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Sun YR, Liu T, Ran N, Chen JY, Niu YS, Wang X, Luo Y, Lu MQ, Yang XL. Assessment of the effectiveness of parent-targeted interventions for the use of child restraint systems: a systematic review and meta-analysis. Transl Pediatr 2022; 11:1939-1948. [PMID: 36643670 PMCID: PMC9834943 DOI: 10.21037/tp-22-560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND It is essential to implement parent-targeted interventions to increase the use of child restraint systems (CRS) and thus reduce the injuries and deaths of children due to motor vehicle collisions. To optimize future intervention designs, this meta-analysis sought to quantify the effects of parent-targeted interventions and explore potential intervention moderators. METHODS Studies met inclusion criteria if they included a parents-targeted intervention that focused on increasing CRS use for children, published from the inception of the databases to January 2022, were systematically retrieved from the PubMed, Embase, Cochrane library, Web of Science, Sinomed, Wanfang, and CNKI databases. Next, 2 researchers independently screened the retrieved articles, evaluated their quality according to the Cochrane Tool, and extracted the data. Finally, Stata12.0 was used for the meta-analysis. Heterogeneity was examined with I2, stratified analyses, and meta-regression. RESULTS Of the 1,690 articles retrieved, 9 studies, comprising 22,329 parents of children aged 0-12 years, were ultimately included in the analysis. The results of the meta-analysis showed that the CRS use rate of the intervention group was 1.62 times higher than that of the control group [95% confidence interval (CI): 1.25-2.11, Z=3.616, P<0.001], indicating the positive effect of parent-targeted interventions on promoting the use of CRS. The subgroup analysis found that interventions guided by behavioral theories increased the use of CRS (odds ratio: 1.44, 95% CI: 1.27-1.63, n=5). The difference in the use of CRS between the groups in the studies that were not guided by theories was not statistically significant, indicating that interventions guided by behavioral theories may be the source of the heterogeneity. Risk of bias was low in most studies. CONCLUSIONS It is necessary to conduct interventions with parents to increase the use of CRS. The effects on CRS use appear to differ depending on whether the interventions are guided by behavioral theories. In-depth research needs to be conducted to explore the characteristics of the interventions, especially those guided by different behavioral theories, to reduce child vehicle injuries.
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Affiliation(s)
- Ya-Ru Sun
- Department of Nursing, School of Nursing, Qingdao University, Qingdao, China
| | - Ting Liu
- Department of Nursing, School of Nursing, Qingdao University, Qingdao, China
| | - Ni Ran
- Department of Child Prevention and Health Care, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jun-Yu Chen
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Yu-Shuo Niu
- Department of Hepatobiliary Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Qingdao, China
| | - Xin Wang
- Department of Nursing, School of Nursing, Qingdao University, Qingdao, China
| | - Ying Luo
- Department of Nursing, School of Nursing, Qingdao University, Qingdao, China
| | - Ming-Qin Lu
- Department of Nursing, School of Nursing, Qingdao University, Qingdao, China
| | - Xiu-Ling Yang
- Department of Nursing, School of Nursing, Qingdao University, Qingdao, China
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Macy ML, Carter P, Kendi S, Pollock B, Miguel LS, Goldstick J, Resnicow K. “Tiny Cargo, Big Deal! Abróchame Bien, Cuídame Bien” an emergency department-based intervention to promote child passenger safety: Protocol for an adaptive randomized trial among caregivers of 6-month through 10-year-old children. Contemp Clin Trials 2022; 120:106863. [DOI: 10.1016/j.cct.2022.106863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/17/2022] [Accepted: 07/27/2022] [Indexed: 11/03/2022]
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Kendi S, Howard MB, Mohamed MA, Eaddy S, Chamberlain JM. So much nuance: A qualitative analysis of parental perspectives on child passenger safety. TRAFFIC INJURY PREVENTION 2021; 22:224-229. [PMID: 33661063 DOI: 10.1080/15389588.2021.1877276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore barriers and facilitators to optimal child restraint system (CRS) use for diverse parents of newborn infants and to obtain input from parents on the use of technology-assisted remote car seat checks as tools for promoting optimal CRS use. METHODS Parents were recruited using purposive sampling. Interviews were conducted with English- or Spanish-speaking parents with a full term newborn and regular access to a car. Interviews were conducted by phone, and recorded and transcribed verbatim. Interviews were conducted until thematic saturation was reached. Data were organized for analysis using Atlas.ti, and codes grouped by theme using constant comparison. RESULTS 30 parents were enrolled. Barriers and facilitators to optimal CRS use were classified into three themes, as were thoughts on the pros and cons regarding remote car seat checks. Themes on barriers and facilitators included motor vehicle and CRS features (such as age and size of the motor vehicle and presence of the Lower Anchors and Tethers for Children LATCH system), resources (availability, accessibility, and accuracy of resources), and parental factors (parental emotions and characteristics). Themes related to pros and cons of remote car seat checks included the ability (and challenge) of remote car seat checks to identify and correct errors, the potential use of remote car seat checks in certain situations (such as CRS transitions and periods of growth), and convenience of remote car seat checks (including increased availability and ease of access). Subthemes with further detail were arranged within each theme identified. CONCLUSION From a parent perspective, there are several identified barriers and facilitators of optimal CRS use. Although car seat checks were identified as a resource, in-person accessibility was an issue, and there were mixed opinions on technology-assisted remote car seat checks. These results provide a foundation for additional study on targeted interventions, including remote interventions for which there is an increased need due to the COVID-19 pandemic.
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Affiliation(s)
- Sadiqa Kendi
- Children's National Hospital, Washington, DC
- The George Washington University School of Medicine and Health Sciences, Washington, DC
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Mary Beth Howard
- Children's National Hospital, Washington, DC
- The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Mohamed A Mohamed
- The George Washington University School of Medicine and Health Sciences, Washington, DC
- The George Washington University Hospital, Washington, DC
| | - Samuel Eaddy
- Children's National Hospital, Washington, DC
- Nova Southeastern University Dr. Kiran C Patel College of Osteopathic Medicine, Fort Lauderdale, Florida
| | - James M Chamberlain
- Children's National Hospital, Washington, DC
- The George Washington University School of Medicine and Health Sciences, Washington, DC
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Casilang CG, Stonbraker S, Japa I, Halpern M, Messina L, Steenhoff AP, Lowenthal ED, Fleisher L. Perceptions and Attitudes Toward Mobile Health in Development of an Exclusive Breastfeeding Tool: Focus Group Study With Caregivers and Health Promoters in the Dominican Republic. JMIR Pediatr Parent 2020; 3:e20312. [PMID: 32821063 PMCID: PMC7474414 DOI: 10.2196/20312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Despite growing interest in the use of technology to improve health outcomes in low- and middle-income countries (LMICs), local attitudes toward mobile health (mHealth) use in these settings are minimally understood. This is especially true in the Dominican Republic, where mHealth interventions are starting to emerge. This information is critical for developing effective mHealth interventions to address public health issues, such as low exclusive breastfeeding (EBF) rates, which can lead to poor outcomes. With an EBF rate of 5% in the first 6 months of life, the Dominican Republic has one of the lowest EBF rates worldwide. OBJECTIVE This study aims to describe the current use of information and communication technology (ICT) and to analyze the attitudes and perceptions related to using mHealth interventions among caregivers of children aged ≤5 years and health promoters in the Dominican Republic. Findings can inform mHealth strategies aimed at improving EBF in this, and other, LMICs. METHODS Participants were recruited from 3 outpatient sites: the Niños Primeros en Salud program at Centro de Salud Divina Providencia in Consuelo (rural setting) and Clínica de Familia La Romana and its program Módulo de Adolescentes Materno Infantil in La Romana (urban setting). Focus groups were conducted with caregivers and community health promoters to identify the use, attitudes, perceptions, and acceptability of mHealth as well as barriers to EBF. Discussions were conducted in Spanish, guided by semistructured interview guides. All sessions were audio-recorded and later transcribed. Thematic content analysis was conducted in Spanish by two bilingual researchers and was structured around a hybrid behavioral theory framework to identify salient themes. RESULTS All participants (N=35) reported having a mobile phone, and 29 (83%) participants had a smartphone. Sources for obtaining health information included the internet, physicians and clinic, family and friends, health promoters, and television. Barriers to mHealth use included the cost of internet service, privacy concerns, and perceived credibility of information sources. Participants indicated the desire for, and willingness to use, an mHealth intervention to support breastfeeding. The desired features of a possible mHealth intervention included offering diverse methods of information delivery such as images and video content, text messages, and person-to-person interaction as well as notifications for appointments, vaccines, and feeding schedules. Other important considerations were internet-free access and content that included maternal and child health self-management topics beyond breastfeeding. CONCLUSIONS There is a high level of acceptance of ICT tools for breastfeeding promotion among caregivers in urban and rural areas of the Dominican Republic. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create an effective intervention. Participants wanted to receive trusted and reliable information through various formats and were interested in information beyond breastfeeding.
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Affiliation(s)
- Clarisse G Casilang
- Department of Pediatrics, Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Centro de Salud Divina Providencia, Consuelo, Dominican Republic.,Clínica de Familia La Romana, La Romana, Dominican Republic.,Children's Hospital of Orange County, Orange, CA, United States
| | - Samantha Stonbraker
- Clínica de Familia La Romana, La Romana, Dominican Republic.,School of Nursing, Columbia University, New York, NY, United States
| | - Ingrid Japa
- Centro de Salud Divina Providencia, Consuelo, Dominican Republic
| | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Luz Messina
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Andrew P Steenhoff
- Department of Pediatrics, Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Elizabeth D Lowenthal
- Department of Pediatrics, Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Linda Fleisher
- Fox Chase Cancer Center, Philadelphia, PA, United States
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Bhaumik S, Hunter K, Matzopoulos R, Prinsloo M, Ivers RQ, Peden M. Facilitators and barriers to child restraint use in motor vehicles: a qualitative evidence synthesis. Inj Prev 2020; 26:478-493. [PMID: 32447304 DOI: 10.1136/injuryprev-2020-043655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 12/31/2022]
Abstract
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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Affiliation(s)
| | - Kate Hunter
- Injury Division, George Institute for Global Health, Camperdown, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Matzopoulos
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Megan Prinsloo
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Rebecca Q Ivers
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Ivers, George Institute for Global Health, Camperdown, New South Wales, Australia
| | - Margaret Peden
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia .,George Institute for Global Health UK, Oxford, Oxfordshire, UK.,Nuffield Department of Womens and Reproductive Health, University of Oxford, Oxford, Oxfordshire, UK
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McDonald CC, Kennedy E, Fleisher L, Zonfrillo MR. Factors Associated with Cell Phone Use While Driving: A Survey of Parents and Caregivers of Children Ages 4-10 Years. J Pediatr 2018; 201:208-214. [PMID: 30017337 DOI: 10.1016/j.jpeds.2018.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/09/2018] [Accepted: 06/01/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To examine characteristics associated with cell phone use while driving by parents and caregivers of children ages 4-10 years. STUDY DESIGN National cross-sectional online survey with a convenience sample (March 2017-April 2017). INCLUSION CRITERIA Parent/caregiver of a child age 4-10 years in their home, age ≥18 years, read and spoke English, and drove child ≥6 times in previous 3 months. Adjusted logistic regression analyses were modeled for outcome measures of previous 3-month self-report cell phone use while driving with the child. RESULTS The analytic sample was n = 760. In the previous 3 months, 47% of parent/caregivers talked on a hand-held phone, 52.2% talked on a hands-free phone, 33.7% read texts, 26.7% sent texts, and 13.7% used social media while driving with their child in the vehicle. Compared with those who always used their typical child restraint system, participants who did not always use were more likely to talk on a hands-free phone (aOR 1.97, 95% CI 1.26-3.09), read a text (aOR 1.74, 95% CI 1.11-2.73), send a text (aOR 1.65, 95% CI 1.04-2.62), and use social media (aOR 2.92, 95% CI 1.73-4.94) while driving. Higher income, not wearing a seat belt (driver) on every trip, and driving under influence of alcohol also were associated with various types of cell phone use while driving. CONCLUSIONS Inconsistent child restraint system use, lack of seat belt use, and driving under the influence of alcohol are associated with parent/caregiver cell phone use while driving. Screening and education related to parental driving behaviors should include addressing multiple risk behaviors.
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Affiliation(s)
- Catherine C McDonald
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA; Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA.
| | - Erin Kennedy
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA; Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Linda Fleisher
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mark R Zonfrillo
- Department of Emergency Medicine, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI
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McDonald CC, Kennedy E, Fleisher L, Zonfrillo MR. Situational Use of Child Restraint Systems and Carpooling Behaviors in Parents and Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081788. [PMID: 30127291 PMCID: PMC6121359 DOI: 10.3390/ijerph15081788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 11/16/2022]
Abstract
Suboptimal compliance with child restraint system (CRS) recommendations can increase risk for injury or death in a motor vehicle crash. The purpose of this study was to examine scenarios associated with incomplete CRS use and non-use in children ages 4⁻10 years. We used a cross-sectional online survey with a convenience sample of parent/caregivers from the United States, age ≥18 years, with a child age 4⁻10 years in their home, who could read and spoke English, and drove child ≥6 times in previous three months. We used descriptive statistics and Mann-Whitney U to describe and compare the distribution of responses to situational use of CRSs among car seat users and booster seat users. We also used descriptive statistics and the Mann-Whitney U to describe and compare the distribution of responses to carpooling items among booster seat users and non-booster seat users. There were significant differences among those who reported most often using booster seats (n = 282) and car seats (n = 127) in situations involving rental cars, driving just around the corner, car too crowded to fit the CRS, not enough CRSs in the vehicle, the CRS is missing from the car, or the child is in someone else's car without a CRS (p < 0.05). Among those who reported most often using booster seats and who carpooled other children (n = 159), 71.7% (n = 114) always used a booster seat for their own child. When carpooling other children, booster seat users were significantly more likely to use booster seats for other children ages 4⁻10 than the non-booster seat users (p < 0.01). Continued education and programs surrounding CRS use is critical, particularly for children who should be in booster seats.
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Affiliation(s)
- Catherine C McDonald
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA.
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Erin Kennedy
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA.
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Linda Fleisher
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Mark R Zonfrillo
- Department of Emergency Medicine, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI 02903, USA.
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