CRICOS No J Melissa Johns Prof. Narelle Haworth & Dr. Alexia Lennon Australian Injury Prevention Network Conference Brisbane 2011 An application of the Health Belief Model to understanding use of child restraint practices

Queensland Legislation Old legislation: –All passengers must be restrained –Children younger than 12 months in a rear facing infant restraint New legislation: –Different restraints depending on age of child up to 7 years –Rear seating for children up to 7 years

Aims Multi-method study including two parts: –Study One: three sets of observations in two regional areas of Queensland –Study Two: two sets of parent intercept interviews conducted in Toowoomba, Queensland The aim of Study Two is to determine parents’ views, opinions and knowledge of child restraint practices and the Queensland legislative amendment

Study Two Method Intercept interviews with parents in a shopping centre in Toowoomba, Queensland. 125 parents reporting on 222 children (aged from 0-8 years) Interviews lasted approximately 10 minutes and included questions about: –Child restraint type and seating position –Purpose of changes to legislation –Ease (or otherwise) of complying with legislation –Health Belief Model constructs: Perceived benefits Perceived barriers Perceived susceptibility Perceived severity Self efficacy

Health Belief Model Individual’s behaviour is: –reason-based –influenced by attitudes, perceptions & beliefs (Glanz, Lewis & Rimer, 2002) Individuals will carry out a health related action if there is a positive expectation that they will avoid a negative health condition by engaging in a recommended action. Example: Parents will restrain their children in appropriate child restraints to avoid child injury or death.

Items used to fulfil Health Belief Model constructs Perceived Benefits: Protect child Avoid punishment Perceived Barriers: Cost Length of trip Parents’ trust in retailer Enough space in car for 3 restraints Relative safety of child restraint vs adult seatbelts for children Relative safety of back seat vs front seat for children Perceived Susceptibility/Severity: Likelihood of crash Likelihood of child injury Severity of child injury Self efficacy: Parents confidence in: Choosing Obtaining Installing Ensuring child wears most appropriate child restraint

Restraint Practices Score of appropriate: ─If all children were seated and restrained appropriately according to the new legislation Score of inappropriate: –If any one child was seated or restrained inappropriately according to the new legislation

Analysis Cronbach’s alpha values of scales for Health Belief Model were low so associations were examined separately Univariate logistic regression was used to examine whether parents’ responses to the Health Belief Model constructs were associated with restraint practices

Results 125 parents, 222 children 74.4% parents achieved score of ‘appropriate’ 25.6% parents achieved score of ‘inappropriate’ Parent demographic information was recorded: –Age –Gender –Income –Highest level of education –Family type No significant differences were detected between parents with a score of appropriate or inappropriate on the basis of demographic variables

Perceived Benefits Significantly more likely to achieve a score of ‘appropriate’ if: −Parents agreed that placing the child in the recommended child restraint for his/her age would avoid a fine −Parents agreed that placing the child in the recommended child restraint for his/her age would avoid demerit points Responses to other items (protect child against injury/death) were not related to the appropriateness of parents’ overall restraint practices.

Perceived Barriers Significantly more likely to achieve score of ‘inappropriate’ if: −Parents disagreed that child restraints provide better protection than a seatbelt for children Agreement/disagreement with other items (cost of child restraints, length of trip, trust in retailer, having enough space in the back seat of the car for three child restraints, and the relative safety of a child restraint instead of an adult seatbelts for children and the back seat instead of the front seat) was not related to the appropriateness of parents’ overall restraint practices

Perceived Susceptibility/Severity Parents’ responses (likelihood of crash, likelihood of child injury, severity of child injury) were not related to appropriateness of overall restraint practices for their children.

Self efficacy Significantly more likely to achieve score of ‘appropriate’ if: −Parents reported that they were completely confident in installing the restraint Responses to other items (confidence in choosing, obtaining and having child wear restraint) were not related to the appropriateness of parents’ overall restraint practices.

Discussion Perceived difficulties in installing restraint more important than choosing, obtaining and wearing correct restraint. More information and education to understand that child restraints provide better protection seatbelt for children. Avoiding fines and demerit points is associated with appropriate restraint practices. Perceived susceptibility and severity, including protecting children against injury or death in a crash did not appear to influence parents’ restraint practices.

Acknowledgements: Funding bodies: RACQ ARC Questions? Mark your Diaries! International Council on Alcohol, Drugs and Traffic Safety Conference (ICADTS T2013) August 2013, Brisbane Convention and Exhibition Centre