Abstract
Caregiver-targeted interventions to improve the use of child restraint systems (CRS) in motor vehicles are common and heterogeneous in their implementation. The effectiveness of these interventions is unknown. To quantify the effects of caregiver-targeted interventions using meta-analytic methods, assess the quality of published studies, and assess for publication bias. PubMed and PsychINFO (January 1, 2004, to April 1, 2019) were searched for English-language studies using a list of search terms. The search and screening process was completed between May 25, 2018, and April 1, 2019. Studies met inclusion criteria if they included a caregiver-targeted intervention that focused on increasing CRS use for children (age, ≤9 years) and report the use of CRS before and after the intervention. Cochrane and PRISMA guidelines were used for the meta-analysis and risk-of-bias review. Information was extracted on intervention type, setting, implementation, and attributes of the study independently between 2 coders. Data were pooled from independent samples, with 1 outcome measure from each intervention implementation or study. This study was an exploratory random-effects meta-analysis. Unadjusted odds ratios were calculated using the sample size and the observed number of children in incorrect or correct restraints in motor vehicles before and after the intervention to determine the odds of incorrect CRS use after completing an intervention. Setting, measurement method, randomization, use of vouchers, and types of restraint were tested as moderators. A funnel plot was used to assess for publication bias. Of 1240 potential articles, 51 were deemed eligible for screening and 10 (8238 participants total) were included in the meta-analysis. Caregiver-targeted interventions were associated with a reduction in the number of children not riding in a CRS (odds ratio, 0.51; 95% CI, 0.36-0.71; P < .001). Variance in the averaged effect size was driven by self-report methods (when removed from analyses, I2 = 61.8%; R2 change = 26.3; P = .02) and hospital settings (when removed from analyses, I2 = 70.7%; R2 change = 17.4; P = .002). Risk of bias was high in most studies; however, there was low evidence for publication bias. In this meta-analysis, caregiver-targeted interventions were associated with a reduction in the number of children not riding in a CRS in motor vehicles; however, the methodological rigor of intervention studies should be enhanced.
Highlights
There have been great strides in child occupant protection during the last several decades, with deaths to child occupants of motor vehicles reduced from 10.5 to 3.2 per 100 000 children between 1970 and 2007.1 This success is largely due to the introduction of child restraint systems (CRS) in conjunction with child occupant protection laws
Caregiver-targeted interventions were associated with a reduction in the number of children not riding in a CRS
Caregiver-Targeted Interventions for Motor Vehicle Safety Systems for Children. In this meta-analysis, caregiver-targeted interventions were associated with a reduction in the number of children not riding in a CRS in motor vehicles; the methodological rigor of intervention studies should be enhanced
Summary
There have been great strides in child occupant protection during the last several decades, with deaths to child occupants of motor vehicles reduced from 10.5 to 3.2 per 100 000 children between 1970 and 2007.1 This success is largely due to the introduction of child restraint systems (CRS) in conjunction with child occupant protection laws. Despite the benefits of correct CRS use, rates of children traveling inappropriately restrained, riding in an adult seatbelt, or unrestrained remain high.[4,5] evidence suggests that restraint laws are efficacious, they are macrolevel interventions[6] and can only indirectly influence caregivers’ behavior Microlevel interventions, or those that target caregivers directly, can be useful for complementing policy-level efforts and are routine fixtures in many public health departments and pediatric care settings.[7] intervention approaches vary (eg, clinical vs community setting), as do the study designs (eg, self-report vs observation) and it is not clear what approach to targeting caregivers might be most effective. Risk of bias assessments were completed for each study, along with an assessment of possible publication bias
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