Advertisement

Assessing an App-Based Child Restraint System Use Intervention in China: An RCT

      Introduction

      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.

      Study design

      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.

      Setting/participants

      Participants were parents from the selected kindergartens.

      Intervention

      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 education messages.

      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.

      Results

      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 component.

      Conclusions

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Tiruneh BT
        • Dachew BA
        • Bifftu BB
        Incidence of road traffic injury and associated factors among patients visiting the emergency department of Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia.
        Emerg Med Int. 2014; 2014439818
        • Zaloshnja E
        • Miller TR
        • Hendrie D
        Effectiveness of child safety seats vs safety belts for children aged 2 to 3 years.
        Arch Pediatr Adolesc Med. 2007; 161: 65-68
        • Elliott MR
        • Kallan MJ
        • Durbin DR
        • Winston FK
        Effectiveness of child safety seats vs seat belts in reducing risk for death in children in passenger vehicle crashes.
        Arch Pediatr Adolesc Med. 2006; 160: 617-621
        • Arbogast KB
        • Jermakian JS
        • Kallan MJ
        • Durbin DR
        Effectiveness of belt positioning booster seats: an updated assessment.
        Pediatrics. 2009; 124: 1281-1286
        • Durbin DR
        • Chen I
        • Smith R
        • Elliott MR
        • Winston FK
        Effects of seating position and appropriate restraint use on the risk of injury to children in motor vehicle crashes.
        Pediatrics. 2005; 115: e305-e309
        • Durbin DR
        Committee on Injury, Violence, and Poison Prevention. Child passenger safety.
        Pediatrics. 2011; 127: e1050-e1066
        • WHO
        Global Status Report on Road Safety 2018.
        World Health Organization, Geneva, Switzerland2018 (Licence: CC BY-NC-SA 3.0 IGO)
        • Moradi M
        • Khanjani N
        • Nabipour AR
        An observational study of child safety seat use in an international safe community: Tehran, Iran.
        Traffic Inj Prev. 2017; 18: 88-94
        • Lei H
        • Yang J
        • Liu X
        • Chen X
        • Li L
        Has child restraint system use increased among parents of children in Shantou, China?.
        Int J Environ Res Public Health. 2016; 13: 964
        • Chen X
        • Yang J
        • Peek-Asa C
        • McGehee DV
        • Li L
        Parents’ knowledge, attitude, and use of child restraints, Shantou, China.
        Am J Prev Med. 2014; 46: 85-88
        • Chen X
        • Yang J
        • Peek-Asa C
        • Chen K
        • Liu X
        • Li L
        Hospital-based program to increase child safety restraint use among birthing mothers in China.
        PLoS One. 2014; 9e105100
        • Lei H
        • Gao R
        • Yang J
        • Li L
        Parent-based intervention to improve child restraint use among kindergarteners in China.
        Am J Public Health. 2018; 108: 1524-1526
        • Zaza S
        • Sleet DA
        • Thompson RS
        • Sosin DM
        • Bolen JC
        Task Force on Community Preventive Services. Reviews of evidence regarding interventions to increase use of child safety seats.
        Am J Prev Med. 2001; 21: 31-47
        • Liu X
        • Yang J
        • Cheng F
        • Li L
        Newborn parent based intervention to increase child safety seat use.
        Int J Environ Res Public Health. 2016; 13: 777
        • Sun ZQ
        • Xu YY
        Medical Statistics.
        People's Medical Publishing House, Beijing, China2014
        • Purc-Stephenson RJ
        • Ren J
        • Snowdon AW
        An exploratory study of parents’ use and knowledge of car safety seats in Beijing, China.
        Int J Inj Contr Saf Promot. 2010; 17: 231-238
        • Chen X
        • Yang J
        • Peek-Asa C
        • Li L
        Parents’ experience with child safety restraint in China.
        BMC Public Health. 2014; 14: 318
        • Rok Simon M
        • Korošec A
        • Bilban M
        The influence of parental education and other socio-economic factors on child car seat use.
        Zdr Varst. 2017; 56: 55-64
        • Snowdon AW
        • Hussein AA
        • Ahmed SE
        Children at risk: predictors of car safety seat misuse in Ontario.
        Accid Anal Prev. 2008; 40: 1418-1423