Maternal Psychological Adjustment and Knowledge of Infant Development as Predictors of Home Safety Practices in Rural Low-Income Communities

Abstract

Unintentional injury is the leading cause of death among toddlers in the United States. Toddlers spend the majority of time at home, and the use of recommended safety practices can prevent many injuries. Maternal psychological adjustment and understanding of child development are thought to influence the implementation of safety practices; however, the extent to which either factor is related has been examined with small samples and without attention to potential confounding. We hypothesize that mothers' use of safety practices will be higher when mothers have more knowledge of development and better psychological adjustment. This study is part of the Family Life Project, a longitudinal birth cohort of children from poor rural communities (n = 1611) and an ethnographic sample (n = 36). Mothers in the birth cohort completed scales to measure knowledge of development, psychological adjustment, and home safety practices. Factor analysis of the safety scale resulted in 4 subscales. Each subscale was predicted from maternal knowledge and adjustment in multivariable regression. Mothers in the ethnographic study described sources of information about home safety, current practices, and barriers. Analyses indicated that mothers with better psychological adjustment were more likely to implement all of the safety practices, and mothers with more knowledge about development were more likely to minimize subtle hazards and install safety devices. An interaction between maternal adjustment and knowledge suggested that mothers with psychological distress were more likely to install safety devices if they had greater knowledge of development. Mothers reported that health care providers were the primary source of safety information, and barriers to implementation included poverty and lack of stable housing. Knowledge of development and better psychological adjustment are associated with improved home safety. Knowledge about development is especially important for mothers with poor mental health. Pediatricians and designers of injury-prevention programs should consider the role of maternal mental health in child safety.