities, and diverse geographic and cultural contexts. These factors influence the effectiveness and sustainability of preventive programs. Therefore, future studies should use validated instruments and rigorous criteria for participant inclusion and exclusion, as well as conduct prolonged follow-ups to assess the ongoing efficacy of interventions.

The findings of this research provide a basis for planning health education programs aimed at preventing unintentional injuries in childhood, benefiting both children and their caregivers within the community context.

References

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History