Improving Preschoolers' Fire Injury Prevention Using the Health Action Model

Young children face elevated risks of unintentional fire injuries, yet few early childhood programs incorporate explicitly theory-informed prevention approaches. Grounded in the Health Action Model (HAM), which emphasizes beliefs, motivation, intentions, and action realization, this study evaluated a developmentally adapted curriculum designed to strengthen preschoolers' fire safety literacy in a preschool located in northern Taiwan. A quasi-experimental design was conducted with 60 senior kindergarten children (aged 5-6 years) assigned to an experimental or waitlist control group. The five-week curriculum integrated scenario simulations, multimedia learning, and hands-on drills targeting five HAM-aligned domains: knowledge, attitudes, skills, intentions, and behaviors. Assessments included picture recognition tasks, teacher-facilitated structured responses, and video-rated skill demonstrations by trained external firefighters. Generalized Estimating Equations (GEE) examined group, time, and interaction effects, controlling for prior fire-related experiences. The intervention produced significant improvements across all five domains of fire safety literacy. While both groups demonstrated short-term gains at post-test, the experimental group showed significantly greater and more sustained improvements at follow-up. These sustained effects were particularly evident in practical fire safety skills (group × follow-up: B = 3.33, p < .001; d = 3.08) and fire safety intentions (group × follow-up: B = 2.00, p < .001; d = 1.43). Significant group × follow-up interactions supported the maintenance of intervention effects over time rather than indicating delayed onset. Prior fire-related experience did not significantly influence outcomes. The HAM-based curriculum was associated with meaningful improvements across multiple domains of preschoolers' fire safety literacy and produced sustained improvements in key domains. These findings highlight the applicability of theory-driven, mechanism-oriented curricula in early childhood injury prevention and support the integration of structured fire safety programs into preschool education.