Child Passenger Safety Knowledge Research Articles

191 - An assessment of learners’ child passenger safety knowledge

191 - An assessment of learners’ child passenger safety knowledge

Impact of Child Passenger Safety Education for Pediatric Nurses.

Hospital-based child passenger safety education is effective in decreasing car seat misuse. Although child passenger safety training has been studied with pediatricians, emergency physicians, and emergency nurses, there is a lack of literature regarding child passenger safety training performed by pediatric nurses. The purpose of this study was to determine the effect of a 30-min child passenger safety education session on pediatric nurses' child passenger safety knowledge and confidence. This was a pre- and posttest comparison study of pediatric nurses' knowledge and confidence levels following child passenger safety training in a pediatric trauma center in New York State conducted from September 2018 to March 2019. Registered nurses from the neonatal intensive care unit, pediatric intensive care unit, general pediatric unit, and mother-baby unit participated in the study. The intervention was a single 30-min child passenger safety training session provided by a certified child passenger safety technician. A demographic questionnaire and 11-question pre- and posttest surveys were used. Data were compared using the t test, the chi-square test, and Fisher's exact tests. A total of 133 nurses participated, of which 97% were female and 50% were White. Posttest scores significantly increased (3.83; 95% CI [3.1, 3.7], t = 22.54, p≤ .001) in nurses' child passenger safety knowledge and confidence after a 30-min modular educational session. Passenger safety training increased pediatric nurses' knowledge and confidence to provide child passenger safety education to families and caregivers. Child passenger safety education is recommended for all nurses who are expected to provide child passenger safety education regardless of unit location.

Evaluation of parental education using biomechanical visualization to increase child restraint use in China

IntroductionDespite demonstrated effectiveness of child restraint system (CRS), its use in China is extremely low due to the lack of national legislation requiring the use of CRS, as well as lack of child passenger safety knowledge among caregivers. Implementing an effective intervention is urgently needed to promote the use of CRS. In this study, we primarily evaluated the effectiveness of biomechanical visualization delivered in the context of CRS education to promote CRS use. MethodsWe conducted a cluster randomised controlled trial to test the effects of educational intervention programs on increased use of CRS. Participants included caregivers from 8 pre-schools located in two cities (i.e., Chaozhou and Shantou) in China. Following a baseline survey, 8 pre-schools were randomly assigned into 1 of 4 groups with 2 schools in each group: 1) CRS education-only, 2) CRS education with behavioral skill training, 3) CRS education with biomechanical visualization, and 4) control. The primary outcome was CRS use, and the secondary outcomes included scores of child passenger safety-related knowledge and CRS use-related attitudes. The effect of the intervention was assessed among caregivers at two time points: baseline preintervention and 6 months postintervention. ResultsMore than 70% caregivers had never used CRS at baseline. No statistically significant between-group differences CRS use were observed at baseline preintervention (34.2%, 25.4%, 29.6% and 21.9%, respectively, P = 0.18). However, compared to the control group, odds of CRS non-use was significantly lower in caregivers assigned to the CRS education with biomechanical visualization (adjusted odd ratio (AOR) = 0.11, 95% confidence interval (CI) = 0.07–0.17), CRS education with behavioral skill training (AOR = 0.15, 95%CI = 0.10–0.24) and CRS education-only (AOR = 0.26, 95%CI = 0.17–0.41) groups, respectively. Statistically significant differences were also observed in the secondary outcomes postintervention across groups. Specifically, the CRS education with biomechanical visualization and CRS education with behavioral skill training groups had higher mean knowledge change scores than the CRS education-only group (3.3 ± 1.5 vs. 2.9 ± 2.2, p = 0.035 and 3.2 ± 1.9 vs. 2.9 ± 2.2, p = 0.039, respectively). We also observed a significantly higher increase in the attitudes scores in the CRS education with biomechanical visualization group compared with the CRS education-only group (4.7 ± 2.1 vs. 3.5 ± 2.8,p = 0.026). ConclusionsThis study shows that both biomechanical visualization and behavioral skill training supplements to education improved understanding of CRS knowledge compared to education only, and all three strategies led to increased CRS use. Importantly, CRS education with biomechanical visualization was shown to be more effective than CRS education alone in improving caregiver’s knowledge and attitudes. The use of biomechanical visualization may be an effective supplement to traditional education programs.

Child passenger safety education in the emergency department: teen driving, car seats, booster seats, and more

BackgroundThe leading cause of death in children less than 19 years old is motor vehicle crashes (MVC). Non-use or improper use of motor vehicle car seats significantly adds to the morbidity and mortality. Emergency department (ED) encounters provide an opportunity for caregiver education. Our objective was to determine the effect of an educational intervention on knowledge and counseling behaviors of pediatric ED nurses regarding child passenger safety (CPS).MethodsA pre/post educational intervention study was conducted with nursing staff in an urban ED. Responses to CPS related knowledge and counseling behaviors were collected using surveys administered before and after the intervention. The ED nurse education intervention was a one-hour lecture based on the American Academy of Pediatrics (AAP) CPS guidelines and Alabama state law regarding ages for each car seat type and teen driving risky behaviors. Individual data from pre and post surveys were matched, and nominal variables in pre-post matched pairs were analyzed using McNemar’s test. To compare categorical variables within pre or post test data, we used the Chi-square test.ResultsPretests were administered to 83/110 ED nurses; 64 nurses received the educational intervention and posttest. On the pretests, nurses reported “never” or “occasionally” counseling about CPS for the following: 56% car seats, 62% booster seat, 56% teen driving, 32% seat belts. When comparing the pretest CPS knowledge between nurses working 0-1 year vs. ≥ 2 years there was no statistically significant difference. Two CPS knowledge questions did not show significance due to a high correct baseline knowledge rate (> 98%), including baseline knowledge of MVC being the leading cause of death. Of the remaining 7 knowledge questions, 5 questions showed statistically significant improvement in knowledge: age when children can sit in front seat, state GDL law details, seat belt state law for back seat riders, age for booster seat, and rear facing car seat age. All four counseling behavior questions showed increases in intent to counsel families; however, only intent to counsel regarding teen driving reached statistical significance.ConclusionsEducational efforts improved pediatric ED nursing knowledge regarding CPS. Intent to counsel was also improved following the education.

Newborn Parent Based Intervention to Increase Child Safety Seat Use.

This paper intends to assess the effect of a maternity department intervention on improvement of knowledge and use of child safety seats (CSS) among newborn parents. An intervention study included three groups (one education plus free CSS intervention group, one education only group, and one control group). The participants were parents of newborns in the maternity department of two hospitals. Both of the intervention groups received a folded pamphlet of child passenger safety, a height chart and standardized safety education during their hospital stay after giving birth. The education plus free CSS intervention group received an additional free CSS and professional installation training at hospital discharge. The control group received a pamphlet with educational information about nutrition and food safety. Three months after enrollment, a telephone follow-up was conducted among participants in the three groups. Data on child passenger safety knowledge, risky driving behaviors, and use of CSS were evaluated before and after the intervention. A total of 132 newborn parents were enrolled in the study; of those, 52 (39.4%) were assigned into the education plus free CSS intervention group, 44 (33.3%) were in the education intervention only group, and 36 (27.3%) were in the control group. No significant differences existed in demographics among the three groups. There was a significant difference in newborn parents’ child passenger safety knowledge and behaviors in the three groups before and after the intervention. In addition, the CSS use increased significantly in the education plus free CSS group after the intervention compared to parents in the education only or control groups. Education on safety, combined with a free CSS and professional installation training, were effective at increasing newborn parents’ knowledge and use of CSS. Future studies with larger sample sizes and longer follow-up are needed to determine a long-term effect of the intervention.

Rural–urban differences in health care provider child passenger safety anticipatory guidance provision

Many children do not travel safely in vehicles, with rural children often traveling less safely than urban children. Motor vehicle crashes were the leading cause of death of children aged from 1 to 14 years in the United States in 2011. Lack of education or inadequate parental education during well-child visits regarding proper child restraint within vehicles by health care providers (HCPs) in rural areas could be resulting in increased misuse of child restraints and lack of restraint use in rural areas. This study sought to determine rural–urban differences in frequency and accuracy of anticipatory guidance related to child passenger safety (CPS) provided by HCPs, in addition to rural–urban differences in HCP confidence in providing this counseling. HCPs from rural and urban areas in several upper Midwest states were surveyed about frequency and confidence of advice provided to parents related to CPS and their knowledge level on this subject. Urban HCPs were significantly more likely than rural HCPs to consistently provide advice to parents related to CPS across all age groups for children aged 12 years or younger. Differences were found between rural and urban HCPs regarding confidence in their ability to address parents׳ questions/concerns, and knowledge related to specific CPS issues. Significant differences exist in the frequency of CPS anticipatory guidance provision and confidence in accurate provision of CPS anticipatory guidance by rural and urban HCPs to parents. Significant differences also exist between rural and urban HCPs in relation to CPS knowledge. Differences may be due to increased levels of training for urban HCPs. This research is important as it adds to the compendium of knowledge related to CPS counseling patterns focused on reducing motor vehicle-related injuries and fatalities in children.

0081 Hospital-community partnerships for culturally competent injury prevention

Statement of purpose An injury prevention program at an academic medical centre in California collaborated with community-based family resource centres (FRC) to disseminate culturally competent child passenger safety education to underserved populations. The purpose of this evaluation was to determine if the hospital’s standardised program curriculum retained effectiveness in increasing caregiver child passenger safety knowledge and self-efficacy after cultural adaptation and delivery by community partners. Methods/Approach The curriculum was implemented with language and cultural adaptations appropriate FRC client population by FRC staff that had completed national child passenger safety technician training. Standardised intervention included: a one-hour class taught in English, Spanish, or Russian; a brief video in the relevant language; hands on demonstration; and the distribution of a no cost car. Program evaluation was conducted using a pre/post self-reporting survey, administered in the language used to teach the class. The mean of correct responses was used to create pre and post knowledge scores, which were then compared using a paired t-test. Results A total of 839 caregivers from 9 community sites and 1 hospital participated in the education program and completed a pre/post survey. Of these, 512 participants spoke English, 302 Spanish, and 25 Russian. While baseline knowledge varied significantly between sites, posttest knowledge scores indicated a significant increase in caregiver knowledge and self-efficacy at all locations. There were no significant differences in posttest knowledge scores between sites. Conclusions The hospital’s standardised child passenger safety education program was effectively disseminated to diverse populations through multiple community partnerships. This collaboration is an effective strategy to increase caregiver knowledge and self-efficacy of child passenger safety among culturally diverse populations. Significance and contribution to the field While further research is needed to determine knowledge retention and behaviour change, this evaluation suggests hospital-community partnerships can be leveraged to improve culturally appropriate dissemination of health and safety education to diverse and underserved population.

Examining the relative effectiveness of different message framing strategies for child passenger safety: Recommendations for increased comprehension and compliance

BackgroundAge-appropriate child restraints and rear seating dramatically reduce injury in vehicle crashes. Yet parents and caregivers struggle to comply with child passenger safety (CPS) recommendations, and frequently make mistakes when choosing and installing restraints. The purpose of this research was to evaluate various methods of framing CPS recommendations, and to examine the relative effectiveness on parents’ knowledge, attitudes, and behavioral intentions related to best practices and proper use of child restraints. Emphasis framing is a persuasion technique that involves placing focus on specific aspects of the content in order to encourage or discourage certain interpretations of the content. MethodA 5 (flyer group) X 2 (time) randomized experiment was conducted in which 300 parent participants answered a pre-survey, viewed one of four flyer versions or a no-education control version, and completed a post-survey. Surveys measured CPS knowledge, attitudes, perceptions of efficacy and risk, and behavioral intentions. The four flyers compared in this study all communicated the same CPS recommendations, but several versions were tested which each employed a different emphasis frame: (1) recommendations organized by the natural progression of seat types; (2) recommendations which focused on avoiding premature graduation; (3) recommendations which explained the risk-reduction rationale behind the information given; or (4) recommendations which were organized by age. In a fifth no-education (control) condition, participants viewed marketing materials. ResultsAnalyses of covariance and pairwise comparisons indicated the risk-reduction rationale flyer outperformed other flyers for many subscales, and significantly differed from no-education control for the most subscales, including restraint selection, back seat knowledge, rear-facing knowledge and attitudes, total efficacy, overall attitudes, and stated intentions. ConclusionsThis research provides insight for increasing caregiver understanding and compliance with CPS information. Recommendations for the field include communicating the rationale behind the information given, using behavior-based directives in headers, avoiding age-based headers, and incorporating back-seat positioning directives throughout.

Pediatricians' Self-Reported Knowledge, Attitudes, and Practices about Child Passenger Safety

To evaluate pediatricians' self-reported knowledge, attitudes, and dissemination practices regarding the new American Academy of Pediatrics' (AAP) child passenger safety (CPS) policy recommendations. A cross-sectional survey was distributed to pediatric primary care physicians via AAP e-mail distribution lists. Knowledge, attitudes, and practices related to current AAP CPS recommendations and the revised policy statement were ascertained. There were 718 respondents from 3497 physicians with active e-mail addresses, resulting in a 20.5% response rate, of which 533 were eligible based on the initial survey question. All 6 CPS knowledge and scenario-based items were answered correctly by 52.9% of the sample; these respondents were identified as the "high knowledge" group. Pediatricians with high knowledge were more likely to be female (P < .001), to have completed a pediatrics residency (vs medicine-pediatrics) (P = .03), and have a child between 4 and 7 years of age (P = .001). CPS information was distributed more frequently at routine health visits for patients 0-2 years of age vs those 4-12 years of age. Those with high knowledge were less likely to report several specific barriers to dissemination of CPS information, more likely to allot adequate time and discuss CPS with parents, and had greater confidence for topics related to all CPS topics. Although CPS knowledge is generally high among respondents, gaps in knowledge still exist. Knowledge is associated with attitudes, practices, barriers, and facilitators of CPS guideline dissemination. These results identify opportunities to increase knowledge and implement strategies to routinely disseminate CPS information in the primary care setting.

An Emergency Department Intervention to Improve Knowledge of Child Passenger Safety

The objective of the study was to test the impact of an educational video in improving child passenger safety knowledge. This was a prospective randomized study performed in the emergency department of an urban children's hospital involving parents of non-critically ill children younger than 9 years. Parents were randomized to observe a video on child passenger safety or comparison group. All completed a survey, 8-question pretest at enrollment, and posttest after 1 month and received written safety materials at discharge. The outcome measure to test knowledge was the difference in mean pretest-posttest scores on a questionnaire. We enrolled 274 parents (137 intervention, 137 comparison). Thirty subjects were found ineligible for analysis after enrollment because their children were outside the age range for inclusion. Analysis was restricted to 131 parents in the intervention group and 113 in the comparison group. No significant differences existed between groups when comparing demographics and child passenger safety characteristics except for the number of children in the household. After excluding those lost to follow-up (91 parents) and who dropped out (14 parents), analysis was restricted to 74 subjects in the intervention group and 65 in the comparison group. Mean pretest scores were as follows: intervention, 4.95 (SD, 1.49); comparison, 5.12 (SD, 1.32). Mean posttest scores were as follows: intervention, 5.24 (SD,1.60); comparison, 4.77 (SD, 1.39). Difference in mean pretest-posttest scores showed a significant improvement in the intervention group compared with the comparison group: 0.65 (95% confidence interval, 0.14-1.16) on independent-samples t test (P = 0.012). Child passenger safety education can be effectively imparted to parents in the emergency department.

Child Passenger Safety Knowledge Lacking in ED

Child Passenger Safety Knowledge Lacking in ED

Evaluating the Educational Component of a Hospital-Based Child Passenger Safety Program

Interventions that combine educational programs and discounted child safety seats have been demonstrated to improve parental child passenger safety knowledge and practices. An educational component consisting of an hour-long bilingual (English/Spanish) class for parents was added to a hospital-based safety seat program. Researchers sought to evaluate participant knowledge retention and safety practices after the class and to identify parental motivators and barriers for correct safety seat use. In particular, researchers were interested in evaluating a child passenger safety program that includes both individualized and group-based educational components in addition to a giveaway seat program, and also serves a subset of Latinos, mostly from the Dominican Republic and the Guatemala, that is less frequently studied. A 15-minute telephone survey was conducted in English or Spanish with past participants (n = 79) of the program. Descriptive statistics and odds ratios were generated to determine statistical significance. Qualitative data from open-ended questions were coded and grouped categorically. The final sample (n = 79) was mostly women (93.7%), Hispanic (78.5%), and foreign-born (77.2%). Six months after participating in the program, there was a statistically significant decrease in parental knowledge regarding appropriate safety seat transitions to booster seats and correct knowledge of the state child safety seat law-with odds ratios of 0.35 (95% CI: 0.13-0.93) and 0.16 (0.04-0.54), respectively. Most commonly reported motivators were safety and fear of police enforcement. Most commonly reported barriers to safety seat use were parents not understanding the importance of safety seats and being in a rush. Parents surveyed > or =6 months after receiving the child passenger safety program displayed less correct safety seat knowledge compared with parents surveyed <6 months after participating in the program. Parents noted multiple barriers to safety seat use. Programmatic changes that merit future study include (1) sending reminders to parents to refresh safety seat transition knowledge, particularly for older children, and (2) incorporating curriculum components that address the parental motivators and barriers to correct safety seat use in the class.

Evaluation of the Boost ‘ em in the Back Seat Program: Using fear and efficacy to increase booster seat use

Objectives Recent research supports the use of high-threat messages when they are targeted appropriately and designed to promote high efficacy as well as fear. This research examined the effectiveness of using a novel threat-appeal approach to encourage parents to place their children in booster seats and rear seats of vehicles. Method A 6-min video-intervention was created and evaluated at after-school/daycare centers via an interrupted time series design with similar control sites for comparison. Caregivers ( N = 226) completed knowledge and practice surveys and fear and efficacy estimations related to childhood motor vehicle hazards. Researchers observed booster-seat and rear-seat use in study site parking lots. Results Compared to baseline and control assessments, the treatment groups’ child passenger safety knowledge, risk-reduction attitudes, behavioral intentions, sense of fear related to the hazard, and sense of efficacy related to the recommended behaviors increased significantly. Further, observed overall restraint use and booster-seat use increased significantly following the intervention. Conclusions Applying high-threat messages to child passenger safety interventions is promising and has the potential to be adapted to other health risk areas.