Many parents with low educational attainment prematurely graduate their children to seat belt restraint rather than use belt-positioning booster seats. This study aimed to identify interventions that promoted booster seat use among this population.
This multi-site study used focus groups to elicit contributing factors to booster seat non-use, which informed subsequent intervention development. A first phase (10 focus groups, N = 117) identified parents' perceived barriers, benefits, and threats relating to belt-positioning booster seats. These findings were used to identify existing and create new interventions. A second phase (20 focus groups, n = 171) elicited parent's reactions to these interventions and provided parents with belt-positioning booster seats and education on their use. Follow-up interviews were conducted six weeks later.
Lack of education and fear of injury were the primary barriers to belt-positioning booster seat use. Parents were motivated by interventions that provided them with clear, concrete messaging relating to use. Parents favored the intervention that presented a real story detailing a child's severe injury that could have been prevented with appropriate restraint. At follow-up, parents credited this intervention with motivating booster seat use most often. Although parent's cited their child's lack of comfort and non-compliance as barriers to use, they were not as motivated by interventions that addressed these barriers.
Effective intervention programs can be created by identifying and addressing factors that contribute to a population's intention to use belt-positioning booster seats. In addition, successful programs must utilize messages that motivate the target population by addressing their perceived threats to booster seat non-use.
"Intervention components often undergo iterative cycles of testing and revision to ensure that the target constructs are effectively addressed (often called ‘pre-testing’). Such theory-informed pre-testing has been applied to injury prevention interventions.45 At the conclusion of step 4, the intervention's initial programme theory should be finalised and the intervention components tested; the intervention is then ready for initial implementation and evaluation. "
[Show abstract][Hide abstract] ABSTRACT: Behavioural science when combined with engineering, epidemiology and other disciplines creates a full picture of the often fragmented injury puzzle and informs comprehensive solutions. To assist efforts to include behavioural science in injury prevention strategies, this paper presents a methodological tutorial that aims to introduce best practices in behavioural intervention development and testing to injury professionals new to behavioural science. This tutorial attempts to bridge research to practice through the presentation of a practical, systematic, six-step approach that borrows from established frameworks in health promotion and disease prevention. Central to the approach is the creation of a programme theory that links a theoretically grounded, empirically tested behaviour change model to intervention components and their evaluation. Serving as a compass, a programme theory allows for systematic focusing of resources on the likely most potent behavioural intervention components and directs evaluation of intervention impact and implementation. For illustration, the six-step approach is applied to the creation of a new peer-to-peer campaign, Ride Like a Friend/Drive Like You Care, to promote safe teen driver and passenger behaviours.
[Show abstract][Hide abstract] ABSTRACT: To determine the factors that influence appropriate restraint usage by child occupants across the age range for which any type of child restraint may be appropriate (0-10 years).
Randomized household telephone survey.
Statewide survey, New South Wales, Australia.
Parents or carers of children aged 0-10 years.
Parental reporting of appropriateness of child restraint.
Demographic information and data on age, size, restraint practices, parental knowledge of child occupant safety, and attitude to restraint use was collected using a structured interview. Data were analysed using logistic regression after cluster adjustment.
Inappropriate restraint use by children was widespread, particularly in children aged 2+ years. Overall, parental knowledge of appropriate ages for restraint transitions was associated with increased likelihood of appropriate restraint use. Lower levels of formal parental education, larger families, parental restraint non-use, and parent/child negotiability of restraint use were predictors of inappropriate restraint use. For particular child age subgroups, the parental knowledge that predicted appropriate restraint use was specific to that age group. Most parents felt that they knew enough to safely restrain their child, despite widespread inappropriate restraint use.
Parents are more likely to make appropriate restraint choices for their children if they possess restraint knowledge specific to their children's age and size. Educational campaigns may be most effective when they provide information for specific ages and transition points. Strategies to overcome parents' misplaced confidence that they know enough to restrain their children safely are also indicated.
[Show abstract][Hide abstract] ABSTRACT: To assess the effect of the newly enacted child passenger safety law, Wisconsin Act 106, on self-report of proper restraint usage of children in Milwaukee's central city population.
A prospective, non-randomized study design was used. The settings used were (a) a pediatric urban health center, and (b) two Women, Infants and Children offices in Milwaukee, Wisconsin. Participants included 11,566 surveys collected over 18 months that spanned the pre-legislation and post-legislation time periods from February 2006 through August 2008.
The study set out to assess appropriate child passenger restraint. The results showed that the changes in adjusted proper restraint usage rates for infants between the pre-law, grace period, and post-fine periods were 94%, 94%, and 94% respectively. For children 1-3years old, the adjusted proper usage rates were 65%, 63%, and 59%, respectively. And for children 4-7years old, the rates were 43%, 44% and 42%, respectively. There was a significant increase in premature booster seat use in children who should have been restrained in a rear- or forward-facing car seat (10% pre-law, 12% grace period, 20% post-fine; p<0.0005). There was no statistically significant change over time in unrestrained children (2.1%, 1.7%, 1.7%, p=0.7, respectively).
The passage of a strengthened child passenger safety law with fines did not significantly improve appropriate restraint use for 0-7year olds, and appropriate use in 1-7year olds remained suboptimal with a majority of urban children inappropriately restrained. Although the number of unrestrained children decreased, we identified an unintended consequence of the legislation - a significant increase in the rate of premature belt-positioning booster seat use among poor, urban children.
The design of child restraint systems maximizes protection of the child. Increasing reports of misuse is a call to those who manufacture these child passenger restraints to improve advertising and marketing to the correct age group, ease of installation, and mechanisms to prevent incorrect safety strap and harness placement. To ensure accurate and consistent use on every trip, car seat manufacturers must ensure that best practice recommendations for use as well as age, weight, and height be clearly specified on each child restraint. The authors support the United States Department of Transportation's new consumer program that will assist caregivers in identifying the child seat that will fit in their vehicle. In addition, due to the increase in premature graduation of children into belt-positioning booster seats noted as a result of legislation, promoting and marketing booster seat use for children less than 40 pounds should not be accepted. Child passenger safety technicians must continue to promote best practice recommendations for child passenger restraint use and encourage other community leaders to do the same.
Journal of safety research 02/2010; 41(1):47-52. DOI:10.1016/j.jsr.2009.12.004 · 1.34 Impact Factor
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