Evaluation of a Safety Capability Intervention Program to Promote a Child Safety Culture: A Mixed-Methods Approach

Millions of children are affected by unintentional injuries each year, resulting in disability, hospitalization, and death. Given that the number of injuries and maltreatment within child care organizations is increasing in Korea, it is necessary to discuss how to prevent and respond to children's safety at the organizational level. Previous studies emphasize a comprehensive managerial approach to address safety issues, but little is known about what specific practices can enhance a safety culture. This study aims to introduce a child safety capability intervention program that focuses on developing and implementing multifaceted policies and procedures focusing on safety culture. Also this study examine its effectiveness in improving child care organizations' safety culture from both employees' and children's perspectives.

A mixed-methods explanatory design was used for this study. Pre-post tests were performed on all 79 child care organizations participating in this program. For the employees' surveys, 79 employees in charge of this program completed the pre-post surveys asking about the perceived level of safety culture comprising awareness of safety policy and procedures and competencies of safety practices. Also, 212 children completed the pre-post questionnaires asking about safety awareness and behaviors. Reliable and valid measures were used to assess safety culture, safety awareness, and behaviors (Child Safeguarding Policy Audit Tool; Lim & Kim, 2019). A paired sample t-test and analysis of covariance (ANCOVA) with the pre-test organizational culture as a covariate were performed. For an in-depth understanding of the safety culture changes, six groups of employees (n=27) and three groups of children (N=12) were interviewed using photovoice.

Quantitative analyses revealed a significant improvement in the safety culture and safety awareness perceived by employees and children. For the employee surveys, a paired sample t-test showed there are differences in the perceived level of organizational safety culture between groups (F (1, 96 ) =9.717, p <.05). The intervention group (M=4.78, SD=.30) displayed a higher safety culture level than the control group (M=4.59, SD=.43). For children, their safety behaviors are significantly improved after the program (t=-2.01, p<.05). Additional focus group interviews for employees support the results obtained from the quantitative data. Overall, employees addressed they experienced organizational changes: valuing children's safety as the top priority and increasing workers' confidence to address child safety. Following themes on organization's cultural changes emerged: "increase safety communications - back to the basics, safety check regularly," "strengthen safety precautions and measures to address a child safety", "encourage a child to involve an organization's safety policies and procedures." Children are asked to take pictures during the interviews and discussed "what does it mean to feel safety," and "what in your organizaitons make you feel safe/unsafe." Children addressed that they increased their perception of safety in their organizations and their ability to make a difference. This study provides evidence on the effective organizational intervention strategies to improve safety culture that can be replicated in other child welfare settings. The findings of this study suggest that developing comprehensive, multifaceted, and explicit organizational safety policies may promote a safety culture for children.