Parents' perceptions, attitudes and behaviours towards child safety: a study in 14 European countries

Parental Home Safety Practices for Domestic Accident Prevention: How Prepared Were Parents for COVID-19 Confinement? A Cross-Sectional Study

(1) Background: Children are susceptible to home injuries. How prepared parents were to protect their children from accidents before and during the COVID-19 quarantine is uncertain. (2) Methods: We conducted a community-based, cross-sectional study in Greece between November and December 2021. We asked parents to complete an anonymous questionnaire voluntarily. Questions focused on accident-preventive measures taken at home during the COVID-19 quarantine. (3) Results: A greater proportion of parents took protective measures for a safer home before the lockdown than during the quarantine, while an interesting percentage of parents never utilized preventive measures for their children. Slightly more than half (58.6%) of parents did not seem to worry about a possible increase in domestic accidents during the quarantine. It was observed that those who had one or two children took more protective measures than those with more than two children. Older parents seemed to explain to their children how to access emergency services more often. Mothers stayed at home with the children more often, and their education affected the presence of some of the assessed measures. In our logistic regression modeling, parental concern about accidents was more related to the incidence of an accident during the pandemic and attendance at seminars. (4) Conclusions: Although the COVID-19 lockdowns disorganized family life, parents were aware of the importance of their parenting role in creating a safe environment for children, but according to the study, there is room for improvement.

Home environmental change for child injury prevention in Nepal: A qualitative study

In Nepal, unintentional home injury is a leading reason for death and disability among pre-school children. However, there is a lack of evidence to inform culturally appropriate interventions to reduce home injuries. This study explored the potential for home environmental change at a community level to prevent unintentional home injury in children and identified the barriers to, and facilitators of, such changes. Focus groups were conducted in the Nepali language with mothers, fathers, teachers, school students and community health volunteers in rural areas of Makwanpur district in Nepal. The discussions were audio-recorded, transcribed, translated into English and analysed thematically. NVivo software was used to support coding and identification of themes. Five focus groups, involving forty-seven participants, were completed leading to the development of four themes. Overall, the findings highlight that community people perceive injuries to be a normal part of childhood and, therefore, few prevention measures were considered. Parents were, however, able to identify ways to change their environment that made it safer. Changes included removing hazards or adding safety equipment, adapting the home or restricting access to potential hazards. Barriers to implementation included limited awareness about injury hazards and risk management, poor quality housing and financial constraint. Facilitators included raising community awareness, acquiring resources and financial support and involving the family and community. Development of interventions to prevent injuries at home in pre-school children should reflect local context and culture; this is best achieved through engagement with parents.

Improving parenting knowledge through caregiver education in China

BACKGROUND

Caregivers' parenting knowledge is of importance to child development and to achieve positive child outcomes. Even though some caregiver education programs have demonstrated positive effects, most of them are carried out in developed countries and among western samples. As a developing country with the second-largest child population worldwide, China has initiated caregiver education programs to promote parenting knowledge among caregivers since 2016. This study examines the effect of an innovative caregiver education program on caregivers' perceived increase of parenting knowledge.

METHODS

A total of 310 caregivers with a child aged between 0 and 3 from Z city, China, were randomly selected to complete a survey. Caregivers' perceived increase of parenting knowledge was assessed by five specified knowledge dimensions, namely, child growth, feeding behaviours, daily care, disease prevention and safety. The independent variable was program participation, measured by respondents' use of program services. OLS regression was employed to assess the association between caregivers' program participation and their perceived increase of knowledge, controlling basic demographic and socio-economic factors.

RESULTS

In general, program participation had statistically significant associations with caregivers' perceived increase of parenting knowledge. The associations varied by service type. Particularly, online development evaluations and in-home sessions showed relatively consistent and positive effects on caregivers' perceived increase of parenting knowledge.

CONCLUSIONS

This caregiver education program had a positive effect on caregivers' perceived increase of parenting knowledge, particularly through the use of the online development evaluations and in-home sessions. As one of the earliest initiatives of this kind in China, the findings reveal the promise of an innovative program to advance caregivers and children.

Perception and awareness of unintentional childhood injuries among primary caregivers of children in Vellore, South India: a community-based cross-sectional study using photo-elicitation method

OBJECTIVE

We studied the primary caregivers' perception, and further, their awareness of unintentional childhood injuries in south India.

METHODS

A cross-sectional study was conducted in the rural block of Kaniyambadi, Vellore, among 300 primary caregivers of children aged between 0 and 14 years. A semi-structured interview was conducted with the primary caregivers using a photo-elicitation method, with a visual depiction of ten injury risky scenarios for a child. Scoring was done to assess the perception of environmental hazards in these scenarios, and further, knowledge on the prevention of these injuries. An independent 't' test was done to elicit differences in mean scores and a multivariate regression analysis was applied to ascertain factors independently associated with the scores.

RESULTS

Primary caregivers had adequate perception regarding risks posed to children in scenarios such as climbing trees (96.2%), playing near construction sites (96%), firecrackers (96.4%) and crossing unmanned roads with no traffic signals (94%). Knowledge of prevention was poor however, in the following scenarios: a woman riding a bicycle without safety features, with child pillion sitting behind bare foot and legs hanging by one side (72.6%); a child playing near a construction site (85.9%); and a child playing with plastic bags (88.3%). Overall, educational status of the primary caregiver and socioeconomic status were associated with poorer perception of risks and knowledge about unintentional childhood injuries and their prevention.

CONCLUSIONS

Pragmatic community-based childhood interventions incorporated into existing programs, with a special focus on road traffic injuries, burns and suffocation need to be implemented in high-risk settings of rural populations in South India.

A systematic approach to injury policy assessment: introducing the assessment of child injury prevention policies (A-CHIPP)

Introduction

This study presents a systematic approach—assessment of child injury prevention policies (A-CHIPP)—to assess and track policies on effective child injury interventions at the national level. Results from an initial pilot test of the approach in selected countries are presented.

Method

A literature review was conducted to identify conceptual models for injury policy assessment, and domains and indicators were proposed for assessing national injury policies for children aged 1–9 years. The indicators focused on current evidence-supported interventions targeting the leading external causes of child injury mortality globally, and were organised into a self-administered A-CHIPP questionnaire comprising 22 questions. The questionnaire was modified based on reviews by experts in child injury prevention. For an initial test of the approach, 13 countries from all six WHO regions were selected to examine the accuracy, usefulness and ease of understanding of the A-CHIPP questionnaire.

Results

Data on the A-CHIPP questionnaire were received from nine countries. Drowning and road traffic injuries were reported as the leading causes of child injury deaths in seven of these countries. Most of the countries lacked national policies on interventions that address child injuries; supportive factors such as finance and leadership for injury prevention were also lacking. All countries rated the questionnaire highly on its relevance for assessment of injury prevention policies.

Conclusion

The A-CHIPP questionnaire is useful for national assessment of child injury policies, and such an assessment could draw attention of stakeholders to policy gaps and progress in child injury prevention in all countries.

This Much Water: a qualitative study using behavioural theory to develop a community service video to prevent child drowning in Western Australia

OBJECTIVES

Drowning in children under the age of 5 is a frequently occurring, yet preventable event. This research used behavioural theory to test the suitability and appropriateness of a drowning prevention message in a community service video.

DESIGN

This qualitative study used content analysis of focus groups. Constructs from the Health Belief Model guided the data analysis.

SETTING

Community organisations and playgrounds in Perth, Western Australia.

PARTICIPANTS

Participants were parents or carers of at least one child under 5 years residing in Western Australia. Seven focus groups (n=57) were conducted with eight participants in each group. Most participants were parents (96%), female (95%), aged between 25 and 34 years (63%) and were born in Australia (68%).

RESULTS

Participants indicated the community service video was credible in communicating the message that young children were susceptible to drowning in shallow water and that various water hazards existed in and around the home. However, a range of external factors, such as the child's age, type of water hazard, presence of siblings and other environmental factors, influenced risk perceptions. Child drowning was seen as a serious issue. Controlling access to water and the role of supervision were understood to be important factors in preventing drowning.

CONCLUSIONS

The lack of published drowning prevention interventions shaped by behavioural theory limits the understanding of best practice. Using constructs from the Health Belief Model, this research confirmed the perceived seriousness, devastating and unforgettable consequence of drowning; however, findings were mixed regarding cues to action. Future development of drowning prevention media messages should test strategies to increase susceptibility and self-efficacy among the target group and explore the impact of different message senders. The findings provide a valuable understanding of possible messages and their execution for use in media campaigns, as one component of an effective public health intervention to prevent child drowning underpinned by behavioural theory.

Parents' Attitudes and Adherence to Unintentional Injury Prevention Measures in Ankara, Turkey

Background:

Childhood unintentional injuries are perceived as a leading public health issue since they are one of the preventable causes of paediatric mortality and morbidity. Whether and how parental factors are related to childhood injury has been researched insufficiently.

Aims:

To investigate parents’ attitudes to preventive measures of unintentional childhood injury, and the parental adherence to these measures.

Study Design:

Cross-sectional, descriptive study.

Methods:

The data were collected from the parents of children younger than ten years of age admitted to university hospital outpatient clinics for any reason and who agreed to be involved in the study. The first part of the questionnaire included sociodemographic profiles of participating children. Serious injuries were considered to be any injury that requires hospital admission. The second part of the questionnaire was prepared to evaluate parents’ adherence to injury prevention rules. A total score calculation about the adherence of the parents to the injury prevention rules was worked out the addition of the scores of each answer given in each age group. Answers for each item given by the parents were scored as wrong (0), sometimes (1) or correct (2). The score for each item was added and the result normalized to 100 points. Only complete questionnaires were used for analysis.

Results:

A total of 1126 children and parent pairs agreed to participate in the survey. It was found that 13.8% of the participating children had experienced at least one serious injury. Although three-quarters of the parents had received information about injury prevention, the overall injury prevention scores were found to be low. As children’s age increased, the total injury prevention scores of parents decreased significantly. Injury prevention scores were shown to increase significantly with high education and maternal occupation. However, scores were shown to decrease significantly with increased child age and family size.

Conclusion:

Our study shows that parental adherence to the child safety measures aimed at decreasing the unintentional injury risk of children is not satisfactory in Turkey. In particular, parents of 5-9-year-old children, big families (more than five people), parents with less than 8 years of education and non-working mothers should be the main target groups for intervention strategies according to our study results.

Household and caregiver characteristics and behaviours as predictors of unsafe exposure of children to paraffin appliances

This study examines adult safety knowledge and practices regarding the use of paraffin cooking appliances. The use of these is common in South Africa with injury risks that are poorly understood. This cross-sectional study was in an informal settlement in Johannesburg, South Africa, where children were reportedly at high risk for burns. This study sought to clarify relationships between key risks and developed individual and composite variables from theoretical constructs and operational definitions of risks for burns. Risks included Child Use of Paraffin Appliances, Child Proximity to Cooking, Risky Stove Use, Caregiver's Burn Treatment Knowledge, Children Locked in House, Children Alone in House. Number of children remains as in proof as this was not a composite scale. Child Proximity to Cooking was associated with more children in the home. Households where children were in greater proximity to cooking were 6 times more likely to be left alone at home, with caregivers with no education over 100 times more likely to lock their children at home. Children locked in were often from homes where caregivers used appliances unsafely. In settings with hazardous energy use, compressed household configurations, and families with multiple children, Risky Stove Use and the practice of locking children in the home may be catastrophic.

Unintentional Injuries in Children Up to Six Years of Age and Related Parental Knowledge, Attitudes, and Behaviors in Italy

OBJECTIVES

To describe risk factors associated with unintentional injuries among children aged <6 years and to examine parents' level of knowledge, attitudes, and behaviors about pediatric injuries and related preventive measures.

STUDY DESIGN

A cross-sectional survey was conducted between May and July 2015 on a random sample of 794 parents of 3- to 6-year-old children through a self-administered anonymous questionnaire.

RESULTS

A total of 409 parents participated. Two-thirds of the children had experienced at least 1 unintentional injury in the previous 12 months. More than one-half of these children were boys. The leading cause was falls; the injuries occurred mainly at home, and only 9.2% were brought for attention to an emergency department. Parents who did not believe that it is possible to prevent unintentional injuries were more likely to have had a child injured. Approximately 70% of respondents were aware of security measures to prevent pediatric injuries, and this knowledge was more prevalent in older parents and in those with at least a college level of education compared with those with a middle school education. The perceived utility of education about preventive measures of pediatric injuries had a mean value of 8.9 on a Likert scale of 1-10 (1, not useful, to 10, very useful) and was significantly higher in mothers.

CONCLUSIONS

This study highlights a clear need for public health educational programs for parents regarding prevention of unintentional injuries in children as a valuable tool to increase safety and injury prevention and to reduce risks, because the majority of such injuries occur at home.

The Difficulty of Prevention: A Behavioral Perspective

Behavioral medicine provides insight in to the problem of injury prevention. Society often views unintentional injuries as only an accident when in reality many accident-related injuries are preventable. However, barriers to behavioral change in injury prevention exist for both patients (eg, inconvenience, perceived risk-benefit ratio) and health care providers (eg, feeling of badgering nonadherent patients, patient misinformation). To overcome barriers, the article discusses strategies for health care providers to address injury prevention such as choosing active over passive strategies, informing patients of predictable injury-prone circumstances, and individualizing patient risks.

Understanding Barriers for Communicating Injury Prevention Messages and Strategies Moving Forward: Perspectives from Community Stakeholders

OBJECTIVES

The primary objective of this study was to elicit the perspectives of direct care providers on barriers and facilitators to communicating injury prevention messages to parents/caregivers of children under 4 years of age. The secondary objective was to examine characteristics of an injury prevention messaging strategy preferred by direct care providers.

DESIGN AND SAMPLE

This qualitative study was conducted across four regions in Ontario Canada. Fifty-nine direct care providers were purposefully sampled and data interpreted using focus group analysis.

MEASURES

Transcripts were analyzed verbatim using content and discourse analysis.

RESULTS

Several barriers to communicating injury prevention messages were identified encompassing (a) role, (b) parental, (c) social determinants, and (d) evidence impediments. In an effort to offset some of these barriers, participants endorsed the development of a tailored multicomponent injury prevention strategy adopting action-based messages.

CONCLUSION

The results of this study provide an in-depth exploration of direct care providers perceptions that can inform the design of materials and dissemination strategies to help increase and optimize access to injury prevention information. Injury prevention messages should be action-oriented, specifically tailored to the stage of child development, and disseminated through both face-to-face interactions and mobile technology.

Comparison of knowledge, attitudes and behaviour of health professionals and parents regarding child injuries

OBJECTIVE

We wanted to primarily examine the knowledge, attitudes and behaviour of parents and health workers (community nurses and paediatricians) regarding child injuries in order to understand the essence of the problem and to find out the most common misconceptions.

METHODS

Respondents were tested through an anonymous, self-administered questionnaire and all p values below 0.05 were considered significant.

RESULTS

Of all respondents, paediatricians answered accurately most of the questions considering knowledge than the other groups. More than 90% of respondents, in all groups, identified correct answers to 10 questions about attitudes towards child injury prevention and safety promotion.

CONCLUSION

This study, which shows the current level of knowledge, attitudes and behaviour patterns of parents and health professionals in Croatia, could help in the preparation of appropriate prevention programmes.

Drowning risk perceptions among rural guardians of Thailand: A community-based household survey

Drowning is one of the most common causes of death among young children in Thailand. Children in primary school in rural settings have a high rate of fatal drowning. Guardians' perceptions are important since children are normally in their care. This study aims to describe drowning risk perceptions of guardians and to identify barriers to developing a child's swimming skills. A cross-sectional household survey was conducted among guardians of children who attended 12 schools serving 48 villages in a rural community. The results revealed that less than one-fifth (18%) of children in the household could swim. Guardians reported that children should learn to swim at the age of seven years. About one-quarter (23%) of guardians did not perceive drowning as the leading cause of death among children. More than a quarter (25.4%) perceived that their child was not at the risk of drowning. No statistical differences were reported on drowning perception among guardians with different swimming skills as well as child's swimming skill. Significantly more parents of children who could not swim perceived lack of swimming instructors, clean water and school swimming lessons as barriers to a child's acquisition of swimming skill. The results highlight the need to consider improving the infrastructure in rural areas to facilitate swimming skills for school children to reduce drowning risk.

Mothers' perspectives on the delivery of childhood injury messages: a qualitative study from the growing up in Wales, environments for healthy living study (EHL)

BACKGROUND

Childhood injury is the second leading cause of death for infants aged 1-5 years in the United Kingdom (UK) and most unintentional injuries occur in the home. We explored mothers' knowledge and awareness of child injury prevention and sought to discover mothers' views about the best method of designing interventions to deliver appropriate child safety messages to prevent injury in the home.

METHODS

Qualitative study based on 21 semi-structured interviews with prospective mothers and mothers of young children. Mothers were selected according to neighbourhood deprivation status.

RESULTS

There was no difference in awareness of safety devices according to mothers' deprivation status. Social networks were important in raising awareness and adherence to child safety advice. Mothers who were recent migrants had not always encountered safety messages or safety equipment commonly used in the UK. Mothers' recommended that safety information should be basic and concise, and include both written and pictorial information and case studies focus on proactive preventive messages. Messages should be delivered both by mass media and suitably trained individuals and be timed to coincide with pregnancy and repeated at age appropriate stages of child development.

CONCLUSIONS

The findings suggest that timely childhood injury-related risk messages should be delivered during pregnancy and in line with developmental milestones of the child, through a range of sources including social networks, mass media, face-to-face advice from health professionals and other suitably trained mothers. In addition information on the safe use of home appliances around children and use of child safety equipment should be targeted specifically at those who have recently migrated to the United Kingdom.

Evaluation of factors influencing knowledge and attitudes of mothers with preschool children regarding their adoption of preventive measures for home injuries referred to academic emergency centres, Tehran, Iran

Excessive dependence of preschool children on their parents has led to a significant increase in the incidence of home injuries. Therefore, the present study aimed to evaluate factors influencing the knowledge and attitudes of mothers in this group regarding their adoption of preventive measures for home injuries. The subjects in this descriptive/analytical study consisted of all mothers of preschool children with home injuries, who had referred to the emergency department of Imam Hussein Hospital and Shohada-e-Haftome Tir Hospital in Tehran, Iran. After knowledge levels and attitudes of mothers were divided into two groups, multivariate logistic regression analysis and chi-squared test were used. Finally, 230 mothers, with a mean age of 29.4 ± 5.2 years, were evaluated, 75.0% of whom had good knowledge and 46.2% had positive attitudes. High school education, mothers' employment and mothers' absence from home for at least 8 hours a day were the factors predicting poor attitudes of mothers. There was a close correlation between mothers' knowledge and attitudes. The results of this study showed that mothers' high educational status, absence, occupation and the number of children in the family and history of accidents during the previous 3 weeks are important predicting factors.

How do public health practitioners in China perceive injury prevention? A survey

To report public health practitioners' perceptions of injury prevention in Changsha, China. We undertook a cross-sectional study at Changsha, Hunan, China. An anonymous self-reported survey was conducted to ascertain the proportion of respondents who answered negatively to questions about the value of injury prevention. Over 20% of respondents answered 'unpreventable' or 'don't know' to whether injuries from natural environmental disaster, homicide/assault, poisoning, animal bite, cut/pierce, suffocation and electric current were preventable. More than 40% of respondents answered 'no' or 'don't know' to whether the prevention of injuries from homicide/assault, cut/pierce, fall, suicide/self-harm, drowning, road traffic crash and fire/burn belonged to the job of public health. Only 48% of respondents supported building a division/office within the Centers for Disease Control and Preventions at all levels. Many public health practitioners in Changsha had misperception about injury prevention. Education and training are needed to correct their misperception.

Injuries associated with housing conditions in Europe: a burden of disease study based on 2004 injury data

BACKGROUND

The authors recently undertook a study for the World Health Organization estimating the European burden of injuries that can be attributed to remediable structural hazards in the home. Such estimates are essential for motivating injury prevention efforts as they quantify potential health gains, in terms of injuries prevented, via specific environmental interventions.

METHODS

We combined exposure estimates from existing surveys and scenarios with estimates of the exposure-risk relationship obtained from a structured review of the literature on injury in the home and housing conditions. The resulting attributable fractions were applied to burden of injury data for the WHO European Region.

RESULTS

This analysis estimated that two specific hazards, lack of window guards at second level and higher, and lack of domestic smoke detectors resulted in an estimated 7,500 deaths and 200,000 disability adjusted life years (DALYs) per year. In estimating the environmental burden of injury associated with housing, important deficiencies in injury surveillance data and related limitations in studies of injury risk attributable to the home environment were apparent. The ability to attribute proportions of the home injury burden to features of the home were correspondingly limited, leading to probable severe underestimates of the burden.

CONCLUSIONS

The burden of injury from modifiable home injury exposures is substantial. Estimating this burden in a comprehensive and accurate manner requires improvements to the scope of injury surveillance data and the evidence base regarding the effectiveness of interventions.

Maternal psychological adjustment and knowledge of infant development as predictors of home safety practices in rural low-income communities

BACKGROUND

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.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Parents of preschool fire setters: perceptions of the child-play fire hazard

The present study sought to learn about risk perceptions held by parents of preschool fire-setters. A 41-item survey was distributed to 60 parents whose children, aged 6 years and younger, had previously set fires and who were involved in intervention programmes throughout the US. Most parents did not think their children would play with matches/lighters, or knew how to use these items, although some had witnessed their children playing with matches/lighters previously. Most parents reported having taken precautions to keep matches/lighters out of reach and also educating their children about fire. Regardless, children not only set fires, but in 40% of cases climbed to access the match/lighter. Parents' perceptions of their children's proclivity for fire play were not consistent with their actual fire-play behaviour. Parents underestimated the likelihood that their children would play with matches/lighters. Although most reportedly undertook preventative measures aimed at thwarting fire play, these strategies were ineffective. Traditionally relied upon precautionary techniques, such as storing lighters out of reach and discussing the dangers of fire, were not sufficient to stem interest and resultant fire play.

Would society pay more attention to injuries if the injury control community paid more attention to risk communication science?

“If a disease were killing our children at the rate unintentional injuries are, the public would be outraged and demand that this killer be stopped.” Former US Surgeon General, C Everett Koop