While child restraint systems are effective in protecting children from crash-related
injuries and deaths, their use in China is extremely low. This study assessed the
effectiveness of child restraint system education with and without behavioral skills
training on improved use and explored participants’ views regarding content and delivery
of an onsite intervention and online (WeChat) boosters.
A randomized trial was conducted in 6 kindergartens from May 2017 to January 2018
in Shantou and Chaozhou, China. Selected kindergartens were randomly assigned to 3
groups: (1) control, (2) child restraint system education‒only, and (3) child restraint
system education plus behavioral skills training. Analysis was conducted in May 2018.
Participants were parents from the selected kindergartens.
Both intervention groups received child restraint system education that included one-time
onsite education and biweekly online boosters for 3 months using an app to deliver
Main outcome measures
Survey questions included parent knowledge, attitude and behaviors of child restraint
system use, and opinions related to the content and delivery of the onsite intervention
and online boosters.
Child restraint system use in both intervention groups was higher than that of the
control group post-intervention (27.3% and 31.7%, respectively). Compared with the
control group, the intervention groups had a higher percentage of correct answers
to all 9 items, except Item 7 measuring the parents’ knowledge, attitude, and behaviors
of child passenger safety after the intervention. Lower parent's level of education
(OR=7.00, 95% CI=2.62, 18.70) and older child age (4 years: OR=3.92, 95% CI=1.08,
5.28; 5 years: OR=2.08, 95% CI=1.52, 5.31) were associated with lower rates of child
restraint system use. Most parents (92.3%) preferred the online over the onsite intervention
An education intervention was effective in improving parents’ knowledge, attitude,
and practice of child restraint system use. A social media intervention booster (WeChat)
may provide a new channel to help promote child passenger safety in China.