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Background <p>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.</p> Methods <p>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.</p> Results <p>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.</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月27日

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  • Xiaodong Chen,
  • Zidan Yang,
  • Kaiting Zhang,
  • Lingyu Xu,
  • Liping Li

摘要

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.