putting public health evidence into practice: increasing the prevalence of working smoke alarms in disadvantaged inner city housing - one way car alarm
Abstract purpose of the study: The British government recommends that local authorities install smoke alarms operated by batteries to prevent fire-related injuries.
However, a randomized controlled trial of the installation of the local authority housing smoke alarm found that the level of the working alarm was low in the follow-up.
Along with the qualitative work of this trial, the barriers and levers to the use of this public health intervention are explored. Design: Semi-
In a randomized controlled trial of the installation of a free smoke alarm, a structured group and individual interview was conducted with a sample of adult participants.
In a local primary school, group interviews and "drawing and writing" exercises were conducted with the children.
Participants: sample of pilot participants and primary school children in the pilot community.
Location: a downtown residential area in central London.
Main result: the main obstacle used by the smoke alarm is the distress caused by false alarm.
Although the trial participants considered themselves to be at high risk of fire and would recommend smoke alarms to others, the respondent's report on the pain caused by false alarms indicated that when people disable alarms, they balance short-term and long-term risks to health and well-being.
Conclusion: This study identifies some of the causes of low levels of functional smoke alarms, as well as problems with alarms.
These results have an impact on the implementation of this public health intervention.
If the alarm manufacturer and the person in charge of the implementation of the scheme consider ways to solve the problems raised in this study, the effectiveness of the installation of the smoke alarm can be improved.
Methods from November 1999 to March 2002, this study conducted a local government housing in London.
The property was severely deprived, with 23% of residents speaking a major language other than English.
The location was selected as a location that may reflect features related to the high risk of house fires --
That is, low-income areas, deprived parliamentary property and housing in poor physical condition.
There is a sharp social class gradient in the possibility of fire-related mortality and morbidity.
12, 13 samples were exported for qualitative work.
14 using the data collected from those who participated in the trial, we identified families of different races, ages, disabilities, family structure, type of housing, housing security rights, and integrated all five types of alarms used in the trial, as well as families who were random but ultimately rejected or did not receive intervention (6.
Recruitment ensures a sample survey of infants under 4 years of age and children over 65 years of age.
Based on available resources, it is planned to connect with approximately 50 adults and 50 children in a collective and one-on-one manner.
Our analysis shows that these numbers are saturated with data.
15 discussions were also held with trial recruiters and alert installers to gather information on the reasons for refusing to attend the trial.
Adult occupants of the identified family who participated in the trial who provided telephone numbers (
88% of all participants)
They were invited to participate in the quality work by telephone and a follow-up confirmation letter was issued.
A group interview was conducted at a local community center.
The evening interview was held for the people who went to work in the daytime.
If people can't leave the house, we offer to meet them at home.
Those who were contacted who were not fluent in English were asked if they wanted to translate.
Children aged 7 to 11 from local primary schools are also invited for interviews in the school's class groups.
We took the option of exiting with the consent of our parents.
The consent of the child himself was also sought.
We collect data using a series of qualitative methods.
These include individual and group interviews with adults, as well as group interviews with children, questionnaires, and "drawing and writing" techniques.
The problem is based on the topic guide with follow-up tips.
The key events were discussed in more depth with the respondents.
This includes two situations where the alarm does not stop;
One of the fires in the apartment next door;
One participant broke her alarm;
One participant was suspicious of the staff who introduced the project;
A fire broke out at home by a participant and was alerted by an alarm.
Thematic guidelines include perceptions of fire risk, benefits and issues with the use of smoke alarms, and reflections on participation in trials.
We asked if the smoke alarm would affect the decision to recommend the alarm to others.
In order to avoid damaging the dynamics of the group by introducing things that may be considered right or wrong, we have not asked participants to indicate whether their alerts are currently working properly.
Finally, there is an opportunity to give feedback on topics that we do not cover that are important to the participants.
The children were invited to talk to us about similar topics and were given a "work manual" to complete which encouraged painting and written responses.
We want to know if they recognize smoke alarms, if they know how they should operate, what happens if they leave (
Or a child corrected us).
Researchers at the promotion conference recorded gender.
We ask adult participants to describe themselves according to age and race.
We met with the children in the class, so their ethnic composition is likely to represent their annual group.
As part of a larger survey, work carried out in 1997 among children in this primary school indicated that 69% were Asian (63% Bengali)
16% white, 5% black, 10% other/unknown.
Two researchers facilitated all group meetings.
Conduct individual interviews with family participants and those who do not speak English (
Who do we use translation)
At the participant's home, an interview was conducted by a researcher.
Telephone interviews were conducted with people who were random but did not have an intervention.
All the interviews were recorded and copied.
The researchers read the data on key topics independently and solved the differences in interpretation through discussion.
In this particular study, the topics and issues raised are relatively simple, and there is a simple discussion among the staff in the main areas (KC and KL)
Human resources are sufficient to resolve differences.
The ethics committee of the Institute of Child Health approved the research programme.
Results during the one-year study, we interviewed a total of 58 adults.
A total of 39 participants were involved in 10 group interviews, from 3 to 9 in the group, and we conducted 9 individual interviews, 3 of which were family participants and 6 were non-family participants
Someone who speaks English
We interviewed 10 people who were randomized to intervene but did not.
Table 1 shows the age, race and other features of self-identification.
About one out of every five adults agreed to participate in the study at the time of initial contact, and about half indicated that those initially interested had attended the discussion group or agreed to a family interview.
Four group interviews were conducted with 41 children.
Detailed results of child participants will be reported elsewhere.
According to the test data, 63% of the qualitative study participants had a working smoke alarm at the end of the 15-month trial.
The leverage used for continuous alarm includes early warning at the time of fire, thus increasing the sense of security.
Those who refuse to install the alarm say they already have one (
In both cases, participants revealed in follow-up that this has not been installed yet)
, Expressed concern about the receipt of interventions that resulted in strangers entering their homes, or expressed doubts about interventions that were provided free of charge.
Some potential participants thought they were "too old to spend money.
"Among those who receive the alarm, there is a feeling of high fire risk.
They believe this intervention should be recommended to others.
However, they found a series of obstacles to continue to use after installation.
These alert low-level alerts at subsequent runs.
The alarm as a pressure source describes the significant adverse effects of the smoke alarm, including the pressure of the false alarm: It's an incredible noise and I'm not going to panic. . .
But when it all happened, I was like 'Oh!
You really want to stop it in your own home.
It's a very calm and safe environment and all of a sudden you get this, you know, it's yelling at you. . .
You feel totally powerless and it's a terrible feeling in your home that you can't control. Mother, white (1)
* It only went out once when I burned something in the kitchen.
By that time, it had risen for about eight months.
I had a high ceiling in the hallway and I forgot how to turn it off. I have a three-year-
Old daughter, she got a fright and started yelling at me.
I don't know how to turn this off. Mother, white (2)
Unfortunately we have an alert and I don't know what's wrong with it, but it's crazy.
It just keeps going. . .
There was no smoke around at all, just something happened.
Father, Black's participants who reported these issues ended up disabling the alarm by removing the battery or removing the battery from the ceiling.
The researchers received some phone messages and a letter asking for help (
"Would you please send someone over after Wednesday, July 4 ? ").
The letter clearly states the pain caused by the smoke alarm: I'm sorry, but it does put me under a lot of pressure as the heat and climbing the ladder try to stop it. . . .
After the dinner was cooked it went out on Wednesday and although it was fan Ning with towels and other things, it continued.
In desperation, I turned on the electric fan, but it lasted for an hour.
No smoke build up to start it, just a slight cooking smoke.
A letter from a woman over 65 years of age said that White problems with maintenance difficulties occurred while calming the alarm and reaching the alarm, such as replacing the battery or pressing the "pause" or "test" button (
A special problem for elderly and disabled participants).
Some participants found it difficult to release the lid of the alarm to replace the battery.
In some cases, the alarm was irretrievably damaged or fell from the ceiling in order to stop the noise.
My mother over 3 years old was scared by the alarm clock and she finished telling the story: So I grabbed a broom and I thought I had to smash it up.
So I started beating it with a broom. . .
It broke around me, and so the smoke alarm was over.
Mom, I told [the installers]
You must be joking.
I changed the battery! . . .
This is very high for me. . .
My legs are not good, I am a diabetic and I don't want to do anything out of the way right now. . .
This is a very bad story for anyone with bad legs or old people. . .
Man black, over 65, was later asked directly to test their alarm clock on a regular basis due to learning about these issues in early interviews.
Several people don't know about it, three described with flames or cigarettes.
13 people were not sure how to identify the low battery signal and 6 described the resulting confusion.
We don't know [
Low battery signal
So we took the battery from [
But someone came over last week and they told us
What is this? .
Woman, Bengali, the battery is dead, they will make noise and they will keep ringing, you will think this is the phone. . .
I woke up one night and I thought, "What is that sound ? "?
I can hear a "beep, beep" every two or three seconds, and I think, "What is this ? "
I never thought of the smoke alarm at the time.
WhiteFew participants, a female over 65, reported that they cleaned the alarm to clean the sensor.
Four participants expressed concern about the device, which they lacked the ability to control :[I]didn’t [test]it, [I’m]
Dare not try.
Women over the age of 65, ethnic "other" participants over the age of 25, describe providing or receiving assistance to families or neighbors due to such problems, others describe, use a broom or umbrella to reach the pause or test button.
Of the 48 adult recipients interviewed, the third found their alarm very sensitive, and a large number of children reported that the alarm always sounded when someone was cooking: when [I]
Boiled steam out]
Woman Bengali, if your parents are cooking
In most cases, the smoke alarm rings when parents cook.
Boy, the man next door, aged 10-11, baked a little bacon each time. . .
Then it starts the alarm off.
Women over 65 years old, in a Chinese family, we always fry things, sometimes the alarm clock will remind me if I fry too much. . .
Even my little boy said, "too much oil!
Dad, it makes a noise when my mom does anything.
Although the trial participants considered themselves to be at high risk of fire and would recommend smoke alarms to others, the pain caused by false alarms was the main obstacle to use.
The respondent's report on the pain caused by false alarms suggests that when people disable alerts, they balance short-term and long-term risks to health and well-being.
2 families in Bangladesh)
Describes taking the battery out of the alarm to stop it from making sound while they cook.
Some children also recommend this as an option.
Three participants expressed concern that a wake-up call could cause riots in their neighbors: I was worried about my neighbors.
There was an old lady across from me who didn't sleep much, sometimes during the day and [sleeping]the alarm]
Will disturb her. . .
Mother, when there is no fire, the white alarm rings as a nuisance alarm, causing them to be ignored as nuisance (
Like a car alarm.
, Or is disabled by removing the battery or alarm.
Residents, including children, no longer associate frequent alerts with emergencies: I have to turn on the TV when the smoke alarm rings.
Kid, 8, sometimes a little annoying because last time I fell asleep my mom was cooking and then it went on again and the sound was so loud that I had to wake up.
Child participants aged 10-11 suggested that alarms that frequently sounded due to no response would be invalid: The alarm made a noise.
What are you going to do?
People are working.
People don't want to help and let people die in the room. . .
Men over 65 years of age, race "other" discussions mainly find out why some participants refused to install the alarm and others stopped using it after installation-
And why others continue to use throughout the trial.
Both this and future work are important.
The lever used for continuous alarm includes early warning and enhanced security in case of fire.
Those who refuse to install the alarm say that they have installed the alarm or are concerned about being intervened, which means getting strangers into their homes.
The person who received the alarm but stopped using cited a range of adverse effects, including maintenance and alarm sensitivity issues, resulting in nuisance alarms and pressure.
This provides an explanation for the functioning smoke alarm after 15 months of installation.
5. although participants in the trial, including children (see fig 1)
Believing that they have a high risk of fire and would recommend smoke alarms to others, respondent reports of the pain caused by false positives, and maintenance issues indicating that by disabling the alarm, people make rational decisions about their health and happiness.
Among people who have managed a range of health risks, a public health intervention that increases meal time, not decreases, is stressful and noise threatens leisure or relationships with peers, alerts can pose a threat to immediate happiness.
Download the example of figure open figure 1 children's drawing in the new tabDownload powerpoint.
The advantages and disadvantages of research the advantages and disadvantages of qualitative work in a trial environment include the possibility that it will take advantage of the user's expertise, improve trial recruitment, and the opportunities it provides, to identify issues that are important to those who are subject to intervention.
Qualitative work followed trial recruitment in this study.
While potential weaknesses include over-introduced bias
In qualitative work, we were also able to recruit a random sample of people but exit before receiving a smoke alert.
Without this kind of study, it may be possible to make a wrong assumption as to why some families have abandoned smoke alarms.
After the results of the trial were published in the British Medical Journal, a reader asked: "What is the result of the trial? . .
One of the six pages specifically discusses the unsurprising fact that families without a figure do not bother to use a smoke alarm.
"As our findings show, disabling smoke alarms is more important than not checking.
Policy implications of smoke alarm manufacturers many smoke alarms are disabled due to over-usesensitivity.
In addition, replacing the battery can be a problem and dangerous operations may be required, and the maintenance instructions are often unclear.
Improved design can lead to more consistent use.
For regulators, incentives to increase smoke alarm manufacturers to produce alarms that meet the needs of users should be considered.
For researchers, dirty work is not a means of determining how to persuade reluctant service users to accept intervention.
Listening to endpoint users can help us identify problems, and qualitative work embedded in trial design can help identify leverage and barriers to effective implementation.
For funders who encourage research design, carrying out appropriate stages in different approaches may yield better results in real-world implementation.
For editors of qualitative and trial results, useful materials can be provided for service planners and practitioners.
Over the past decade, the impact of the development of research policies in and out of medicine in the UK has become increasingly prominent.
Some research programs including the UK Economic and Social Research Council's Evidence Network 20 and the Campbell cooperation organization 21
The "sisters" of the Cochrane Collaboration Network, dedicated to social care, education and criminal justice --
Despite the criticism of preventive activities by the Social Sciences, the view that "prevention" should be exempt from strict scrutiny, and the "D" aspect of research and development needed to support public health interventions is still underdeveloped, it is an area that has problems around implementation, relevance, cost-effectiveness, and acceptability of the receiving end.
This work resonates with other studies where health knowledge and health behavior may be inconsistent.
For example, studies of female smoking show that they are well aware of the risk of smoking, but as long as women receive short-term health benefits, efforts to prevent or promote health may be ineffective, for example, create a little space for yourself (
"I will be with you when I smoke a cigarette ").
22 smoke alarms may be seen as potential health benefits, but the pressure effects from the alarms can make them less attractive in crowded or noisy accommodations.
Effective support in a successful implementation programme, and the installation of the type of alarm most likely to work after 15 months found in the trial may be related to higher smoke alarm functions.
Manufacturers may need to explore other ways to ensure that smoke alarm users have better control over the alarms at home.
Unanswered questions and future research, while trial5's findings suggest that this is a clear "best buy" in terms of battery-powered smoke alarms ", installing a relatively low level of functionality in this population indicates that there is still a lot of work to be done in finding acceptable smoke alarms, addressing health risks that have an important impact on reducing inequality.
Developing appropriate methods to link trials and quality work may yield better results in real-world execution.
Further work needs to be done on the classification of methods.
25 it is likely that a more appropriate design will begin with quality work, improved occupancy and maintenance instructions.
In a sense, the people who live in council Manor are in common with the children of the local primary school
The authors of this work, we thank them and the staff of the primary school for their help.
Joe dilloff, Anna Downey and Catherine goldward helped collect data on children.
Angela Wade, Mark sculliver and Maggie Barker made useful observations during the study design process and subsequently.
We appreciate the useful comments from three fellow reviewers Danny Dolin, Ian Graham and an anonymous referee who have read this paper.
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Table 1 provides OpenUrlAbstract/FREE complete text annotation * Overall age, race, and other features.
We asked the people we interviewed to describe themselves, and some refused to provide age or race data.
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Funding: British Medical Research Council (Isrct N 47572799);
West Euston Partnership Camden and Islington Health Action Area;
Conflict of interest at the Joan Dawkins Foundation: no announcement.