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Health promotion and disease prevention often take the form of population- and individual-based interventions that aim to reduce the burden of disease and associated risk factors. There is a wealth of programs, policies, and procedures that have been proven to work in a specific context with potential to improve the lives and quality of life for many people. However, the challenge facing health promotion is how to transfer recognized good practices from one context to another. We present findings from the use of the implementation framework developed in the Joint Action project CHRODIS-PLUS to support the transfer of health promotion interventions for children’s health and older adults identified previously as good practices. We explore the contextual success factors and barriers in the use of an implementation framework in local contexts and the protocol for supporting the implementation. The paper concludes by discussing the key learning points and the development of the next steps for successful transfer of health promotion interventions.

The purpose of the Finland`s National Action Plan for Safety Promotion among Children and Youth, launched in 2009, is to promote safety and to reduce the incidence of injuries, self-harming and corporal punishment systematically in the long terms. The work is geared towards improved national coordination in multi-discipline cooperation.In Finland an average of 112 children and adolescents die as a result of an unintentional injury each year (5,5 million inhabitants). The majority of these accident fatalities (82%) involve people aged 15 to 24. Per year, an average of 13 800 persons under 25 years requires inpatient care because of accidental injuries. Each year, an average of 89 persons aged under 25 commit suicide, and about 700 persons in the same age group require inpatient care because of self-harming. Despite the legislation regulations in Finland since 1983 many children are suffering corporal punishment (incl. mental maltreatment): according to study results about third of the parents is using some kind of disciplinary violence against their children.An evaluation of National Action Plan in 2010−2016 is shown that from the total number of 210 measures in program, 32 of them had been completed and 71 had progressed well. In 65 measures, action was still in its early stages and 20 measures had remained unimplemented. The new implementation paper for the National Action Plan in 2018−2025 is published in March 2018.Systematic safety promotion of children and youth and action coordination will create a framework for effective work. It is particularly important to identify and provide early support and referral to treatment for those parents and families in whose backgrounds there are risk factors for injuries and suicidal tendencies as well as child maltreatment, such as mental health problems or substance abuse.

Medicolegal autopsies are a vital tool for obtaining reliable injury mortality data. In Finland, medicolegal autopsies have increased from 13.6% of all deaths in 1970 to 23.8% in 2004. In fact, medicolegal autopsies are performed in 87.2% of all unintentional injury deaths, 98.3% of homicides and 99.5% of suicides. Finland has exceedingly high medicolegal autopsy rates compared with other countries. Autopsy rates should be appropriately considered when performing international comparisons of injury-related deaths.

BackgroundIn Finland, more than 900 older people 65+ died due the fall in 2012. In addition, a fall was contributing factor of death of 770 persons 70 years and older. In 2012, costs of hospital inpatient care due to falls were close to EUR 400 million (THL injury database 2014).Description of the problemFalls prevention has become extremely timely along with Finnish ageing policy prioritising older people living at their own home as long as possible. Despite vast quantity of evidence about falls prevention, the actions to put them in practice have not been as systematic and widespread as possible. Falls prevention needs to be an integral part of care and services for older people at all levels of care and among all service providers.ResultsNational program, called IKINÄ, was launched in 2006 to enhance dissemination and implementation of sustainable falls prevention in Finland. Aim of the program is to provide knowledge and stress the importance of falls prevention to policy-makers and other executive authorities in national level as well as municipalities. To enhance implementation of falls prevention IKINÄ-program produces evidence-based tools and materials for professionals and organisations working with older people.During past ten years awareness of falls, their consequences and need for falls prevention have increased among professionals, both at executive level and those working in clinical practice, in the field of older people care and services in Finland. For example, several social and health care organisations have set the reduction of falls and fall injuries as their strategic goals. Thus, implementation of evidence-based falls prevention has become more systematic.ConclusionsFalls prevention requires to be continuous work and a joint effort of professionals working at all levels of care system of older people services. Sufficient resources should be allocated for falls prevention to ensure safe living at home for older people.

BackgroundNational action plan for injury prevention among children and youth in Finland was launched in 2009. National Institute for Health and Welfare (THL), national research and expert agency under the Ministry of Social Affairs and Health (MSAH), has coordinated the program. National action plan includes 216 objectives and proposed measures to promote and prevent accidental injuries and suicides.Description of the problemAround 122 Finnish children and young people under the age of 25 die annually in accidental injuries and 13,500 are hospitalised (2011–2013). Accidental injuries remain the leading cause of death under the age of 25. Majority of the deaths (83%) occur to 15–24 year olds. Around 25 percent of all 15–24 year-olds who die from accidental injury are intoxicated. Traffic accidents are the most common accidental cause of death in this age group. Accidental falls are causing most of the treatment inpatients periods in hospital, respectively.ResultsDespite the continuous decrease of deaths from accidental injuries since the 1970’s, accidental injuries causes major health losses among children and youth. The objectives, measures and their implementation and responsibilities of the National action plan are divided into a number of different experts and government departments. Legislation and national policy guidelines, as well as statistics and databases are generally at a good level in Finland. The monitoring of the management and implementation should be paid more attention.ConclusionsIn order to be successful a National action plan requires high level recognition and adequate resources together with systematic coordination. National action plan is essential to be approved by the appropriate ministries and politicians. That made possible and empowered the national level activities and promoted a network of cooperation between the different actors. There is need for targeted accidental injury prevention especially for youth from 15 to 25 years.

BackgroundPeople in vulnerable positions, e.g. elderly or disabled people, substance abuser or mental health patients have an increased risk of becoming fire victims. To avoid this risk fire safety knowledge and good practices are needed for professionals working in the field.The social and health policy in Finland prioritise assisted living and home care. At the same time the rescue service act stresses that the responsibility of fire safety is on building owners and service providers. Therefore, care professionals are in a novel situation as they are working at clients home and required to take into consideration diverse environment and self-determination of an individual.The aim of this study was to investigate the fire risk and good practices in assisted living and home care.MethodsThe data is from six group interviews done during 2014–2015. Each group included the whole care service chain: the client and one of his/her relatives, care-giver, service provider and planner representatives and fire safety officer. Each group interviewed represented different type of clients and assisted living facilities and service. Interviews took place in various regions in Finland.ResultsEach agent at the service chain had ambition to improve fire safety. However, the knowledge among professionals what requires to be done and what others belonging to the same service chain are doing was inadequate. Some safety tools were used but oftentimes the user did not understand enough about their function. Overall, most were interested in safety information and to improve the safety, but the will to invest on safety was low.ConclusionsThe care service chain has overall good motivation to improve the safety and fire safety of vulnerable people. However requirements of rescue service act did not materialise in assisted living as well as possible. There is apparent need of knowledge and vocational education material.

BackgroundAll pupils participating in education are entitled to a safe learning environment. The Health Care Act (1326/2010) obliges comprehensive schools to monitor health and safety of school environments and well-being in learning communities every three years.MethodsHealth and welfare promotion in schools and educational institutions has been monitored by the National Institute for Health and Welfare and the Board of Education since 2006. In 2013 data were collected nationally using a form addressed to headmasters of Finnish comprehensive schools (N = 2734). The response rate was 74% (N = 2022). The topics covered also accidental injuries at school, accidental injury prevention, and safety promotion.ResultsInspection of health and safety of school environments and well-being in learning communities provides valuable information about the safety situation in the schools and their surroundings. One in four schools (24%) reported either that they did not know whether an accidental injury risk assessment indoors had been part of the inspection or that these issues had not been considered in the inspection. About three in four schools (76%) had taken into account indoors risk locations for accidental injuries.One in three schools (33%) did not know whether an accidental injury risk assessment outdoors had been included in the most recent inspection or not. Accidental injury risks had been assessed in 68 per cent of the schools, and outdoors safety was found deficient in 28 per cent of the schools.ConclusionsMultiprofessional inspection provides valuable information about school indoors and outdoors conditions, school surroundings, and safety at school trips. Most schools had paid attention to accidental injury prevention and safety both indoors and outdoors. However, a significant part of the schools did not monitor the risk of accidental injuries indoors or in the school yard.

BackgroundThe rescue act 2011 in Finland stresses that the responsibility of fire safety is on building owners and service providers. The regulation is justifiable, because people in vulnerable positions, for example elderly and disabled, have an increased risk being fire victims.The aim of this study was to investigate the implementation of rescue service act among service providers in residential, institutional and home care facilities and to monitor changes from 2013 to 2015.MethodsOnline surveys on fire hazard assessment and risk management practices were done in 2013 and 2015. Respondents were managers of residential, institutional and home care facilities for the vulnerable people.Information of the facilities was obtained from the nationwide Register of Institutions in Social Welfare and Health Care. The study sample was systematically selected (every other) and it consisted 1605 organisations.ResultsIn 2013 93% of institutional and 95% residential units had written guidelines to ensure fire safety. In 2015 the proportion has decreased to 84 in institutional and 88% in residential units. At home care written guidelines had less than 50%. The accident prevention guidelines had increased in institutional units from 66% to 74% and in residential units from 66% to 77%. At home care the guidelines had 50%. Safety guidelines in general e.g. crime prevention has also decreased and was now less than 50%, at home care only 22%. Patient and residential safety guidelines were increased only at home care from 55% to 60%.ConclusionsThe organisations have increased their preparedness for fire risk with sprinklers. But at the same time they made less written guidelines to prevent to fire. Fire risk assessment and management practices have improved only in home care. In IR-units the situation seems to be weaker than in 2013. The situation is not acceptable and the reasons should be diagnosed.

BackgroundFire safety in institutional care of vulnerable people in Finland is at a good level. However, in assisted living, residential and home care fatal fires still occur. Risk assessment, as well as knowledge of good procedures is therefore needed. Information of fire safety is included in vocational education of social and health care sector but for formal, non-formal and in-formal education material to improve care practices and identify the fire hazards at clients home is lacking.ObjectiveThe aim of the project was to produce evidence-based educational material about fire safety for social and health care professionals. To produce this material, data gathered by National Institute for Health and Welfare, literature and good practices from social and health care and rescue services were utilised. The project took place 2012–2016 and was sponsored by Fire Protection Fund.ResultsFire safety education material for social and health care professionals, students and planners was first published in 2014. The web-based material includes information about background, legislation, fatal fire cases, principles of risk management and learning from accidents. In addition, there are statistic, special knowledge about fire sensitive fabrics, electrical equipment and chemicals and also good practices to improve fire safety. Additional compact educational package for craft teachers is available. The material can be used also in voluntary work and for example for people taking care of their relatives.ConclusionsWeb-based material is freely available at https://www.thl.fi/fi/tutkimus-ja-asiantuntijatyo/hankkeet-ja-ohjelmat/step-hanke/stepin-koulutusaineisto. The material is available in Finnish and Swedish. English version is under consideration as there is urgent need of fire safety training also for increasing number of foreigners and immigrants in Finland.

BackgroundThe aim of this research was to examine the burden of (severe) fire-related injuries in Finland.MethodsAll together twelve separate data sets were gathered for conducting the study. Finnish Hospital Discharge register (FHDR) was the core data in which the injured persons could be identified. The Causes of Death register was the data to identify fire-related deaths. Criteria of inclusion for further study were that a person had been to inpatient care or died. Data on sickness allowances, different kinds of rehabilitation funding, (disability) pensions were obtained from the Social Insurance Institution of Finland. Other types of disability allowances or pensions were obtained from the Finnish Centre for Pensions. Causes of Death data supplemented with socioeconomic data were obtained from Statistics Finland. A data from Statutory Accident Insurance was obtained to cover work-related accidents. A five-year sample of patients with fire-related burn was obtained from the Helsinki Burn Centre. The Finnish Hospital Discharge Register was available at the National Institute for Health and Welfare, Finland. The whole study consisted of five sub-studies published in scientific journals.ResultsQuality, usability and some methodological issues of using the FHDR were resolved. A descriptive epidemiological study on the injuries nationwide was conducted. Inpatient care costs were approximated nationwide. Indirect burden of fire-related deaths was reported. Finally, indirect costs and benefits of fire-related injuries were studied.ConclusionsConducting an incidence-based cost of illness study requires detailed person-level data. Due to multiple sources and raw data being administrative on nature makes the research burdensome. Annually on average direct and indirect costs exceed EUR 40 million (population 5.4 million). Majority of the costs are indirect.