Home visitation programs that are conducted by professionals to decrease risk of unintentional injury and child abuse are well supported by research. However, there is a lack of research on the efficacy of home visitation programs that are conducted by lay educators. To examine if lay educators could provide education that impacts specific behavior changes, the IPC partnered with the Texas Home Instruction for Parents of Preschool Youngsters (HIPPY) to implement a residential fire and scald burn prevention project. Phase I of the project was implemented in 2009, and Phase II was implemented in 2011.
Phase I of the project was implemented in Grand Prairie, Texas. HIPPY home educators were randomly assigned into intervention and comparison groups. Educators in the intervention group received education from IPC staff on residential fires and scald burns, smoke detector placement and testing, and decreasing the hot water temperature for the household. Both groups were trained on how to conduct pre- and post-home assessments and provided with literature containing referrals for smoke detectors to disseminate to participants. There were 100 participants in each group.
Following the pre-intervention home assessments, the educators in the intervention group provided literature and one-time verbal education to participants on residential fire prevention, smoke detector placement and testing, hot water temperature testing, and proper temperature for hot water heater. Educators in the comparison group only provided written literature. The post-intervention assessments were conducted two months following the pre-assessment.
Phase I Results
The prevalence of smoke detectors increased in both the comparison and intervention groups as follows:
- Intervention group – 13% increased prevalence of smoke detectors
- Comparison group – 11% increased prevalence of smoke detectors
The percentage of homes that had decreased hot water temperature on the post –intervention assessment was larger for the intervention group.
- Intervention group – 14% decreased hot water temperature to at or below 120 degrees
- Comparison group – 6% decreased hot water temperature to at or below 120 degrees
There were several issues that were identified in the first phase of the intervention. The data collected during pre and post intervention home assessments were inconsistent; the educators either rounded the hot water temperatures up or down; there was potential “spill over” because the intervention and comparison groups were in the same geographic area; and simply going into an individual’s home alerts that person that there may be a need for modifications.
For Phase II of the project, Irving, Texas was selected as the intervention site, and Dallas served as the comparison site. Home visitors provided literature and verbal educational messages about the importance of smoke alarms and appropriate hot water temperature (i.e., < 120 F) to parents. To address the issue regarding the “rounding up or down” on the hot water temperature, a trained IPC staff member conducted the pre and post intervention home assessments during Phase II. The post-intervention assessments were conducted 3 weeks to 1 month following the pre-intervention assessments. An additional written survey was completed on participants in the intervention group, which included the following questions:
- Was an additional smoke alarm(s) installed in your home?
- Was the hot water temperature lowered in your home?
If changes to the hot water temperature or smoke alarms were made, which was the most important factor that led you to make changes?
- I was encouraged to do so by my HIPPY home instructor.
- The written information provided to me indicated that I needed to make changes.
- The processes of having an individual check my smoke alarms and hot water temperature.
Phase II Results
Smoke alarm prevalence increased and hot water temperature decreased in both the intervention and comparison sites, as observed during Phase I. Therefore, only data from the intervention site (Irving) was analyzed for further analysis.
Ninety-six homes were included in the further analysis. Thirteen percent of homes had both optimal smoke alarm coverage and optimal hot water temperature. Of the remaining homes, 27% either acquired a smoke alarm or lowered hot water temperature by >5 degrees on follow-up assessment. Of those who still lacked optimal smoke alarm or hot water temperature, 62% reported trying to make one of the changes. Participants reported that the most important factor for making a change was having an individual check the smoke alarm and hot water temperature.
Using non-professional educators to incorporate injury prevention messages into an existing home visitation program may be an effective way to increase working smoke alarm prevalence and improve hot water temperature, especially if it includes physically checking the status of smoke alarms and hot water temperature.
The program appears to be cost effective because it utilized lay educators and does not require the distribution and installation of smoke alarms, but rather connects individuals to resources through which they can obtain smoke alarms.