Classroom-embedded two-phase add-on program for fall-injury prevention in rural primary schools

BACKGROUND: Falls are a leading cause of injury among Chinese children, especially in rural areas. We evaluated a classroom-embedded, two-phase add-on school program integrating Health Belief Model (HBM)-guided education with supervised in-class balance training in rural Shantou, China. METHODS: We conducted a two-school, controlled before-and-after evaluation in rural Shantou with school-level allocation. The intervention school received monthly HBM-guided education during months 1-12 and supervised, zero-equipment balance training delivered twice weekly during months 7-12; the comparison school continued usual health education.The primary outcome was the rate of fall-related injuries during the 12-month period. Secondary outcomes were the proportion of students with ≥ 1 fall-related injury and balance performance. Difference-in-differences (DID) compared pre-post changes in balance between groups with 95% CIs. RESULTS: We analyzed 381 students (intervention = 198; control = 183; mean age 10.07 [SD 1.39] years; 195 [51.18%] boys). Adjusted analyses showed a lower rate of fall-related injuries in the intervention versus control group (IRR 0.54, 95% CI 0.29-0.98). The proportion of students with ≥ 1 fall-related injury did not differ significantly. Balance improved more in the intervention group, the DID showed a 1.94-second increase (95%CI, 0.18 to 3.70) in eyes-closed marching-in-place time, a 0.62-second decrease (95%CI, -1.22 to -0.02) in balance-beam time, and a 0.43-point increase (95%CI, 0.003 to 0.87) in one-leg standing with eyes closed. CONCLUSION: A 12-month classroom-embedded two-phase add-on program combining HBM-guided monthly education with supervised in-class balance training reduced the rate of fall-related injuries and improved balance among primary schoolchildren.