A Randomized Trial of Evidence-Driven, Community-Based Injury Prevention Coalitions
Principal Investigator: Peter Layde, MD, MSc Co-Investigators: Ann Christiansen, MPH, Clare Guse, MS, Prakash Laud, PhD
Background and Significance
A significant challenge for the field of injury prevention and control is translating research findings into effective community-based prevention programs, policies, and practices. The National Center for Injury Prevention and Control believes that dissemination research can overcome this challenge by providing insight into the methods, structures, and processes needed to disseminate, translate, and integrate injury prevention and control research into everyday practice. The application of theoretical advances into applied programs is often a disconnect between researchers and communities. Researchers may have detailed information on the burden and scope of various injuries and on interventions that have been demonstrated to be effective in controlled studies. They lack, however, the knowledge or expertise in community priorities and means of implementing interventions in specific communities. Community-based coalitions interested in injury prevention frequently have detailed knowledge of community priorities and how to accomplish work within their community but may lack information on the magnitude and scope of various injuries in their community and on effective programs and policies that they can implement to reduce the burden. One result of this disconnect between researchers and communities is that community organizations and coalitions end up implementing ineffective injury prevention interventions or, perhaps even more frequently, not implementing any injury prevention interventions.
The proposed study builds on a model program developed and piloted by the IRC-MCW that bridges the gap between injury prevention and control research and the implementation of evidence-driven, community-based programs, policies, and practices through the use of an "enabling system." An enabling system links community coalitions with researchers by establishing an infrastructure of support through technical assistance, best practices guides, and direct consultation in all aspects of coalition development and management, as well as development, implementation, and assessment of the impact of a program, policy, or practice. This study proposes to implement and rigorously evaluate the use and impact of an enabling system on reducing the burden of injuries.
We propose a randomized community trial of two components of our Injury Prevention Coalitions model;
1) provision of evidence on injury burden and effective interventions to local communities and
2) enabling system support of the coalition building process and injury prevention prioritization and intervention implementation. We hypothesize that enabling system support will be more effective at reducing injuries in a community than the provision of evidence alone.
The specific aims for this proposal are:
1) Identification of counties interested in developing community-based coalitions to implement injury prevention;
2) Randomized assignment of communities into three groups: 1) control, 2) evidence intervention only, and 3) evidence intervention plus enabling system support.
3) Analyze implementation of injury prevention programs, policies, and practices in control, evidence only, and evidence plus enabling communities.
4) Measure outcomes variables of emergency department visits and inpatient hospitalizations for targeted injuries in control, evidence only, and evidence plus enabling communities.
Preliminary sample size determination suggests that we will have sufficient power to detect increases in injury occurrence on the order of 10% - 15% for common injury outcomes with randomization of three communities into each of the intervention groups. Because of the scope and nature of this project it would only be feasible as a large research project.