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Rebecca Ivers - One of the best experts on this subject based on the ideXlab platform.
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facilitators and barriers to Child Restraint use in motor vehicles a qualitative evidence synthesis
Injury Prevention, 2020Co-Authors: Soumyadeep Bhaumik, Kate Hunter, Rebecca Ivers, Richard Matzopoulos, Megan Prinsloo, Margaret M PedenAbstract: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 focused 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 focused analysis. Results We identified a total of 335 records from searching the databases and five records from other sources. After screening, we identified 17 studies that met our inclusion criteria. All but one study (which had Children as participants) focused 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 focused 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-income and middle-income countries. Furthermore, there is a need for more evidence conducted in semiurban and rural areas and to involve fathers, policy-makers, implementers and enforcement agencies in such studies.
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effectiveness of Child Restraint legislation to reduce motor vehicle related serious injuries and fatalities a national interrupted time series analysis
Accident Analysis & Prevention, 2020Co-Authors: Janani Shanthosh, Julie Brown, Rebecca Ivers, Kris Rogers, Thomas Lung, Andrew Wilson, Stephen JanAbstract:Abstract Children that are unrestrained while travelling in a motor vehicle are more vulnerable to serious injury and death. The greatest levels of crash protection are achieved when Children use the most age or size appropriate form of Restraint. In this study, we aimed to examine the effectiveness of the introduction of age-appropriate Child Restraint legislation on serious and fatal injury in five Australian states and territories. For this interrupted time series analysis, we used a segmented regression method to assess the association between the implementation of Child-Restraint legislation and motor-vehicle related serious injuries and fatalities using data obtained from transport authorities in each jurisdiction. We estimated the change in annual rates after the implementation of legislation with the number of motor-vehicle accidents resulting in fatalities or serious injuries as the outcome, and the total number of injuries (minor, serious and fatal) as an offset in the model. We identified 10882 motor-vehicle related crashes resulting in fatalities (n = 188), serious injuries (n = 1730) and minor injuries (n = 8964). In NSW and VIC, the rate ratio was statistically significant and positive, indicating an increase in the rate of serious injuries and fatalities in the period post-legislation compared to the period prior to legislation. In all other states and territories, we did not find a statistically significant effect of legislation Road safety programs incorporating interventions targeted at increasing awareness of optimal Restraint practices, strengthened enforcement and measures to improve the affordability of Restraints are needed to support legislation.
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effectiveness of Child Restraint legislation to reduce motor vehicle related serious injuries and fatalities a national interrupted time series analysis
Social Science Research Network, 2019Co-Authors: Janani Shanthosh, Julie Brown, Rebecca Ivers, Kris Rogers, Thomas Lung, Andrew Wilson, Stephen JanAbstract:Background: Children that are unrestrained while travelling in a motor vehicle are more vulnerable to serious injury and death. The greatest levels of crash protection are achieved when Children use the most age or size appropriate form of Restraint. In this study, we aimed to examine the effectiveness of the introduction of age-appropriate Child Restraint legislation on serious and fatal injury in five Australian states and territories. Methods: For this interrupted time series analysis, we used a segmented regression method to assess the association between the implementation of Child-Restraint legislation and motor-vehicle related serious injuries and fatalities using data obtained from transport authorities in each jurisdiction. We estimated the change in annual rates after the implementation of legislation with the number of motor-vehicle accidents resulting in fatalities or serious injuries as the outcome, and the total number of injuries (minor, serious and fatal) as an offset in the model. Findings: We identified 10882 motor-vehicle related crashes resulting in fatalities (n=188), serious injuries (n=1730) and minor injuries (n=8964). In NSW and VIC, the rate ratio was statistically significant and positive, indicating an increase in the rate of serious injuries and fatalities in the period post-legislation compared to the period prior to legislation. In all other states and territories, we did not find a statistically significant effect of legislation. Interpretation: Road safety programs incorporating interventions targeted at increasing awareness of optimal Restraint practices, strengthened enforcement and measures to improve the affordability of Restraints are needed to support legislation. Funding Statement: The George Institute for Global Health. Declaration of Interests: The authors state: "None declared." Ethics Approval Statement: The authors declare: "Ethics committee approval was not needed as the data was de-identified, publicly accessible government data."
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increase in best practice Child car Restraint use for Children aged 2 5 years in low socioeconomic areas after introduction of mandatory Child Restraint laws
Australian and New Zealand Journal of Public Health, 2013Co-Authors: Julie Brown, Lisa Keay, Kate Hunter, Lynne E Bilston, Judy M Simpson, Rebecca IversAbstract:Objectives : To examine changes in Child car Restraint practices in low socioeconomic areas following the introduction of mandatory Child car Restraint legislation in New South Wales (NSW), Australia. Methods : Data from two cross-sectional studies of Child car Restraint use at pre-schools, early Childhood centres and primary schools before and after the introduction of legislating mandatory age-appropriate car Restraint use for Children up to the age of seven years was used in this analysis. All included observations were from local government areas with socioeconomic status in the lowest 30% of urban Sydney. Children aged 2–5 years were observed in their vehicles as they arrived at observation sites (107 pre-legislation, 360 post-legislation). Multilevel logistic regression was used to examine changes in observed age-appropriate and correct use of car Restraints. Results : Age-appropriate car Restraint use was higher post-legislation than pre-legislation. After controlling for Child's age, parental income, language spoken at home and adjusting for clustering, the odds of Children being appropriately restrained post-legislation were 2.3 times higher than in the pre-legislation sample, and the odds of them being correctly restrained were 1.6 times greater. Conclusions : Results indicate an improvement in car Restraint practices among Children aged 2–5 in low socioeconomic areas after introduction of Child Restraint laws. Implications : Despite improvements observed with enhanced legislation, further efforts are required to increase optimal Child car Restraint use.
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Child Restraint use in low socio economic areas of urban sydney during transition to new legislation
Accident Analysis & Prevention, 2013Co-Authors: Lisa Keay, Kate Hunter, Lynne E Bilston, Jocelyn Brown, Judy M Simpson, Mark Stevenson, Rebecca IversAbstract:Child Restraints protect a young Child against injury in crashes but best practice Child Restraint use is low in Australia, particularly among lower socio-economic groups. We investigated factors associated with Restraint use to inform the development of education and distribution programmes to support new Australian legislation on Child passengers among families in low socio-economic areas of metropolitan Sydney. We interviewed a parent or carer of 1160 Children aged 2-5 years enrolled at one of 28 early Childhood centres in low socio-economic areas of urban Sydney. Appropriate Child Restraint use was defined as a forward facing Child Restraint (FFCR) for 2-3 year olds and a FFCR or booster seat for Children aged 4 years or more. Predictors of self-reported appropriate use were explored using logistic regression. Analysis was conducted on one Child from each family in the target age range (2-5 years): 586 (51%) were male and the mean age was 3.5 (Standard Deviation 0.8) years. There were 432 (45%) families with annual income below $60,000, 248 (22%) spoke a language other than English at home and 360 (33%) had 3 or more Children. Fifty-four percent of carers indicated that their 2-3 year old Children travelled in a FFCR. Inappropriate use among Children in this age group was more likely when the carer was <36 years (odds ratio (OR) 1.62, 95% confidence interval (CI) 1.08-2.45), in families with ≥3 Children (OR 1.64, 95% CI 1.10-2.44) and when the carer believed that a booster seat was just as safe as a FFCR (OR 2.98, 2.05-4.32). Eight-eight percent of carers of 4-5 year olds reported use of a booster seat or FFCR. Non-use was associated with low household income (OR 3.10, 95% CI 1.67-5.75), in families with ≥3 Children (OR 2.03, 95% CI 1.09-3.76) and families where a language other than English is spoken at home (OR 2.39, 95% CI 1.10-5.21). Non-English speaking families had less awareness of the new law and poorer knowledge of safety benefits of Child Restraints. They also had lower household incomes and more concerns about cost of Child Restraints and booster seats. These findings can inform development of interventions to promote best practice Child Restraint use, which will reach non-English speaking families in this region. They also confirm the importance of economic and logistic barriers to best practice Child Restraint use.
Kristy B Arbogast - One of the best experts on this subject based on the ideXlab platform.
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The influence of Child Restraint lower attachment method on protection offered by forward facing Child Restraint systems in oblique loading conditions
2018Co-Authors: Hans W Hauschild, John R Humm, Narayan Yoganandan, Matthew R Maltese, Frank A. Pintar, Bruce Kaufman, Kristy B ArbogastAbstract:Objective: The research objective was to quantify the influence of Child Restraint lower attachment method on head kinematics, head impact potential, and head, neck, and thorax injury metrics for a Child occupant secured in a forward-facing Child Restraint system (FFCRS) in oblique side impacts. Methods: Fifteen sled tests were conducted with a Q3s seated in an FFCRS secured to the center position on a production small SUV bench seat. Three lower attachment methods were evaluated: rigid ISOFIX, a flexible single loop lower anchors and tethers for Children (LATCH) webbing routed through the vehicle belt path of the FFCRS, and dual flexible LATCH webbing attachments on either side of the FFCRS. All were tested with and without a tether with one repeat test in each test condition. The same model FFCRS was used for all tests; only the attachment method varied. The vehicle bench seat was fixed on the sled carriage at 80° (from full frontal). The input pulse was the proposed FMVSS 213 side impact pulse scaled to a 35 km/h delta-v. Two-way analysis of variance (ANOVA) was used to evaluate the effect of lower attachment and tether use on 3 outcome metrics: lateral head excursion, neck tension, and neck lateral bending. Data included anthropomorphic test dummy (ATD) head excursions, head linear accelerations and angular velocities, neck loads and moments, thoracic accelerations, lateral chest deflections, lower anchor loads, and tether webbing loads. ATD head kinematics were collected from 3-dimensional motion capture cameras. Results: Results demonstrated a reduction in injury measures with the rigid ISOFIX and dual webbing attachment compared to the single webbing attachment with decreased lateral head excursions (331, 356, and 441 mm for the rigid ISOFIX, dual webbing, and single webbing systems, respectively, P
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caregivers use of Child passenger safety resources and quality of future Child Restraint system installations
Safety, 2017Co-Authors: Jessica Hafetz Mirman, Dennis R Durbin, Kristy B Arbogast, Kristi Metzger, Sara J Seifert, Mark R ZonfrilloAbstract:Objectives: Child Restraint System (CRS) misuse is common. We characterized caregivers’ use of Child passenger safety informational and instructional resources and determined whether there were differences in the quality of CRS installations associated with prior exposure to specific resources as evaluated in a standardized CRS installation environment. Methods: Caregivers completed self-report surveys and installed a forward-facing CRS in a controlled environment. Installations were evaluated for security (tightness) and accuracy (no errors) by a Child passenger safety technician (CPST). Results: CRS manuals were the most common way caregivers learned to install a CRS. Primary care providers (PCP)s were the most frequently endorsed source of CRS safety information. There was no strong pattern of associations between prior exposure to resources and installation quality (security or accuracy), although some evidence supports protective effects of learning from CPSTs; 13% (19 out of 151) installations were secure and 57% (86 out of 151) installations were accurate. Conclusions: A focus on developing effective and lasting behavioral interventions is needed.
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protection of Children in forward facing Child Restraint systems during oblique side impact sled tests intrusion and tether effects
Traffic Injury Prevention, 2016Co-Authors: Hans W Hauschild, John R Humm, Narayan Yoganandan, Bruce A Kaufman, Matthew R Maltese, Frank A. Pintar, Kristy B ArbogastAbstract:ABSTRACTObjective: Testing was conducted to quantify the kinematics, potential for head impact, and influence on head injury metrics for a center-seated Q3s in a forward-facing Child Restraint system (FFCRS) in oblique impacts. The influences of a tether and intruded door on these measures were explored.Methods: Nine lateral oblique sled tests were conducted on a convertible forward-facing Child Restraint seat (FFCRS). The FFCRSs were secured to a bench seat from a popular production small SUV at the center seating position utilizing the lower anchor and tether for Children (LATCH). The vehicle seat was fixed on the sled carriage at 60° and 80° from full frontal (30° and 10° forward rotation from pure lateral) providing an oblique lateral acceleration to the Q3s and FFCRS. A structure simulating an intruded door was mounted to the near (left) side of vehicle seat. The sled input acceleration was the proposed FMVSS 213 lateral pulse scaled to a 35 km/h delta-V. Tests were conducted with and without the tet...
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Protection of Children in forward-facing Child Restraint systems during oblique side impact sled tests: Intrusion and tether effects
2016Co-Authors: Hans W Hauschild, John R Humm, Narayan Yoganandan, Matthew R Maltese, Frank A. Pintar, Bruce Kaufman, Jinyong Kim, Kristy B ArbogastAbstract:Objective: Testing was conducted to quantify the kinematics, potential for head impact, and influence on head injury metrics for a center-seated Q3s in a forward-facing Child Restraint system (FFCRS) in oblique impacts. The influences of a tether and intruded door on these measures were explored. Methods: Nine lateral oblique sled tests were conducted on a convertible forward-facing Child Restraint seat (FFCRS). The FFCRSs were secured to a bench seat from a popular production small SUV at the center seating position utilizing the lower anchor and tether for Children (LATCH). The vehicle seat was fixed on the sled carriage at 60° and 80° from full frontal (30° and 10° forward rotation from pure lateral) providing an oblique lateral acceleration to the Q3s and FFCRS. A structure simulating an intruded door was mounted to the near (left) side of vehicle seat. The sled input acceleration was the proposed FMVSS 213 lateral pulse scaled to a 35 km/h delta-V. Tests were conducted with and without the tether attached to the FFCRS. Results: Results indicate the influence of the tether on kinematics and injury measures in oblique side impact crashes for a center- or far-side-seated Child occupant. All tests without a tether resulted in head contact with the simulated door, and 2 tests at the less oblique angle (80°) with a tether also resulted in head contact. No head-to-door contact was observed in 2 tests utilizing a tether. High-speed video analysis showed that the head moved beyond the CRS head side wings and made contact with the simulated intruded door. Head injury criterion (HIC) 15 median values were 589 without the tether vs. 332 with the tether attached. Tests utilizing a tether had less lateral head excursion than tests without a tether (median 400 vs. 442 mm). Conclusion: These tests demonstrate the important role of the tether in controlling head excursion for center- or far-side-seated Child occupants in oblique side impact crashes and limiting the head injury potential with an intruded door. The tether may not influence the kinematics of a near-side-seated occupant as strongly where the vehicle door or side structure interacts with the CRS and influences its motion. The results indicate that there may be an opportunity to improve Child head kinematics and head protection in oblique side impacts through different CRS attachment methods and/or alternative vehicle side structure protection or padding.
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an evaluation of the effectiveness of forward facing Child Restraint systems
Accident Analysis & Prevention, 2004Co-Authors: Kristy B Arbogast, Michael J Kallan, Dennis R Durbin, Rebecca A Cornejo, Flaura Koplin WinstonAbstract:The objective of this study was to determine the effectiveness of forward facing Child Restraint systems (FFCRS) in preventing serious injury and hospitalization to Children 12-47 months of age as compared with similar age Children in seat belts. Data were obtained from a cross-sectional study of Children aged 12-47 months in crashes of insured vehicles in 15 states, with data collected via insurance claims records and a telephone survey. Effectiveness estimates were limited to those Children between 12 and 47 months of age seated in the back row(s) of vehicles, restrained in FFCRS, regardless of misuse, or seat belts of all types and usage. Completed survey information was obtained on 1207 Children, representing 12632 Children in 11619 crashes between 1 December 1998 and 31 May 2002. Serious injuries occurred to 0.47% of all 12-47-month olds studied, including 1.72% of those in seat belts and 0.39% of those in Child Restraint systems. The risk of serious injury was 78% lower for Children in FFCRS than in seat belts (odds ratio (OR) = 0.22, 95% confidence interval (CI) = 0.11-0.45, P = 0.001). The risk of hospitalization was 79% lower for Children in FFCRS than in seat belts (OR = 0.21, 95% CI = 0.09-050, P = 0.001). There was no difference between the Restraint types in preventing minor injuries. As compared with seat belts, CRS are very highly effective in preventing serious injuries and hospitalization, respectively. This effectiveness estimate is substantially higher than older estimates, demonstrating the benefits of current CRS designs. These results provide those educating parents and caregivers population-based data on the importance of Child Restraint use.
Julie Brown - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of Child Restraint legislation to reduce motor vehicle related serious injuries and fatalities a national interrupted time series analysis
Accident Analysis & Prevention, 2020Co-Authors: Janani Shanthosh, Julie Brown, Rebecca Ivers, Kris Rogers, Thomas Lung, Andrew Wilson, Stephen JanAbstract:Abstract Children that are unrestrained while travelling in a motor vehicle are more vulnerable to serious injury and death. The greatest levels of crash protection are achieved when Children use the most age or size appropriate form of Restraint. In this study, we aimed to examine the effectiveness of the introduction of age-appropriate Child Restraint legislation on serious and fatal injury in five Australian states and territories. For this interrupted time series analysis, we used a segmented regression method to assess the association between the implementation of Child-Restraint legislation and motor-vehicle related serious injuries and fatalities using data obtained from transport authorities in each jurisdiction. We estimated the change in annual rates after the implementation of legislation with the number of motor-vehicle accidents resulting in fatalities or serious injuries as the outcome, and the total number of injuries (minor, serious and fatal) as an offset in the model. We identified 10882 motor-vehicle related crashes resulting in fatalities (n = 188), serious injuries (n = 1730) and minor injuries (n = 8964). In NSW and VIC, the rate ratio was statistically significant and positive, indicating an increase in the rate of serious injuries and fatalities in the period post-legislation compared to the period prior to legislation. In all other states and territories, we did not find a statistically significant effect of legislation Road safety programs incorporating interventions targeted at increasing awareness of optimal Restraint practices, strengthened enforcement and measures to improve the affordability of Restraints are needed to support legislation.
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A novel system for Child Restraint selection -A preliminary evaluation of shoulder height labels
2020Co-Authors: Lynne Bilston, Erin Lucas, Michael Lumley, Julie BrownAbstract:ABSTRACT Many parents have difficulty selecting appropriate Restraints for their Children on the basis of height and weight, as they often do not know these data. In this study, we evaluated an alternative selection method-shoulder height labelling. Child Restraints were modified to include shoulder height labels indicating the minimum and maximum shoulder heights for which the Restraint is suitable. Convertible Restraints also included a label indicating the shoulder height when transitions should occur (e.g. rear to forward-facing). A sample of naïve and experienced Child Restraint users (N=20) evaluated comprehensibility of the labels and suitability of Restraints for mannequins, in a pilot study. The labels were also assessed by volunteers in Child Restraint fitting stations in Australia and New Zealand
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effectiveness of Child Restraint legislation to reduce motor vehicle related serious injuries and fatalities a national interrupted time series analysis
Social Science Research Network, 2019Co-Authors: Janani Shanthosh, Julie Brown, Rebecca Ivers, Kris Rogers, Thomas Lung, Andrew Wilson, Stephen JanAbstract:Background: Children that are unrestrained while travelling in a motor vehicle are more vulnerable to serious injury and death. The greatest levels of crash protection are achieved when Children use the most age or size appropriate form of Restraint. In this study, we aimed to examine the effectiveness of the introduction of age-appropriate Child Restraint legislation on serious and fatal injury in five Australian states and territories. Methods: For this interrupted time series analysis, we used a segmented regression method to assess the association between the implementation of Child-Restraint legislation and motor-vehicle related serious injuries and fatalities using data obtained from transport authorities in each jurisdiction. We estimated the change in annual rates after the implementation of legislation with the number of motor-vehicle accidents resulting in fatalities or serious injuries as the outcome, and the total number of injuries (minor, serious and fatal) as an offset in the model. Findings: We identified 10882 motor-vehicle related crashes resulting in fatalities (n=188), serious injuries (n=1730) and minor injuries (n=8964). In NSW and VIC, the rate ratio was statistically significant and positive, indicating an increase in the rate of serious injuries and fatalities in the period post-legislation compared to the period prior to legislation. In all other states and territories, we did not find a statistically significant effect of legislation. Interpretation: Road safety programs incorporating interventions targeted at increasing awareness of optimal Restraint practices, strengthened enforcement and measures to improve the affordability of Restraints are needed to support legislation. Funding Statement: The George Institute for Global Health. Declaration of Interests: The authors state: "None declared." Ethics Approval Statement: The authors declare: "Ethics committee approval was not needed as the data was de-identified, publicly accessible government data."
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barriers to correct Child Restraint use a qualitative study of Child Restraint users and their needs
Safety Science, 2018Co-Authors: Alexandra Hall, Judith Lynne Charlton, Lisa Keay, Kirsten Mccaffery, Kate Hunter, Andrew Hayen, Lynne E Bilston, Julie BrownAbstract:Abstract Motor vehicle crashes are a major cause of death and injury to Children worldwide. Although risk of injury to Child passengers can be reduced by using a Child Restraint, most Restraints are incorrectly used. This greatly reduces the Restraints’ protective potential; however there is limited research on drivers of correct Child Restraint use. The aim of this study was to explore perceived barriers and motivators of correct Child Restraint use in experienced Child Restraint users, to inform interventions to promote correct use. Motivations and risk perceptions concerning incorrect Child Restraint use among high and low socioeconomic populations and culturally and linguistically diverse (CALD) Child Restraint users in Sydney, Australia were qualitatively examined. Six focus groups (N = 44 participants) were facilitated using a semi-structured discussion guide. Transcriptions were deductively analysed using QSR NVivo11 software and the COM-B model of behaviour. Common perceived barriers to correct Restraint use were: (a) difficulty interpreting instructions and labels, particularly among CALD participants; (b) remembering and attending to correct use information; (c) lack of information and behavioural feedback on how to correctly install and use a Child Restraint; and (d) low confidence in ability to install and use a Child Restraint correctly. The results indicate current Child Restraint product information is poorly understood, particularly among those whose first language is not English. Interventions to increase correct Child Restraint use should address access to correct use information, capability to understand and use these, and the influence of motivation, memory and attention in the process.
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pa 16 5 1933 user centred instructions reduce misuse of Child Restraint systems results from a controlled laboratory trial
Injury Prevention, 2018Co-Authors: Alexandra Hall, Lisa Keay, Kate Hunter, Andrew Hayen, Lynne E Bilston, Jl Charlton, Bianca Albanese, Julie BrownAbstract:Evidence-based solutions are needed for the widespread and longstanding problem of Child Restraint (CRS) misuse. Following results from previous work that found product information supplied with CRS substantially impacts the way a Restraint is used, an intervention targeting product information as a mechanism to increase correct use was developed. This user-centred intervention was developed using best practice instructional design, consumer feedback and iterative consumer testing. To determine whether user-centred instructions are more effective than current product instructions at promoting correct use of CRS in the laboratory, a controlled laboratory study was conducted with 36 experienced and naive CRS users (over 18 years and reimbursed AUD$25 for travel). Participants installed a convertible CRS in the forward-facing mode. Correct use was assessed through observed installation of the CRS and securing of a mannequin in the Restraint using a 20-item pro-forma. One-way Analysis of Variance (ANOVA) was used to compare differences between groups on overall correct use and percentage correct use. No participant in the control group used the CRS without error however 100 per cent correct use was achieved by 28% of participants in the intervention group (between groups difference in correct use, Welch’s F, p By using a novel performance-based user-testing method, CRS product information can be designed to increase the correct use of CRS. This method may provide a template for designing future product information to be supplied for Child Restraints going forward as well as other safety products.
Kate Hunter - One of the best experts on this subject based on the ideXlab platform.
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facilitators and barriers to Child Restraint use in motor vehicles a qualitative evidence synthesis
Injury Prevention, 2020Co-Authors: Soumyadeep Bhaumik, Kate Hunter, Rebecca Ivers, Richard Matzopoulos, Megan Prinsloo, Margaret M PedenAbstract: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 focused 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 focused analysis. Results We identified a total of 335 records from searching the databases and five records from other sources. After screening, we identified 17 studies that met our inclusion criteria. All but one study (which had Children as participants) focused 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 focused 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-income and middle-income countries. Furthermore, there is a need for more evidence conducted in semiurban and rural areas and to involve fathers, policy-makers, implementers and enforcement agencies in such studies.
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user driven design of Child Restraint information to reduce errors in use a pilot randomised controlled trial
Injury Prevention, 2020Co-Authors: Judith Lynne Charlton, Alexandra Hall, Lisa Keay, Kate Hunter, Bianca Albanese, Andrew HayenAbstract:Background Incorrect use of Child Restraints is a long-standing problem that increases the risk of injury in crashes. We used user-centred design to develop prototype Child Restraint instructional materials. The objective of this study was to evaluate these materials in terms of comprehension and errors in the use of Child Restraints. The relationship between comprehension and errors in use was also explored. Methods We used a parallel-group randomised controlled trial in a laboratory setting. The intervention group (n=22) were provided with prototype materials and the control group (n=22) with existing instructional materials for the same Restraint. Participants installed the Restraint in a vehicle buck, secured an appropriately sized mannequin in the Restraint and underwent a comprehension test. Our primary outcome was overall correct use, and our secondary outcomes were (1) comprehension score and (2) percent errors in the installation trial. Results There was 27% more overall correct use (p=0.042) and a higher mean comprehension score in the intervention group (mean 17, 95% CI 16 to 18) compared with the control group (mean 12, 95% CI 10 to 14, p Conclusions Consumer-driven design of informational materials can increase the correct use of Child Restraints. Targeting improved comprehension of informational materials may be an effective mechanism for reducing Child Restraint misuse.
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barriers to correct Child Restraint use a qualitative study of Child Restraint users and their needs
Safety Science, 2018Co-Authors: Alexandra Hall, Judith Lynne Charlton, Lisa Keay, Kirsten Mccaffery, Kate Hunter, Andrew Hayen, Lynne E Bilston, Julie BrownAbstract:Abstract Motor vehicle crashes are a major cause of death and injury to Children worldwide. Although risk of injury to Child passengers can be reduced by using a Child Restraint, most Restraints are incorrectly used. This greatly reduces the Restraints’ protective potential; however there is limited research on drivers of correct Child Restraint use. The aim of this study was to explore perceived barriers and motivators of correct Child Restraint use in experienced Child Restraint users, to inform interventions to promote correct use. Motivations and risk perceptions concerning incorrect Child Restraint use among high and low socioeconomic populations and culturally and linguistically diverse (CALD) Child Restraint users in Sydney, Australia were qualitatively examined. Six focus groups (N = 44 participants) were facilitated using a semi-structured discussion guide. Transcriptions were deductively analysed using QSR NVivo11 software and the COM-B model of behaviour. Common perceived barriers to correct Restraint use were: (a) difficulty interpreting instructions and labels, particularly among CALD participants; (b) remembering and attending to correct use information; (c) lack of information and behavioural feedback on how to correctly install and use a Child Restraint; and (d) low confidence in ability to install and use a Child Restraint correctly. The results indicate current Child Restraint product information is poorly understood, particularly among those whose first language is not English. Interventions to increase correct Child Restraint use should address access to correct use information, capability to understand and use these, and the influence of motivation, memory and attention in the process.
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pa 16 5 1933 user centred instructions reduce misuse of Child Restraint systems results from a controlled laboratory trial
Injury Prevention, 2018Co-Authors: Alexandra Hall, Lisa Keay, Kate Hunter, Andrew Hayen, Lynne E Bilston, Jl Charlton, Bianca Albanese, Julie BrownAbstract:Evidence-based solutions are needed for the widespread and longstanding problem of Child Restraint (CRS) misuse. Following results from previous work that found product information supplied with CRS substantially impacts the way a Restraint is used, an intervention targeting product information as a mechanism to increase correct use was developed. This user-centred intervention was developed using best practice instructional design, consumer feedback and iterative consumer testing. To determine whether user-centred instructions are more effective than current product instructions at promoting correct use of CRS in the laboratory, a controlled laboratory study was conducted with 36 experienced and naive CRS users (over 18 years and reimbursed AUD$25 for travel). Participants installed a convertible CRS in the forward-facing mode. Correct use was assessed through observed installation of the CRS and securing of a mannequin in the Restraint using a 20-item pro-forma. One-way Analysis of Variance (ANOVA) was used to compare differences between groups on overall correct use and percentage correct use. No participant in the control group used the CRS without error however 100 per cent correct use was achieved by 28% of participants in the intervention group (between groups difference in correct use, Welch’s F, p By using a novel performance-based user-testing method, CRS product information can be designed to increase the correct use of CRS. This method may provide a template for designing future product information to be supplied for Child Restraints going forward as well as other safety products.
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increase in best practice Child car Restraint use for Children aged 2 5 years in low socioeconomic areas after introduction of mandatory Child Restraint laws
Australian and New Zealand Journal of Public Health, 2013Co-Authors: Julie Brown, Lisa Keay, Kate Hunter, Lynne E Bilston, Judy M Simpson, Rebecca IversAbstract:Objectives : To examine changes in Child car Restraint practices in low socioeconomic areas following the introduction of mandatory Child car Restraint legislation in New South Wales (NSW), Australia. Methods : Data from two cross-sectional studies of Child car Restraint use at pre-schools, early Childhood centres and primary schools before and after the introduction of legislating mandatory age-appropriate car Restraint use for Children up to the age of seven years was used in this analysis. All included observations were from local government areas with socioeconomic status in the lowest 30% of urban Sydney. Children aged 2–5 years were observed in their vehicles as they arrived at observation sites (107 pre-legislation, 360 post-legislation). Multilevel logistic regression was used to examine changes in observed age-appropriate and correct use of car Restraints. Results : Age-appropriate car Restraint use was higher post-legislation than pre-legislation. After controlling for Child's age, parental income, language spoken at home and adjusting for clustering, the odds of Children being appropriately restrained post-legislation were 2.3 times higher than in the pre-legislation sample, and the odds of them being correctly restrained were 1.6 times greater. Conclusions : Results indicate an improvement in car Restraint practices among Children aged 2–5 in low socioeconomic areas after introduction of Child Restraint laws. Implications : Despite improvements observed with enhanced legislation, further efforts are required to increase optimal Child car Restraint use.
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effectiveness of Child Restraint legislation to reduce motor vehicle related serious injuries and fatalities a national interrupted time series analysis
Accident Analysis & Prevention, 2020Co-Authors: Janani Shanthosh, Julie Brown, Rebecca Ivers, Kris Rogers, Thomas Lung, Andrew Wilson, Stephen JanAbstract:Abstract Children that are unrestrained while travelling in a motor vehicle are more vulnerable to serious injury and death. The greatest levels of crash protection are achieved when Children use the most age or size appropriate form of Restraint. In this study, we aimed to examine the effectiveness of the introduction of age-appropriate Child Restraint legislation on serious and fatal injury in five Australian states and territories. For this interrupted time series analysis, we used a segmented regression method to assess the association between the implementation of Child-Restraint legislation and motor-vehicle related serious injuries and fatalities using data obtained from transport authorities in each jurisdiction. We estimated the change in annual rates after the implementation of legislation with the number of motor-vehicle accidents resulting in fatalities or serious injuries as the outcome, and the total number of injuries (minor, serious and fatal) as an offset in the model. We identified 10882 motor-vehicle related crashes resulting in fatalities (n = 188), serious injuries (n = 1730) and minor injuries (n = 8964). In NSW and VIC, the rate ratio was statistically significant and positive, indicating an increase in the rate of serious injuries and fatalities in the period post-legislation compared to the period prior to legislation. In all other states and territories, we did not find a statistically significant effect of legislation Road safety programs incorporating interventions targeted at increasing awareness of optimal Restraint practices, strengthened enforcement and measures to improve the affordability of Restraints are needed to support legislation.
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effectiveness of Child Restraint legislation to reduce motor vehicle related serious injuries and fatalities a national interrupted time series analysis
Social Science Research Network, 2019Co-Authors: Janani Shanthosh, Julie Brown, Rebecca Ivers, Kris Rogers, Thomas Lung, Andrew Wilson, Stephen JanAbstract:Background: Children that are unrestrained while travelling in a motor vehicle are more vulnerable to serious injury and death. The greatest levels of crash protection are achieved when Children use the most age or size appropriate form of Restraint. In this study, we aimed to examine the effectiveness of the introduction of age-appropriate Child Restraint legislation on serious and fatal injury in five Australian states and territories. Methods: For this interrupted time series analysis, we used a segmented regression method to assess the association between the implementation of Child-Restraint legislation and motor-vehicle related serious injuries and fatalities using data obtained from transport authorities in each jurisdiction. We estimated the change in annual rates after the implementation of legislation with the number of motor-vehicle accidents resulting in fatalities or serious injuries as the outcome, and the total number of injuries (minor, serious and fatal) as an offset in the model. Findings: We identified 10882 motor-vehicle related crashes resulting in fatalities (n=188), serious injuries (n=1730) and minor injuries (n=8964). In NSW and VIC, the rate ratio was statistically significant and positive, indicating an increase in the rate of serious injuries and fatalities in the period post-legislation compared to the period prior to legislation. In all other states and territories, we did not find a statistically significant effect of legislation. Interpretation: Road safety programs incorporating interventions targeted at increasing awareness of optimal Restraint practices, strengthened enforcement and measures to improve the affordability of Restraints are needed to support legislation. Funding Statement: The George Institute for Global Health. Declaration of Interests: The authors state: "None declared." Ethics Approval Statement: The authors declare: "Ethics committee approval was not needed as the data was de-identified, publicly accessible government data."