Evaluation of parental education using biomechanical visualization to increase child restraint use in China. (May 2022)

• Record Type: Journal Article
• Authors: Peng, Yixiang; Zhang, Mengwei; Yan, Shuzhen; Li, Xiaogai; Yang, Jingzhen; Fan, Guanhua; Li, Liping
• Is Part Of: Accident analysis and prevention. Volume 169(2022)
• Publication Date: 2022-05
• Subjects: Biomechanical visualization -- Child occupant protection -- Child passenger safety -- Child restraint system; Accidents -- Prevention -- Periodicals; Accident Prevention -- Periodicals; Accidents -- Prévention -- Périodiques; 363.106
• DOI: 10.1016/j.aap.2022.106633
• Languages: English
• ISSNs: 0001-4575

Abstract

Highlights: The best solution for protecting children from road traffic crashs injuries and fatalities is the appropriate and correct use of child restraint system (CRS). The rate of CRS use in China is extremely low. Educational interventions have been used to increase the use of CRS, but the effectiveness is mixed. CRS education with biomechanical visualization was effective in improving caregivers' knowledge, attitudes and use of CRS. Biomechanical visualization may be an effective supplement to education aiming to improving CRS knowledge and use behaviors. Abstract: Introduction: Despite 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. Methods: We 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. Results: More 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). Conclusions: This 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.