Facilitators and barriers to child restraint use in motor vehicles: a qualitative evidence synthesis

BackgroundRoad 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.MethodsWe 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.ResultsWe 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.ConclusionThe 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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Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis

Reproductive Health ◽

10.1186/1742-4755-11-71 ◽

2014 ◽

Vol 11 (1) ◽

Cited By ~ 281

Author(s):

Meghan A Bohren ◽

Erin C Hunter ◽

Heather M Munthe-Kaas ◽

João Paulo Souza ◽

Joshua P Vogel ◽

...

Keyword(s):

Evidence Synthesis ◽

Qualitative Evidence Synthesis ◽

Middle Income ◽

Middle Income Countries ◽

Qualitative Evidence ◽

Facilitators And Barriers ◽

Low And Middle Income

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Child restraint use in motor vehicles in Shanghai, China: a multiround cross-sectional observational study

BMJ Open ◽

10.1136/bmjopen-2021-050896 ◽

2021 ◽

Vol 11 (11) ◽

pp. e050896

Author(s):

Ting Chen ◽

Abdul M Bachani ◽

Qingfeng Li

Keyword(s):

Risk Factors ◽

Observational Study ◽

Motor Vehicles ◽

Child Safety ◽

Shopping Malls ◽

Children's Hospitals ◽

Cross Sectional ◽

Restraint Use ◽

Children’S Hospitals ◽

Child Restraint

ObjectivesWhile appropriate child restraint use in motor vehicles can reduce the risk of injuries or deaths, few previous studies have assessed child restraint practice in China. We aim to describe the prevalence of child restraint use and investigate risk factors affecting child restraint practice in Shanghai, China.Design and settingA cross-sectional observational study was conducted near children’s hospitals, kindergartens, entertainment places and shopping malls in Shanghai, China.ParticipantsEight rounds of data were collected between October 2015 and April 2019 with a total sample size of 12 061 children.Primary outcome measuresAt each site, trained field workers observed and recorded child restraint use in all passing motor vehicles with at least one child passenger.ResultsThe overall child safety restraint use rate was 6.42%. Child restraint use rate rose over time, from 5.12% in round 1% to 8.55% in round 8 (p<0.001). Results from the adjusted logistic regression model showed that children occupants with the following risk factors had a higher likelihood of child restraint use: children younger than 5 years compared with those aged 5–12 years (OR 2.12; 95% CI 1.78 to 2.53; p<0.001), sitting in rear seat compared with those in front seat (OR 31.80; 95% CI 4.45 to 227.14; p=0.001), children occupants observed near entertainment places (OR 2.34; 95% CI 1.67 to 3.28; p<0.001) or near shopping malls (OR 1.86; 95% CI 1.36 to 2.55; p<0.001) compared with those near children’s hospitals and transportation in the morning compared with afternoon (OR 1.30; 95% CI 1.04 to 1.62; p=0.021).ConclusionsThe overall child safety restraint use rate was low in Shanghai. Our findings may shed light on monitoring child restraint practice and have implications for intervention programmes for children occupants with the identified risk factors, which may help to promote child restraint use in motor vehicles and prevent road traffic injuries or deaths.

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Affordability and Availability of Child Restraints in an Under-Served Population in South Africa

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17061979 ◽

2020 ◽

Vol 17 (6) ◽

pp. 1979 ◽

Cited By ~ 1

Author(s):

Prasanthi Puvanachandra ◽

Aliasgher Janmohammed ◽

Pumla Mtambeka ◽

Megan Prinsloo ◽

Sebastian Van As ◽

...

Keyword(s):

South Africa ◽

Road Traffic ◽

Public Health Problem ◽

Global Public Health ◽

Injury Death ◽

Middle Income ◽

Suitable Alternative ◽

Middle Income Countries ◽

Restraint Use ◽

Child Restraint

Background: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5′s and 24.5 per 100,000 for 5–14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. Little is known about barriers to child restraint use especially in low- and middle-income countries. Methods: We carried out observation studies and parent/carer surveys in 7 suburbs of Cape Town over a three month period to assess usage rates and explore the knowledge and perceptions of parents towards child restraint legislation, ownership and cost; Results: Only 7.8% of child passengers were observed to be properly restrained in a CRS with driver seatbelt use and single child occupancy being associated with higher child restraint use. 92% of survey respondents claimed to have knowledge of current child restraint legislation, however, only 32% of those parents/carers were able to correctly identify the age requirements and penalty. Reasons given for not owning a child seat included high cost and the belief that seatbelts were a suitable alternative. Conclusions: These findings indicate the need for a tighter legislation with an increased fine paired with enhanced enforcement of both adult seatbelt and child restraint use. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS.

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Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd011558.pub2 ◽

2017 ◽

Cited By ~ 30

Author(s):

Susan Munabi-Babigumira ◽

Claire Glenton ◽

Simon Lewin ◽

Atle Fretheim ◽

Harriet Nabudere

Keyword(s):

Postnatal Care ◽

Evidence Synthesis ◽

Qualitative Evidence Synthesis ◽

Skilled Birth Attendants ◽

Middle Income ◽

Middle Income Countries ◽

Birth Attendants ◽

Qualitative Evidence ◽

Low And Middle Income

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Patient and carer involvement in palliative care research: An integrative qualitative evidence synthesis review

Palliative Medicine ◽

10.1177/0269216319858247 ◽

2019 ◽

Vol 33 (8) ◽

pp. 969-984 ◽

Cited By ~ 6

Author(s):

Eleni Chambers ◽

Clare Gardiner ◽

Jill Thompson ◽

Jane Seymour

Keyword(s):

Palliative Care ◽

Evidence Synthesis ◽

Evidence Base ◽

Qualitative Evidence Synthesis ◽

Training Support ◽

Care Research ◽

Qualitative Evidence ◽

Health And Social Care ◽

Facilitators And Barriers ◽

The Impact

Background: Patient/carer involvement in palliative care research has been reported as complex, difficult and less advanced compared to other areas of health and social care research. There is seemingly limited evidence on impact and effectiveness. Aim: To examine the evidence regarding patient/carer involvement in palliative care research and identify the facilitators, barriers, impacts and gaps in the evidence base. Design: Qualitative evidence synthesis using an integrative review approach and thematic analysis. Data sources: Electronic databases were searched up to March 2018. Additional methods included searching websites and ongoing/unpublished studies, author searching and contacting experts. Eligibility criteria were based on the SPICE (Setting, Perspective, Intervention, Comparison, Evaluation) framework. Two quality assessments on methodology and involvement were undertaken. Results: A total of 93 records were included. Eight main themes were identified, mainly concerning facilitators and barriers to effective patient and carer involvement in palliative care research: definitions/roles, values/principles, organisations/culture, training/support, networking/groups, perspectives/diversity, relationships/communication and emotions/impact. Evidence on the impact of involvement was limited, but when carried out effectively, involvement brought positive benefits for all concerned, improving the relevance and quality of research. Evidence gaps were found in non-cancer populations and collaborative/user-led involvement. Conclusion: Evidence identified suggests that involvement in palliative care research is challenging, but not dissimilar to that elsewhere. The facilitators and barriers identified relate mainly to the conduct of researchers at an individual level; in particular, there exists a reluctance among professionals to undertake involvement, and myths still perpetuate that patients/carers do not want to be involved. A developed infrastructure, more involvement-friendly organisational cultures and a strengthening of the evidence base would also be beneficial.

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It’s crunch time: Exploring the sensibility of food textural acoustics for individuals with dysphagia

South African Journal of Communication Disorders ◽

10.4102/sajcd.v68i1.806 ◽

2021 ◽

Vol 68 (1) ◽

Author(s):

Tasneem F. Karani ◽

Mershen Pillay

Keyword(s):

Scoping Review ◽

Evidence Synthesis ◽

Acoustic Properties ◽

Qualitative Evidence Synthesis ◽

Group Discussions ◽

Middle Income ◽

Review Analysis ◽

Fields Of Study ◽

Qualitative Evidence ◽

Complex Process

Background: Various fields of study have alluded to food textural, and its associated acoustic, properties (i.e. food textural acoustics). However, because of the challenging nature of the inclusion of acoustic properties in diet textural modifications in dysphagia (swallowing disorders), this construct has not been sufficiently considered in the field.Objective: To investigate the sensibility of food textural acoustics as a construct to understand eating for individuals with dysphagia.Method: The study design was based on qualitative evidence synthesis methodologies. This involved revised scoping review methods (peer-reviewed published articles from 1980 to 2020 over seven databases), with an adapted consultation phase through online focus group discussions with six world experts. The data was analysed using frequency and thematic analysis, and ideology critique.Results: A total of 11 articles were included in the revised scoping review analysis (seven research studies and four review articles). The analysis of these articles revealed a lack of diversity in geography, discipline and perspective exploring the construct of food textural acoustics. A total of three themes with three associated core arguments emerged from the revised scoping review and the consultation phase. These arguments highlighted (1) the need to study food textural acoustics because of its salience and pleasure responses, (2) possible methodological dilemmas in studying food textural acoustics due to the complexity of eating, and (3) considerations with regard to the approach and positioning adopted when studying the construct.Conclusion: Food textural acoustics may be a sensible construct to understand eating for individuals with dysphagia. As eating is a complex process, there is a need to challenge the methods we use when studying this construct of food textural acoustics. We hope that this article inspires researchers and practitioners to think differently by using textural, and its associated acoustic, properties as a way to reimagine dysphagia practice, especially for those from low- to middle-income contexts such as South Africa and Brazil.

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Public engagement and crowdfunding for health research: A global qualitative evidence synthesis and TDR pilot

10.1101/2021.11.08.21266070 ◽

2021 ◽

Author(s):

Eneyi E Kpokiri ◽

Clarisse Sri-Pathmanathan ◽

Priyanka Shrestha ◽

Sana Navaid ◽

Teerawat Wiwatpanit ◽

...

Keyword(s):

Public Engagement ◽

Health Research ◽

Mixed Methods Research ◽

Evidence Synthesis ◽

Mitigation Strategies ◽

Qualitative Evidence Synthesis ◽

Middle Income ◽

Pilot Programme ◽

The Public ◽

Qualitative Evidence

Background: Many exceptional researchers, especially in low-and middle-income countries (LMICs) face structural disadvantages in applying for research grants. Public engagement and crowdfunding make it possible for researchers to directly seek support from the public, by engaging large groups of people who make small contributions to support a project. This manuscript synthesizes global qualitative evidence and describes a WHO-TDR public engagement and crowdfunding pilot programme. Methods: We searched six databases for primary qualitative and mixed-methods research. We used a thematic synthesis approach and assessed our findings using the GRADE-CERQual approach. A crowdfunding approach to finance research studies was tested through a pilot programme, with a focus on infectious diseases of poverty. TDR Global mentors provided support for five finalists to engage the public and develop crowdfunding campaigns. Results: Nine studies were included in the qualitative evidence synthesis. Themes were developed into seven key findings, including the need for extensive public engagement, the potential for crowdfunding to open a communication channel between researchers and the public, key correlates of crowdfunding success and the risks of crowdfunding health research with associated mitigation strategies. The TDR pilot programme received 121 entries from 37 countries. Five LMIC-based researchers received training and joined a working group. Three researchers launched their crowdfunding campaigns, met their goals and received substantial monetary and non-monetary contributions. Conclusion: Public engagement provides a foundation for effective crowdfunding for health research. Our evidence synthesis and pilot data provide practical strategies for LMIC researchers to engage the public and conduct crowdfunding campaigns.

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Restraint Use by Children Involved in Crashes in Hawaii, 1986–1991

Transportation Research Record Journal of the Transportation Research Board ◽

10.1177/0361198196156000102 ◽

1996 ◽

Vol 1560 (1) ◽

pp. 8-12 ◽

Cited By ~ 3

Author(s):

Joan L. James ◽

Karl E. Kim

Keyword(s):

Logistic Regression ◽

Urban Areas ◽

Logistic Regression Model ◽

Child Safety ◽

Fatal Injury ◽

Restraint Use ◽

Child Restraint ◽

Logistic Regressions ◽

Crash Types ◽

Safety Seat

The use of child safety seats for crash-involved children in Hawaii from 1986 through 1991 is described. Child safety seat use increased over this period, whereas unrestrained children and belt use for children decreased. Male drivers are more likely to have unrestrained infants; female drivers are more likely to have unrestrained toddlers. Toddlers are more likely to be unrestrained in automobiles and trucks, and infants are more likely to be unrestrained in vans, on the freeway, during nighttime hours, and in urban areas. Child-restraint use for infants is twice the rate for toddlers, and infants are less likely to suffer nonincapacitating, incapacitating, and fatal injuries. A logistic regression model shows that children riding in automobiles are less likely to be restrained; belted drivers are far more likely to restrain children; and one- and two-year-olds are less likely to be restrained. Separate logistic regressions for crash types reveals that restrained children are less likely to suffer a non-incapacitating, incapacitating, or fatal injury in head-on and rear-end crashes and more likely to sustain injuries in broadside crashes.

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