Russell, B.S., Trudeau, J., & Britner, P.A. (2008). Intervention type matters in primary prevention of abusive head injury: Event history analysis results. Child Abuse & Neglect, 32, 949-957.
Shaken baby syndrome (SBS) is one of the most severe forms of abuse affecting children under two, leading to death or permanent damage for most victims. Although SBS shares many of the risk factors common across other forms of maltreatment, the evidence in the SBS literature suggests that perpetrators shake infants in order to stop a cry, discipline the child, or in the course of inappropriate play, behaviours that may lend themselves to public education prevention campaigns. The present study is one of the first empirical evaluations to examine changes in awareness from baseline to follow-up.
A total of 264 adults recruited from the University of Connecticut community were randomly assigned to three groups: a brochure-only condition or to two different video conditions, each with an informational brochure. Using an assessment tool developed by the investigators, the SBS Awareness Assessment, the three groups were assessed prior to receiving the video or brochure, and then followed up at 2, 6, and 12 weeks. All three groups improved from baseline to follow-up, with the teaching video intervention having the greatest probability for increased awareness, followed by the testimonial video, with the brochure only group being least likely to show changes in awareness. Overall, the proportion of participants who scored in the "red flag" group (low awareness on two or more critical items) dropped significantly from 11.3% at pre-test to 5.6% at the 2-week follow-up. In addition to providing further evidence that public education can affect awareness of SBS, this study shows that careful consideration needs to be given to the selection of the most effective educational materials.
This was generally a well designed study that used random assignment, repeated follow-ups, and careful control through Event History Analyses of potentially confounding factors. The attrition rate was low: only 14% of participants failing to return any of the follow-up surveys. Careful attention was given to the development and testing of the SBS Awareness Assessment, a promising instrument for future studies. Two limitations, however, should be considered in drawing conclusions from this study. Since changed attitudes do not necessarily translate into behaviours, one cannot draw any conclusions about the impact of the educational materials on shaking or other potentially abusive behaviours. Secondly, with respect to the overall improvement of all groups, one cannot rule out a testing effect from the repeated application of the SBS Awareness Assessment (a second no pre-test control group should be used in future studies).