Facilitators and barriers to child restraint use in motor vehicles: a qualitative evidence synthesis

Journal article

Background: Road traffic collisions contribute a significant burden of mortality and morbidity to children globally. The improper or non-use of child restraints can result in children sustaining significant injuries in the event of a collision. Systematic reviews on the effectiveness of various interventions to increase the use of child restraints already exist but to the best of our knowledge, there has been no qualitative evidence syntheses on the facilitators and barriers to child restraint usage. This review aims to fill that gap.

Methods: We searched for qualitative studies, which focussed on perceptions, values and experiences of children, parents/caregivers or any other relevant stakeholders on the use of restraints for children travelling in motor vehicles in PubMed, EMBASE and Global Health and screened reference lists of all included studies. We assessed the quality of included studies with the Critical Appraisal Skills Programme (CASP) checklist and used the PROGRESS Plus lens for an equity focussed analysis.

Results: We identified a total of 335 records from searching the databases and 5 records from other sources. After screening, we identified 17 studies that met our inclusion criteria. All but one study (which had children as participants) focussed on the perceptions, attitudes, and barriers of parents or caregivers. The included studies were from three high-income (n=14) and one upper-middle income (n=3) country. In addition, although many focussed exclusively on participants from culturally and linguistically diverse minorities, the issue of equity was not well addressed. Five major themes emerged from the analysis: (1) Perceived risk for injuries and perceived safety benefits of child restraint usage varies in different settings and between different types of caregivers; (2) Practical issues around the use of child restraints is a major barrier to its uptake as a child safety measure; (3) Restraint use is considered as a mechanism to discipline children rather than as a safety device by parents and as children became older they actively seek opportunities to negotiate the non-usage of restraints; (4) Adoption and enforcement of laws shape perceptions and usage in all settings; and (5) Perceptions and norms of child safety differ among culturally and linguistically diverse groups.

Conclusion: The results of this systematic review should be considered when designing interventions to promote the uptake of child restraints. However, there is a need to conduct qualitative research around the facilitators and barriers to child restraint usage in low- and middle-income countries. Furthermore, there is a need for more evidence conducted in semi-urban and rural areas and to involve fathers, policy makers, implementers and enforcement agencies in such studies.

Authors: Bhaumik, S; Hunter, K; Matzopoulos, R; Prinsloo, M; Ivers, R

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: Injury Prevention
• Volume: 26
• Issue: 5
• Pages: 478-493
• Publication date: 2020-05-23
• Acceptance date: 2020-04-03
• DOI: 10.1136/injuryprev-2020-043655
• EISSN: 1475-5785
• ISSN: 1353-8047
• Language: English
• Keywords: Road traffic injury; child seats; seatbelt; child restraint systems; injury prevention; FFR