JMIR Publications

ABSTRACT

Background:

Outdoor play and risk-taking behaviours, including play at heights, are important to children’s physical, social and cognitive development. These aspects of play are important to consider when informing prevention policies for serious injuries that commonly occur on play structures. Supracondylar fractures of the humerus (SCH) are the most common type of elbow fractures that result from falls on an outstretched hand among healthy children. Despite being one of the leading causes of admission to hospital and surgical intervention, the details surrounding the cause of these injuries are often not recorded. Previous research has correlated decreased overall playground safety with higher rates of SCH fractures. Play structure height, as well as the type of undersurface have been identified as potential risk factors for severe injuries, including SCH fractures, in part due to their low compliance with safety standards. This paper explores the challenges we encountered, the resulting insights and methodological modifications we made.

Objective:

The aim of this paper is to discuss the challenges related specifically to clinical research in pediatrics and the strategies developed to conduct a study that prioritizes the engagement and perspective of children and their families.

Methods:

To explore the link between the severity of SCH fractures and children’s behavioural, environmental, and mechanistic factors, we conducted a mixed method study. We used qualitative interviews with children combined with the use of visual aids, such as photographs, and quantitative analysis of playground structures comparing them to the safety standards. This combination of methods has been shown to assist children who have experienced elbow fractures in sharing their viewpoints in a clinical setting. Through purposeful integration of children’s perspectives and child-friendly methodologies into research, relevant factors pertaining to the injury may be identified that are often overshadowed in routine, adult-focused elicitation.

Results:

During phase 1 (the original methodology) from June 2017 to July 2018 there were 58 eligible study participants and 17 were recruited. For phase 2 (the revised methodology) between October 2018 and March 2020 there were 116 eligible participants and 50 that were recruited.

Conclusions:

To inform evidence-based injury prevention policies that take into consideration the aspects of play most important to a child’s development, more research on SCH fractures is needed to gain a better understanding of the specific mechanisms and child-related factors surrounding injuries. The changes in methodology made following the first phase of data collection were effective in our ability to recruit participants. By identifying and addressing challenges pertaining to recruitment and resource limitations, we were able to collect data in a concise manner while not compromising the quality of the data and make for an easily adoptable methodology for other sites interested in participating in the study.