The second stage of the Public Health Approach to Injury Prevention is determinants and involves assessing the factors that both raise and lower the risk of that injury occurring. Those determinants that have a positive influence are known as “protective factors” and those that have a negative influence are known as “risk factors”.

Determinants can occur at multiple levels, including;

• Social such as economic, cultural, commercial and political determinants.
• Environmental factors.
• Behavioural and individual characteristics of a person.

By thinking about the factors that influence injury, we are able to identify opportunities to target interventions to effectively influence these determinants.

How do we assess the determinants of injury?

The information required to identify the determinants of the injury issue that you are aiming to address may have already been identified during your surveillance stage, or you may require additional strategies to further expand the information you have gathered.

As outlined in Learn – Surveillance there are a variety of strategies that can be used to gather information regarding the determinants of injury, such as; data analysis, published evidence and research, and stakeholder and community engagement.

Additional determinants specific tools include;

• A Fishbone Diagram – a cause and effect tool that assists in developing a comprehensive list of all of the possible factors contributing to the injury that is of concern.
• Causal trees – assist in creating a hierarchy of all of the causes that are contributing to the problem that is being investigated. 

Models and theories to describe the determinants of injury

Models and theories can be useful tools to explain how different concepts relate to each other and therefore can be helpful in further understanding the determinants of an injury issue.

Below are a selection of models and theories of change that can be useful to inform how determinants may influence your initiative;

• The Socio-ecological Model – considers the interaction between individuals, relationships, community and societal factors, and how they influence the injury being investigated.
• Precede-Proceed – is a health promotion planning tool that takes into account multiple factors that influence health, including; social, epidemiological, behavioural, environmental, educational, organisational and administrative factors.
• Stages of Change Theory – explains the behavioural change process that occurs across the five stages of; pre-contemplation, contemplation, preparation, action and maintenance.
• Health Belief Model – states that behaviour change will occur with three simultaneous existing ideas of perceived severity, perceived threat and perceived benefits.
• Reasoned action and planned behaviour model – the Theory of Reasoned Action and the Theory of Planned Behaviour are social cognitive models that suggest that health behaviours are based upon intentions which are formed by a mixture of personal attitudes and pressure to adopt health-related behaviours.

Key determinants tools

• Fishbone Diagram
• Causal trees
• Health Belief Model
• Injury Matters’ Guide to promoting safety and preventing injury for local governments – information and support for identifying priority injury topics and effective interventions for addressing injury topics.
• The Social Determinants of Injury
• The Commercial Determinants of Health