In Canada, injury is the leading cause of death and disability for children between one and eleven years old. Unintentional injuries account for 33% of all deaths among children in this age group.¹ In Alberta, a concern about these rates led to the birth of a simple, yet effective program called A Million Messages.

This unique program began in the Edmonton area in 1998 as the result of a partnership between Kidsafe Alberta and Community Health Services health workers (in the formerly named Capital Health Region) who had an interest in children and safety. The group felt that while there were many injury prevention programs available, these programs were sporadic and a more concerted and organized effort was needed to lower the rates of injury in children.

The first step was to identify a set of key messages. In order to do so, the group combed the data from a variety of sources to get an idea of some of the more common injuries among children. National statistics, data from the Canadian Hospital Injury Reporting Program (CHIRPP) and data from the Capital Health region (Edmonton and area) were examined to determine trends in childhood injury. Once they had an idea of the key types of injury, the group used a child development model to match these types of injuries with a variety of milestones such as when a child first rolls over, walks, climbs, learns to ride a bike, etc. They recognized that not only were these milestones connected to injury, they also provided a good opportunity for "teachable moments" during which key messages could be delivered.

Unlike other provinces, every child in Alberta must be seen by a community health nurse for all immunizations between the ages of two months and six years of age. It was decided that these visits would be a perfect time to deliver age-appropriate messages to parents. However, in order for the program to work, the messages must be simple and easy to deliver. It became obvious that a standardized approach, which incorporated injury prevention messages into the daily work of Community Health Nurses, would be one of the most efficient ways to deliver such a prevention strategy.

According to Lacey Hoyland, Injury Prevention Coordinator at Alberta Health Services — Edmonton Zone in Edmonton, Alberta the reason that A Million Messages has been so successful is because it balances the needs of three key groups: children, their parents and community health nurses. For example, the program developers realized that if they created an injury prevention program that required additional work for parents and nurses then it would not be adopted and it would not succeed.

Another secret to the program’s success can be found in the famous quote by Marshall MacLuhan "the medium is the message". Not only are the "million messages" practical and make sense to parents, they are also delivered using colourful and up-beat graphics that have provided a consistent "look and feel" to the program.

A Million Messages has undergone several evaluations and the results have been consistently positive. A process evaluation was conducted to identify issues and challenges prior to implementation and two years later, an outcome evaluation revealed the impact of the program on staff, managers, clients and wait times. Overall, the evaluation results have been positive and clearly show that parents are listening. The implementation of A Million Messages in the Capital Health region has resulted in a 46% increase in self-reported behaviour changes in parents. "New parents can attest to the ability of the program to influence changes in behaviour that result in a safer environment for their children."²

Lacey Hoyland believes that the beauty of the program lies in its simplicity. Because the program is straightforward and simple to implement, this standardized approach has made it easier for the program to be adopted and expanded to other health regions within Alberta. Not only are community health nurses still utilizing the tool, it is also being used by health practitioners working with parents and children, individual paediatrician’s offices and clinics such as the casting clinic at the Stollery Children’s Hospital in Edmonton. The program is currently being implemented province-wide and has also been picked up by organizations across Canada.

To obtain further information regarding A Million Messages contact:

Lacey Hoyland
Injury Prevention Coordinator
Alberta Health Services — Edmonton Zone
Edmonton, Alberta
(780) 735-3010 or
lacey.hoyland@albertahealthservices.ca

¹ Public Health Agency of Canada. The Chief Public Health Officer's Report on The State of Public Health in Canada 2009. Growing Up Well — Priorities for a Healthy Future Ottawa; The Queen's Printer: 2009.

² Volpe R, Lewko J. Science and Sustainability in the Prevention of Neurotrauma. An Ontario Neutrauma Foundation Review of Best Practice. Toronto, Ontario: June 2008.