The impact of South Yorkshire Fire and Rescue’s Home Safety Visits on the Health Seeking Behaviour of Residents in Gleadless Valley

Author: Olisaeloka George Nsonwu BSc Biochemistry/Microbiology MPH Public Health

Supervisor: Dr Julie Dickinson

ABSTRACT Aim: To determine the impact of South Yorkshire Fire and Rescue’s home safety visits on the health seeking behaviour of residents in Gleadless Valley, by determining the outcome of the home safety visits on their knowledge of fire safety and prevention as well as their experience and attitude towards the home safety visits. Methodology: This study uses a qualitative, cross-sectional, non-experimental approach, by conducting one-on-one interviews with participants. The interviews were recorded, transcribed and analysed using a thematic analysis framework with three themes; retention of knowledge on fire safety messages, attitude of participants toward the home safety visits and practice of the fire safety messages after the home safety visits. Findings: A total of 16 sub-themes were observed which suggested that participants did not remember most of the fire safety messages given to them during their home safety visits and that most participants were satisfied with the home safety visits. It also found that older adults among the participants (over 65 years old) felt they had not gained any new knowledge on fire safety and engaged in some practices that exposed them to the risk of injury or death from a residential fire. Conclusion: Providing fire safety messages to participants is not enough to make participants adopt fire safety practices. However as shown from this study, the provision of safety equipment (smoke alarms) and an emphasis to participants on; the dangers of residential fires, as well as the associated benefits of practicing fire safety messages (during home safety visits) could help increase participants practice of fire safety messages. Keywords: Home safety visits, Fire prevention, Fire safety knowledge retention

INTRODUCTION A residential fire is a disaster involving a fire in a self-contained unit, which is primarily used for accommodation purposes e.g. apartments, detached homes and caravans. Statement of the problem. Injuries and death from residential fires (IDRF) are public health concerns of global proportions, even though they are not as recognized or publicized on the international stage when compared to injuries from communicable, tropical or chronic diseases. The burden of the residential fires is not limited to countries and demographic borders. In the United Kingdom (UK) in 1999, 466 deaths and 14,600 non-fatal deaths were attributed to the residential fires (DiGuiseppi et al., 2002). In the United States of America, these numbers were higher, with about 3000 deaths and 17,000 injuries each year (Istre et al., 2001). This burden is felt by individuals, families and the society at large. Response of Fire and Rescue Services Over the past 25 years, the paradigm of viewing residential fires as “unavoidable accidents” has changed to that of “largely preventable events” (Arch and Thurston, 2013). As a result a focus has therefore been set on fire preventive and safety services. In an effort to address this, the parliament of UK enacted the Fire and Rescue Service Act (2004). As a result, all Fire and Rescue Services (FRS) across the Great Britain have become involved is some form of community engagement programme. For most services this involves providing home safety visits (HSV) which involves; an assessment of the residence for risk factors of IDRFs (Arch and Thurston, 2013), provision and installation of smoke alarms (DiGuiseppi et. al, 2002), and provision of fire safety messages (FSM) to encourage fire safety practices in homes. These FSMs usually include; the need for fire escape plans and bedtime routines, maintenance of smoke alarms and the proper response to a fire in the home (Deave et. al, 2013).

Due to the increasing scarcity of resources for FRSs (Cambridgeshire Fire and Rescue Service, 2012; Morris and Johnston, 2011), evaluation of FRSs HSVs have become relevant to justify the prioritization of their limited resources and demonstrate the role of HSVs in fire safety and reducing the risk of IDRF. South Yorkshire Fire and Rescue (SYFR) conducted a series of targeted HSVs in the Geadless Valley neighbourhood, during which smoke alarms were provided and installed, while FSMs were delivered to participants based on risks identified in their homes. This study aims to assess the impact of this project on the health seeking behaviour of the participants by determining the outcome of the HSVs on participants’ knowledge of fire prevention and determine the participants experience and attitude towards these visits. METHODS This study uses a qualitative, cross-sectional, non-experimental approach to address its research question, by using interviews to explore participants’ attitude and experience of their HSVs and the recollection of FSMs given to them during their HSVs. Sampling Using a purposive sampling technique, 20 individuals were selected from a sample of 37 members of the Gleadless Valley Community, whom had received HSVs provided by SYFR. Only participants classified as being High Risk Individuals (HRI) (indicated by the number of risk factors identified in their home during their HSVs) were selected. Data Analysis Thematic analysis was used for this study and this was based on three overarching themes shown below; 1. Retention of knowledge on FSMs. 2. Attitude of participants toward the HSVs

3. Practice of FSMs after the HSVs Statements made by participants which referred to any of the three overarching themes where grouped into sub-themes to develop a conceptual frame work. These sub-themes were then analysed to determine any relationship with the research question Ethical consideration The researcher received ethical approval for this study from the ethical committee at the School of Health and Related Research (ScHARR), University of Sheffield. Participants were provided with an information and consent sheet prior to the interviews. It informed participants of the potential risks involved in participating and their rights as a potential participant. RESULTS Table 1: Result of Participant’s Recruitment Total

Unreachable

Declined

Contacted 20

7

3

Accepted to be interviewed Attended

Did Not Attend

6

4

In total, six participants took part in the interviews (Table 1). All can be classified as adults (over 45 years) with three of them being classified as elderly adults (over 65 years). Risks Identified During HSVs All six participants had smoke alarms; however they were only working in three of the participants’ homes. A further three participants reported using candles as a lighting source and two participants owned and used electric blankets. Finally, four participants admitted using some kind of deep frying equipment like a deep fryer, chip pan or wok

Data Analysis Table 2: Conceptual Framework Research Question Themes

Sub-themes

Health Seeking Behaviour of Residents of Gleadless Valley that Received Home Safety Visits Attitude of Participants Toward the Home Safety Visits

Practice of Fire Safety Messages After The Home Safety Visits

Retention of Knowledge on Fire Safety Messages

Provision of Smoke Alarms

Testing Smoke Alarms

Smoke Alarms

Nature of Home Service Visit

Safety with electrical appliances

First response to a fire from deep frying equipment

Safety Knowledge Learnt

Compromising between safety and convenience

Safety with Candles

Increased Awareness on Fire Safety Practices

Exit Routes

Safety with Electric Blankets

Quality of Service

Bed Time Routine

Safety with Electrical Appliances

(Home Assessment / Safety Education)

Duration of the HSV

A total of 16 sub-themes were observed, which were all related to the three overarching themes mentioned earlier in the data analysis section. The sub-themes revealed are highlighted in greater detail below within the context of their overarching theme.

Attitude of Participants towards their Home Safety Visits Participants revealed varying attitudes towards the HSVs, which were all within the contexts of; perceived benefit of their HSV, satisfaction of the HSV and recommendations for its improvement. These have been grouped into various sub-themes. Provision of Smoke Alarms Almost all (five out of six) participants described their HSV as being beneficial, in part due to the provision and installation of free smoke alarms. One participant described this benefit as an increase in the number (quantity) of smoke alarms, while two participants described their benefit as; the longer battery lives (quality) of the installed smoke alarms. An example can be seen in this remark by a participant; Nature of Home Safety Visit Half of the participants felt they had benefited from the experience in part due to the kind of service that was provided during their HSVs,

in particular; safety assessment of their

homes. This can be seen in a participant’s remark below; “…before they just came in and fitted the smoke alarms, which they were doing in the entire area, so they didn’t talk much about safety. So this time they came out and they talked about safety … “(Interview 004) Safety Knowledge Learnt Three participants reported learning new safety measures from their HSVs. However, half of the participants reported not benefiting from the experience admitting they didn’t learn anything new pertaining to fire safety. These participants reported that they already knew and practiced most, if not all FSMs given them. An example can be seen in the excerpt below;

“Beneficial? Erm, I suppose it would help a lot of people but it didn’t help me so much because I already know…” (Interview 1) Increased Awareness on Fire Safety Practices Two participants reported that the experience of the HSV left them with an increased awareness on some fire safety practices, which were expressed as an increase in the practice of these FSMs. An example can be seen in the excerpt below; “Yes, yes. Because normally [I do], anyways now I do it even more but before I used to check all electrical equipment [to] make sure.” (Interview 4) Quality of Service Majority of the participants (four out of six) expressed satisfaction with their HSVs and attributed this to the quality of the service provided. This was described as the behaviour of fire safety officers (FSO) and manner in which they conducted themselves. However, 1 participant showed dissatisfaction with the number of FSOs that conducted her HSV. She also complained of a lack of prior notice before conducting the HSV, these can be seen in the statement below; “And I felt four were too much i mean 2 would have been fine” (Interview 7) “ “…rather than showing up unannounced. I mean it was lucky it was convenient for me that time, but it might not have been” (Interview 7) Duration of the Home Safety Visits Half of the participants made references to the amount of time (each visit lasted about 15 to 20 minutes) the FSOs spent conducting their HSV. Two participants were satisfied with the amount of time spent, describing it as brief but sufficient. However, 1 participant complaint was that;

“It seemed a bit rushed to me” (Interview 007) Practice of Fire Safety Messages after the Home Safety Visits Testing Smoke Alarms Only half of the participants reported testing their smoke alarms, however they all reported no particular pattern in testing but rather tested the smoke alarms at their convenience. An example is seen below; “…em I haven’t quite checked again from that day” (Interview 004) Safety with electrical appliances Half of the participants reported taking measure aimed at using electrical appliance safely since their HSV. Two participants reported switching off electrical appliances whenever they were not in use. One participant reported carrying out repair works and purchasing a new extension to avoid overloading his. An example of this safety measure can be seen in the remark below; “I have got an electric deep fat fryer yeah, with a thermostatic control on it” (Interview 001) Compromising between safety and convenience Half of the participants admitted being in a situation where they acted contrary to the FSMs they were given for the benefit of convenience. As an example is seen in the statement below; “…we had got one or two bits and pieces on the stairs I know we shouldn’t have them but really they were to one side they weren’t” (Interview 001)

Exit Routes Three of the participants reported removing objects that were blocking stairwells, walk ways and doors since receiving their HSV. However, two participants admitted that they would proceed to the balcony or veranda in the event of a fire. An example can be seen in the statement below; “We’d go to a small balcony off the bedroom to the next” (Interview 001) Bed Time Routine Two participants reported implementing a form of bedtime routine since they received the HSV. The remark below highlights a good example of this; “…We check everything at night, turn things off…” (Interview 006). Retention of Knowledge on Fire Safety Messages Testing Smoke Alarms Only Two participants were able to recall the recommended number of times (once a week) to test their smoke alarms. First response to a fire from deep frying equipment Of the four participants given safety advice on how to respond to a fire from deep frying equipment, only one participant recalled the recommended action; which was to evacuate the premises. Safety with Candles All three participants given advice on safety with candles recalled the recommended safety measures which were; to not leave a burning candle unattended and to place them in proper candle holders or containers.

Safety with Electric Blankets All two participants given safety advice on safety with candles recalled the recommended safety measures which were; to not leave them switched on overnight and to service their electric blanket regularly. However, only one participant recalled both safety measures. Safety with Electrical Appliances Two participants were able to recall the recommended safety measures with electrical appliances which were; to switch off electrical appliances when not in use and not to overload extensions. However, only one participant was able to recall both safety measures. DISCUSSION Attitudes and Experience of Participants towards Home Safety Visits and the Fire Safety Messages Provided Smoke Alarm Provision, Installation and Testing This study found that most participants referred to their benefit from the HSVs as the provision and installation of these smoke alarms, as opposed to the fire safety knowledge gained. This could be because smoke alarms were the only safety equipment provided during the HSVs and they have a physical presence in their residence, such that constant visual contact with them serves as a constant reminder of the smoke alarm and the HSVs. Another reason could be because smoke alarms are tangible objects they are more easily counted as quantitative benefits. Finally, this could be as a result of reduction in false alerts from the smoke alarms which were replaced with improved versions by the FSOs, as seen in the earlier remark made in “Interview 005”.

Safety Knowledge Learnt About half of the participants admitted not learning anything new regarding fire safety. Interestingly, they were all older adults (65+ years old). This finding is consistent with previous studies like Diekman et. al (2010) which identified sentiments such as “they think they know it all” and “they think it’s not going to happen to them” among older adults, particularly the men. This perception on FSMs could endanger older adults by providing them with a false sense of security. For example; in the excerpt below a participant expresses confidence in tackling a fire from a chip pan or deep fryer; However, further along during the interview she admits that; she had never used an electric blanket and doesn’t really know how to use it. Quality and Duration of the Fire Safety Visits Most participants were pleased with the brief nature of the HSVs, and also the achievements within that period. A common remark among the participants was “how thorough” the visits were. There was a general sense of satisfaction in the quality of service provided by FSOs. Interestingly participants expressed this as; the mannerism and conducts of the FSOs as opposed to the nature of the HSVs itself. Findings from the data analysis also indicate that, the number of FSOs present during HSVs could be seen to influence participants’ satisfaction. This finding is based on the fact that only 1 participant experienced dissatisfaction and it was related to the number (4) of FSOs present during her HSV. This participant’s experience was the only exception as others had only 2 FSOs present.

Compromising Between Safety and Convenience Some participants engaged in activities contrary to the FSMs, particularly when doing so was more convenient. The significance of this finding lies in the fact that the participants are aware that their actions are contrary to the FSMs when they engage in them. This could indicate that those participants have a low perceived risk. An example of this scenario can be seen in the excerpt below; “I know we shouldn’t have them but really they were to one side, they weren’t going to ever stop us from getting down” (Interview 001) This should be a cause for concern, as Yang et. al (2006)’s study suggests that individuals with low perceived risk are about 17 times more likely to have a high actual risk. Also both Irwin (1974) and Parker et. al (2013) describe that the Health Belief Model predicts individuals with lower perceived risks are less likely to engage in measures to reduce that risk. The reasons mentioned above and the fact that most of the participants are elder adults means that; these participants have a greater risk of IDFR, a finding supported by previous studies such as Holborn et. al (2003) and Brennan (1999). Participants’ Recollection of the Points Delivered To Them during Their Home Safety Visits Smoke Alarming Testing This study found that most of the participants did not remember the recommended number of times to test their smoke alarms, and even participants that did, admitted that in practice they did so at their convenience. This was surprising because as DiGuissepi et. al (2001) suggests; one would expect giving an individual a smoke alarm would motivate him to use it, but participants did the contrary. DiGuissepi et. al (2001) suggests that this could mean that the participants may be lacking awareness on the value of smoke alarms.

Exit Routes Most of the older adults admitted that they would retreat to a balcony or veranda in the event of a fire, which is contrary to SYFR recommendations. There are several reason why this is a cause for concern; 

Existing literature such as Mulvaney et. al (2009)’s study, points towards the inability of older adults to exit the premises as a significant cause IDRF.



Participants, who move to the balcony or veranda, risk trapping themselves and their ability to leave the balcony would depend on their next door neighbour being present



As suggested in Allareddy et. al (2007)’s study, the hard to reach nature of Gleadless Valley could delay SYFR’s mobilization to the scene in the event of a fire. This delays their risk of not being rescued in time.

Bed Time Routine Findings showed that bed time routines were practiced by fewer participants. This is not very surprising as most of the participants were older adults and a bed time routine involves making rounds of the home before sleeping to ensure all safety measures are in place. As Diekman et. al (2010) has suggested; a physically tasking activity such as this could prove difficult for older adults. This study also found that those who practiced it had a spouse or did not live alone. The most likely explanation for this was a logical one, as the tasks would be shared between the occupants making them easier to accomplish. First response to a fire from deep frying equipment Though most participants admitted they would attempt to put off a fire from a chip pan or deep fryer, this is contrary to the recommend response by SYFR, which is to exit the premises, closing the doors behind and calling the fire service.

Gender based differences in response to a fire could be a possible explanation for this. Because majority of those that suggested tackling the fire where men. The Health Belief Model could provide another explanation for these findings. Karen and Donald (2008) suggestions on self-efficacy could mean that the participants would tackle the fires because they had more confidence in their ability to succeed. Safety with Electrical Appliances Only two participants could remember the recommended measure which was; not to overload sockets and to switch off appliances when not in use. Some participants who could not remember the recommended measure suggested measures of their own. However these were mostly tertiary preventive measures and would only help in reducing the damages from IDRF rather than prevent them. A possible explanation for this could again be gender. The only participant to correctly remember the recommended measure was a woman and this could be associated with the fact that women are considered to have better house-keeping habits (Chien and Wu, 2008). Another possible explanation could be the duration of occupancy of the participants. The participants, who did not remember the recommended measures, had lived in their places of residence for as long as 17-52 years. Zhang et. al (2006) suggests that this long period of stays in a dwelling can provide an occupant with a false sense of security and influence them to ignore fire hazards. Limitations to the study Participant recruitment was done by phone and on a week day, it is possible that those who were unreachable were busy at work, as a result biasing participant selection toward the unemployed or retired. This is significant because employment has been shown to influence participants’ fire safety practices including smoke alarm ownership (Parker et. al, 2013; Yang et. al 2006).

Another limitation is the relatively small sample size, as a result finding from this study cannot be generalised to other populations and would need further investigation. Data provided by the participants were all self-reported and were prone to social desirability bias, a form of response bias. As Deave et. al (2013) explains, participants could have exaggerate safety practices so as not to appear irresponsible. Conclusion This study found that most participants were satisfied with the visits and felt that they had benefited from the experience. However, it also found that most participants could not recall most of the FSMs delivered to them, which was the primary aim of the visits by SYFR. To improve the recollection and practice of FSMs delivered during these visits; FSMs should be tailored to include not only fire safety knowledge and practices, but also awareness on the dangers and damages caused by residential fires. This could go a long way in improving the success of such visits.

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