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REVIEW • Rev. Bras. Enferm. 76 (Suppl 4) • 2023 • https://doi.org/10.1590/0034-7167-2022-0807 linkcopy

Educational technologies for accident prevention due to falls in childhood: a scoping review

Tecnologías educativas para la prevención de accidentes por caídas en la infancia: revisión de alcances

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives: to map evidence on educational technology use for accident prevention due to falls in childhood.

Methods: a scoping review, carried out in October and November 2022, in the MEDLINE, Web of Science, BDENF and CINAHL databases and LILACS bibliographic index. There was no delimitation of language or time. Data were extracted and analyzed descriptively by two independent researchers. The research protocol was registered in the Open Science Framework.

Results: twenty-six studies were selected. Booklets, pamphlets and leaflets were the most used technologies, presenting health services as the most frequent environment to develop research on fall prevention. The technologies developed were important outcomes: increased knowledge of children, family members, caregivers, health and education professionals.

Conclusions: educational technology use makes it possible to increase knowledge, adopt safe practices and reduce falls.

Descriptors: Child; Child, Preschool; Educational Technology; Accident Prevention; Accidental Falls

Database (Total studies)	Search final strategy
Medline via PubMed (1,909)	((((“child”[MeSH Terms]) OR (“child, preschool”[MeSH Terms])) OR (“infant”[MeSH Terms])) AND ((((((“educational technology”[MeSH Terms]) OR (“health education”[MeSH Terms])) OR (“multimedia”[MeSH Terms])) OR (“communications media”[MeSH Terms])) OR (“audiovisual aids”[MeSH Terms])) OR (“teaching materials”[MeSH Terms]))) AND ((((“accident prevention”[MeSH Terms]) OR (“accidents”[MeSH Terms])) OR (“accidental falls”[MeSH Terms])) OR (“falls”[All Fields]))
CINHAL (295)	((MH “Child”) OR “child” OR (MH “Child, Preschool”) OR “child, preschool” OR (MH “Infant”) OR “infant” ) AND ( (MH “Educational Technology”) OR “educational technology” OR (MH “Health Education”) OR “health education” OR (MH “Multimedia”) OR “multimedia” OR (MH “Communications Media”) OR “communications media” OR “audiovisual aids” OR (MH “Teaching Materials”) OR “teaching materials” ) AND ( “accident prevention” OR (MH “Accidents”) OR “accidents” OR (MH “Accidental Falls”) OR “accidental falls” OR “falls”)
Web of Science (191)	(TS=(child) OR TS=(“child, preschool”) OR TS=(infant)) AND (TS=(“educational technology”) OR TS=(“health education”) OR TS=(multimedia) OR TS=(“Communications Media”) OR TS=(“Audiovisual Aids”) OR TS=(“Teaching Materials”)) AND (TS=(“accident prevention”) OR TS=(accidents) OR TS=(“accidental falls”) OR TS=(falls))
BDENF and LILACS via Virtual Health Library (VHL) (21)	((mh:(criança)) OR (mh:(“pré-escolar”)) OR (mh:(lactente))) AND ((mh:(“tecnologia educacional”)) OR (mh:(“educação em saúde”)) OR (mh:(multimídia)) OR (mh:(“meios de comunicação”)) OR (mh:(“recursos audiovisuais”)) OR (mh:(“materiais de ensino”))) AND ((mh:(“prevenção de acidentes”)) OR (mh:(acidentes)) OR (mh:(“acidentes por quedas”)) OR (quedas)) AND ( db:(“LILACS” OR “BDENF”))
2,416	-

Reference/country/year	Educational technology	Type of accident/place
A1(²⁴)/Brazil/2013	- Model with the scenario of the “Three Little Pigs” story; adapted, containing a tree, three houses; - A book with the safe version of the story; - Puppets and panel with student responses.	- Bike falls when riding without training wheels; from the tree when climbing to play in the branches; from the window without protection; from the ladder; in the boiling water cauldron/municipal kindergarten school.
A2(¹³)/Canada/2015	- Playground safety checklist; - Method of induced hypocrisy (posters representing safe and risky behavior in the playground); - Photos of children playing on playground equipment (slide, swings, climber, monkey bars) for discussion; - Video clips (DVD); - Signature of the forms “Commitment to avoid risky games on the playground”, “Promise to play safely”; - Role play and discussion guide.	- Falls from local playground/playground equipment and clubs.
A3(²⁵)/ New Zealand/1999	- Intervention group: information about the hazards, an engineer’s report, regular contact and encouragement to act on the report, and assistance in obtaining funding; - Control group: information about playground hazards.	- Falls from playground equipment/24 schools.
A4(²⁶)/United States/2002	- Computer program for assessment and provision of personalized information entitled “Baby, be safe”; - Customized and generic injury prevention leaflet.	- Falls from stairs and with a walker/primary care pediatric clinic.
A5(²⁷)/United States/1977	- Fall report by emergency rooms and police stations, followed by counselling, referral and data collection by public health nurses; - Media campaign to inform the public and raise awareness of the dangers; - Community education for prevention through door-to-door hazard identification, counseling by community workers, community organizing efforts with schools, tenant groups, clinics, churches, health care providers; - Provision of free, easy-to-install window guards for families with young children living in high-risk areas.	- Falls from windows/health centers, hospitals, pediatric clinics, police stations, community councils, children’s health clinics, family health centers, day care centers, career initiation programs, community school councils, child welfare agencies, neighborhood service offices, community corporations, supermarket chains, church pastors and a long list of community-based organizations including neighborhood associations, tenant groups, community service offices, rehabilitation groups housing.
A6(²⁸)/Brazil/2015	- Filming of caregiver-baby; - Analysis of caregivers’ behaviors; - Illustrative leaflet and educational video.	- Falls of babies during changing clothes (falls from heights)/two Basic Health Units.
A7(²⁹)/Brazil/2009	Educational actions with participatory and transformative pedagogical bases: - The creation and dramatization of the song “A Lição do Sapeca”; - The creation of the dynamics of the “Simulated House”; - The creation of the dynamic “What is this?” and dialogue.	- Falls/an early childhood education school.
A8(³⁰)/South Korea/2020	- Safe Kids Hospital (SKH) app for children; - Semi-structured interviews, narrated audio and text for caregivers, along with real photos and videos that described the definition and real cases of safety incidents among hospitalized children.	- Falls/an urban medical center.
A9(³¹)/Brazil/2021	- Educational video.	- Fall in a hospitalized child/a university hospital.
A10(³²)/ South Korea/2021	- Experimental group I: SKH application for children and educational materials for caregivers; - Experimental group II: 31 paper images based on situations of hospital beds, windows, bathrooms, corridors and elevators; - Control group: usual educational intervention for children’s caregivers.	- Falls/pediatric ward of three general hospitals.
A11(¹⁴)/China/2015	- Intervention group: children, their parents/guardians and the school received a multi-level school-family-individual education, which included a child injury prevention poster in schools, an open letter on safety instruction for parents/guardians and education in health in various media (Microsoft PowerPoint lectures, videos, manuals) for children; - Control group: children received manual education only.	- Falls/two primary schools and three secondary schools.
A12(³³)/Singapore/2013	- A multilingual poster on fall prevention has been strategically placed next to all cribs.	- Falls/a pediatric acute care hospital.
A13(¹⁵)/United States/2014	Fall prevention program: - Educational poster and the Humpty Dumpty Falls Scale for nurses; - Educational booklet for parents: “Preventing Falls, Increasing Safety”.	- Falls in the hospital/pediatric unit of a medical center.
A14(³⁴)/France/2003	- Group 1: counseling, two pamphlets on domestic injuries and prevention methods, emergency telephone numbers and a safety kit. - Group 2: counseling and pamphlets, but did not receive the kit.	- Falls in the bathtub, stairs, walker due to slipping on rugs, carpets and wires, from high chairs, balcony and window/home visits.
A15(³⁵)/United States/2018	- A parental security agreement; - Education, re-education and modeling of safe sleep practices; - Implementation of a reproting and debriefing system for falls in children.	- Newborn falls in the hospital and at home/Intensive Care Unit of a hospital.
A16(¹⁶)/Canada/2008	- Construction of posters; - Intervention of hypocrisy (review the posters and interview); - Interview with questionnaires.	- Falls on playground/school equipment.
A17(⁷)/Brazil/2021	Educational game prototype for common childhood accident prevention.	- Fall from bed and in the playground/scenarios: home, public road, school environment and public square or park.
A18(³⁶)/Canada/2013	- Videos addressing the theme “safe children” and a post-video discussion; - Parents received active supervision for a month to assess adopted safety practices.	- Falls/home.
A19(³⁷)/England/2019	- Grow up Safely (GUS) Android mobile app, designed to enhance parents’ knowledge and understanding of potential injury risk areas.	- Furniture falls/service at a local children’s center.
A20(³⁸)/England/2007	- Educational program Risk Watch Injury Prevention, using risk watch folders and ‘‘risk boxes’’ as teaching resources.	- Falls from stairs/primary schools.
A21(¹⁷)/United Kingdom/2006	- Injury prevention program: the Citizen Safety Project (CSP).	- Falls/rural secondary school and primary school.
A22(¹⁸)/Sweden/2012	- Motala program implementation to prevent serious and less serious unintentional child injuries.	- Falls at home, schools and sports/community facilities.
A23(³⁹)/Taiwan/2009	- Warning posters about accidental falls at the bedside; - Education related to the family through educational cards about falls; - Marking of the nursing care plan to remind nurse caregivers to comply with accidental falls education; - Highlight families whose children may belong to the high-risk group and carefully monitor these patients; - Monthly verification of the safety of the bedside railings.	- Fall in hospital bed/pediatric observation unit.
A24(⁴⁰)/United States/2020	- Sessions.	- Falls/semi-urban clinic of the Special Supplemental Nutrition Program for Women, Infants and Children and an urban pediatric primary care clinic.
A25(⁴¹)/Canada/2009	- Educational video.	- Falls/home.
A26(⁴²)/Canada/2014	- The Million Messages is an innovative program that partially uses print media to provide families with childhood injury prevention messages.	- Fall at home (bathtub, stairs and toilet)/local community.

Article	Design/Participants	Outcomes
A1(²⁴)	Descriptive study with 30 students (five and six years old) and a teacher.	The activities aroused children’s attention about risk situations for accidents and prevention strategies. The educational material was well prepared and can be extended to the whole school.
A2(¹³)	Experimental study with children aged 7 to 12 years/experimental group - 80 children; control group - 24 children.	The program was easy to implement and effective in positively changing injury beliefs about children’s risky practices on playground equipment.
A3(²⁵)	Clinical trial with 24 schools.	There was a significant drop in risk in intervention schools compared to control schools. Intensive intervention is more effective than just providing information.
A4(²⁶)	Randomized controlled study with 174 parents of children aged between 6 and 20 months.	Personalized communications were found to be more effective in promoting injury prevention behaviors than generic print media.
A5(²⁷)	Two-year pilot program that was developed by combining service with research.	There was a significant reduction in falls. The program is a solution to an urgent urban problem that other cities might consider to avoid loss of life and limb, and the corollary financial, burden for hospitalization, rehabilitation and maintenance of the injured and permanently disabled.
A6(²⁸)	Descriptive and exploratory research with 25 caregiver-infant dyads.	Observing babies’ and their caregivers’ behavior is essential to identify risk situations for falls from the most varied places and heights. The video seems to be a good strategy for promoting safety behaviors and preventing accidental falls in babies.
A7(²⁹)	Qualitative research with 11 professionals, 18 children and 20 family members.	The health team set in motion the process of community mobilization to prevent childhood domestic accidents. Communication was effectively established between the researcher and the health team and between the team and the children and parents. The playfulness of educational technologies favored subjects’ acceptance and their experiences.
A8(³⁰)	Quasi-experimental study with 30 hospitalized preschool children and 30 caregivers.	The level of security awareness increased after the security incident prevention program using the SKH application. Participants found the app easy to use and a fun way to learn. Children showed high levels of satisfaction with children’s characters and high levels of curiosity, and they enjoyed continuing to play.
A9(³¹)	Methodological research with 13 expert judges and nine health professionals.	The educational video prepared, “Fall prevention in hospitalized children”, proved to be valid in terms of content and appearance by both the judges and the target audience, with the potential to mediate educational practices in a hospital context as well as training health professionals in child health care.
A10(³²)	Randomized controlled clinical trial with 116 hospitalized children aged between 3 and 6 years and their caregivers.	Hospital safety awareness increased more after the intervention in experimental groups I and II than in the control group. It is considered a useful educational intervention to prevent safety incidents in clinical areas.
A11(¹⁴)	Experimental research with children from 08 to 16 years old.	The multilevel education intervention can significantly increase knowledge and attitude scores for accidental injuries, as after the intervention, injury incidence decreased. It should help children change their risky behaviors and reduce accidental injury incidence.
A12(³³)	Quasi-experimental study with 30 children aged 3 years or less.	The presence of a fall prevention poster to remind parents/caregivers to safely lift and lock crib rails at all times was effective in reducing the number of falls.
A13(¹⁵)	Quality improvement project – pilot study with 29 pediatric nurses.	After reading and reviewing the educational poster, all 29 nurses were able to correctly answer the 8-question drop post-test. For nurses, the Humpty Dumpty Falls Scale was useful for their clinical practice, increasing their awareness of patients at risk of falling, and helping them to implement safety precautions.
A14(³⁴)	Randomized study, with two groups of 50 people. Families of children aged at least 6–9 months.	Focus group meetings with health professionals were relevant both for the process assessment and for the impact. Home delivery of the kit was considered conducive to discussion and the effectiveness of the intervention, raising awareness of potential household hazards and leading to reflection on safety. The questionnaire was also perceived positively and was considered a vehicle for providing information.
A15(³⁵)	Observational and descriptive study with nurses and parents.	A newborn safety package was implemented to promote safe sleep and minimize the risk of falls in the acute care setting. Parents and nurses working together create a safe environment to protect patients from harm.
A16(¹⁶)	Case-control study with 239 children aged 2 to 13 years.	The hypocrisy-induced intervention was effective in reducing children’s risk-taking intentions. Most children who received the intervention no longer intended to engage in risky behaviors that they had previously endorsed.
A17(⁷)	Descriptive study.	The prototype is a potential playful instrument to be implemented to mediate child health education actions.
A18(³⁶)	Randomized clinical trial with 186 mothers.	After the intervention, parents showed a decrease in the time their child was completely unsupervised, an increase in the time they kept their child in sight, and an increase in the level of supervision provided when the child was out of sight.
A19(³⁷)	Randomized clinical trial with parents/caregivers of infants who are not yet crawling, parents aged 23 years or younger, and parent-infant group.	Most participants felt that the information included in the app was well written and informative and had the right level of information. Two of the groups commented that the information was succinct and easy to read, with one participant stating that it was very well written, easy to read and interesting.
A20(³⁸)	Cluster-randomized controlled trial, carried out in 20 schools and with 459 children.	The first year of a teacher-led educational program in primary schools was effective in increasing some aspects of children’s safety knowledge and skills.
A21(¹⁷)	Controlled study in secondary school (22 students) and rural secondary school (55 students).	The idea of peer mentoring of an accident prevention and risk awareness project was perceived very positively, as was the transferable nature of the Citizen Security Project for other years.
A22(¹⁸)	Quasi-experimental design.	The program was only partially successful in that it reduced the injury rate in employed households, but did not influence the injury rate in self-employed households for boys and non-professionally active households.
A23(³⁹)	Prospective study with pediatric patients admitted to the pediatric observation unit.	The occurrence of accidental falls decreased significantly in the third period. After performing the last intervention, an improvement of 100% was achieved.
A24(⁴⁰)	Randomized study with 277 mother-infant dyads.	Among families with multiple home security issues, the intervention resulted in relatively large effects, whereas the effects for families with no/few home security issues were small and not significant.
A25(⁴¹)	Descriptive study with mothers of young children.	The results provide information on strategies that promote commitment to more closely supervise mothers as well as strategies to prevent accidents. Future research will need to determine whether the findings generalize to parents or other caregivers.
A26(⁴²)	Descriptive study with 60 mothers of young children.	Portraying the consequences of injuries and displaying appropriate negative emotions on children’s face would affect parents’ perceptions of safety messages in addition to the effects achieved by describing the risk of injuries. Results confirmed that these image characteristics have an important effect on parents’ attention to the message and risk assessment.

Categories	Technology
Technologies applied in schoo ls(¹⁴, ¹⁶, ¹⁷, ²⁴, ²⁵, ²⁷, ²⁹, ³⁸)	Booklets, pamphlets and leaflets; video clips; dynamics; guidelines and advice; forms and questionnaires.
Technologies applied in the community(¹³, ¹⁸, ²⁷, ³⁷, ⁴²)	Booklets, pamphlets and leaflets; video clips; guidelines and advice; computer programs, applications and games; Forms and questionnaires; Media campaigns.
Technologies applied at home(⁷, ²⁷, ³⁴, ³⁶, ⁴¹)	Booklets, pamphlets and leaflets; guidelines and advice; computer programs, applications and games; video clips; provision of safety equipment.
Technologies applied in health services(¹⁵, ²⁶, ²⁷, ²⁸, ³⁰, ³¹, ³², ³³, ³⁵, ³⁹, ⁴⁰)	Booklets, pamphlets and leaflets; video clips; guidelines and advice; computer programs, applications and games; forms and questionnaires; scale.

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