Four Key themes identified
Sub-themes under four key themes, with supported quotes, were list in Table
2. The following were the four key themes identified based on parents’ experiences and practices regarding to CSS. Under each theme, the data on the differences between CSS users and non-users were presented and compared:
Table 2
Sub-themes from specific topics under four key themes
1) |
Having a child safety restraint installed in the rear seat with an adult sitting next to the restrained child is ideal, and child safety restraint is an alternative when adult accompaniment is not available.
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Both parents in CSS user group and non-use group indicated that infants are not suitable to sit in CSS; they need to be secured in the arm of an adult. When children are old enough to school age, CSS is no longer necessary. | I would like to have an adult, my mother or my wife, to hold my baby in arm and sit on the left side of the back seat. CSS is the second choice since it is not ready available for use. (father E in CSS non-use group) |
B. For non-user group, parents often explained that short distance and slow speed in the city would not cause serious injury even in a crash; CSS is not that important. | We don’t ask my child to wear the seat belt because most of the time we are driving in the downtown area. (mother D in CSS non-use group) |
2) |
Having effective parental strategies could help make a difference in child safety restraint use.
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A. Parents in CSS user groups would make every effort to seat their children in the CSS as long as possible. | I tried to convince him by saying that if he sits in the CSS, he could go anywhere or get a candy. (mother D in CSS group) |
B. Parents in CSS non-user groups would persuade their children sitting in the rear. What they worry most is their children would not like to sit in the CSS if they buy it. | I heard that children don’t like to sit in the CSS, even if they do, the time they can use CSS is not long. So it is impractical. It is a waste even if I buy it.(mother B in CSS non-use group) |
3) |
Inadequate promotion and parents’ poor safety awareness contribute to the low rate of child safety restraint in China.
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A. All of the parents reported that they have once seen the car crash video in which children were thrown out of the car. Most parents in CSS user groups indicated that using the safety restraint could possibly reduce the harm. Most parents in the other groups indicated that strictly obeying the traffic law is the way to prevent it. | No one knows it, how can we use it. I heard it and want to buy it, but I fail to persuade my husband because I don’t know much about it. (mother A in CSS non-use group) |
| B. Parents in the user group focused on the quality of CSS, as bad quality of CSS would harm the child if a crash occurred. | I would like to choose a better CSS for my baby because I know from TV that a bad quality CSS might not protect the child in a crash when compared to a good one.(mother A in CSS group) |
4) |
Mandatory legislation on child safety restraint use could be an effective approach.
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Only severe punishment could constrain people from dangerous behavior, whether they have high safety consciousness or not. | People may not act unless severe punishment is in place. A fine is needed in the current Chinese society.(mother E in CSS group) |
| Law enforcement could be better carried out if in combination with public education on child safety traveling. | This is not solely the responsibility for the traffic department; educational institutions should also be involved. (father E in non-use group) |
1. Having a child safety restraint installed in the rear seat with an adult sitting next to the restrained child is ideal, and child safety restraint is seen as an alternative when adult accompaniment is not available
Parents in CSS user group described their experiences using CSS. They all agreed that the ideal practice for a child passenger in a car is to have CSS installed in the rear seat, and have an adult sitting next to the restrained child. Non-CSS users though that a child should sit in the back seat with an adult, and did not routinely identify restraint as important.
The backseat behind the driver is the safest because the driver would respond immediately to any unsafe event to protect himself or herself. CSS is designed to protect children from crash-related injury, as a safety seat belt for adults. Ideally, having an adult sitting next to the restrained child can help ensure the safety seat remains fastened and child is comfortable with CSS, because of driving the car, I can’t see that.
— mother A in CSS group
Most parents in the CSS non-user group thought the safest situation was to have a child sit in the backseat accompanied by an adult. Only two respondents mentioned a CSS as necessary.
I would like to have an adult, my mother or my wife, to hold my baby in arm and sit on the left side of the back seat. CSS is the second choice since it is not ready available for use.
— father E in CSS non-use group
Almost all participating parents, either CSS users or non-users, agreed that the front seat was unsafe; not only the child sitting there would distract the driver, but also thought that injury cause by sitting in the front seat would be much more serious than those sitting in back seat if a crash were to occur.
The parents in the CSS user group also had good knowledge regarding the risk of traffic injuries if a child was not properly restrained in the car. When asking parents about reasons why they used or did not use a CSS, the main reason stated by parents in the CSS was that CSS could help secure the child in a car and protect him/her from crash-related injury as well as prevent the child from moving in the car when they drove with the child unaccompanied.
The traffic condition is worrying in the city, I can have my own speed controlled but I can’t control other drivers. Many people don’t drive defensively. It is dangerous. This is why I have to buy a CSS to protect my child.
— mother C in CSS group
Most parents in the non-user group believed that having another adult sitting in the car next to the child was safer than having a child restrained in CSS, and it was unnecessary to have CSS if the adult was present. The biggest concern of these parents was that their child would reject sitting in a CSS. One young mother said she clearly knew that having the child in a CSS is a safe practice, but she had to concede because her child refused to be seated in the CSS, and her mother insisted that holding the baby is the safest way. Though she had a CSS, she had never used it. Another mother in the non-user group shared the similar view and thought CSS was not practical.
I heard that children don’t like to sit in the CSS, even if they do, the time they can use CSS is not long. So it is impractical. It is a waste even if I buy it.
— mother B in CSS non-use group
2. Having effective parental strategies could help make a difference in child safety restraint use
Parents of CSS users or non-users reported the barriers of having their children sitting in the CSS, including if a child preferred to sit in the front seat, where he or she can enjoy the better view as the car is moving, and if a child disliked to be restrained in the fixed seat with a belt fastened, which limited their activity. Parents in non-user group easily compromised to the children’s preferences. Parents in the CSS non-use group did place their children sit in the rear of the car. Two mothers in this group required their child to wear a seat belt in the backseat. The rest indicated that they did not bother to have any restraint as long as the child was sitting in the back.
We don’t ask my child to wear the seat belt because most of the time we are driving in the downtown area. My boy sometimes wears it just for fun and then unfastens it in a minute because he feels uncomfortable with that. He isn’t used to it.
— mother D in CSS non-use group
Only one mother in the CSS non-use group would strictly require her child to continue wearing the seatbelt while the car was operating.
I would look in the rearview mirror time to time when driving. If I found my girl unfastened the seat belt, I would remind her or sometimes stop the car on the roadside until she wore it again. It is troublesome.
— mother C in CSS non-use group
Difference was found in parents’ attitudes and practices between the CSS user group and CSS non-user group. Parents in the CSS user group made an effort to train their children to sit in the CSS until a habit was formed. One parent found that using a cartoon card was a very effective way to persuade her daughter to sit in the CSS.
We have cartoon card on a safe travelling education story; my girl loves the story. Once she was unwilling to sit on the CSS, I would remind her by saying “Mika (a character in the story) sits in the CSS, Mika wears the seat belt. What should you do?” She knows the story and would like to behave as Mika does.
— mother C in CSS group
Another parent suggested that linking the CSS to things the child likes could help with developing safe habits.
At the beginning, he didn’t like CSS at all. I tried to convince him by saying that if he sits in the CSS, he could go anywhere or get a candy. He was happy with CSS because there was always incentive associated with his CSS use. As time went by, he was fine with CSS even without any incentive.
— mother D in CSS group
But even in the CSS user group, sometimes, parents compromised to their child’s preference. Two mothers in this group said that they ultimately agreed to let their children not sit in the CSS in part because none of their friends or colleagues used CSS. Their children actually experienced ridicule by their peers, with peers saying things like “only a little baby needs to sit in such a seat” or “you are never growing-up.” Another mother in this group said that “My girl was upset with being sit in CSS and kept asking why she has to sit in it while other girls in her age did not. So I began to tell myself that, ok, she is already five, she can sit well in the backseat now.”
3. Inadequate promotion and parents’ poor safety awareness contribute to the low rate of child safety restraint in China
None of the CSS user group used the basket-style infant car seat when their children were infants. All of the parents in CSS user group stated that their children started to sit in the CSS at around 1 year of age, with the earliest user at 9 months. All of the CSSs used were made in China, with price of 1000 Yuan or less (equivalent to $166). They had not encountered any quality problems while using these CSSs. Most parents knew about the existence of CSS before their babies were born and tired to buy CSS when they thought it was a right time for their baby.
Lack of publicity of CSS and poor safety awareness on child restraint were listed as the most important reasons for low rate of CSS use in emerging motorization China. For example, CSSs were not seen in any car dealerships. Another reason indicated by parents for the low rate of CSS use was related to general problems with installation and removal. Parents indicated that installing a CSS in a car would take away a seat that could have been available for an adult passenger to use.
No one knows it, how can we use it. I heard it and want to buy it, but I fail to persuade my husband because I don’t know much about it. He said, “Why bother to buy a seat when there are many seats in car?” So I think if it can be sold in the car dealer shop, the salesperson would introduce CSS to their customers.
— mother A in CSS non-use group
When asking about the cost of CSS, most parents expressed they could afford it if it was necessary. Most preferred a rental scheme as CSS may not be used for a long time. When inquiring about their thoughts regarding the effective promotion method(s) to increase the frequency of CSS use, almost all of the parents in the CSS user group suggested that media should publicize CSS, accompanied with stories detailing the huge difference CSS could make during a crash when a child is secured by CSS.
Parents have wrongly believed that holding the children in arm is protective, they have no idea what injury can happen to their baby when in a sudden crash. They should look at the video on vehicle collision, it’s horrible.
I think young parents would like to buy it for their child, but treat it just like a piece of clothes or toy, use it for a while and place it away when their baby doesn’t like it. They themselves don’t know how important the CSS is to their children and they do not have enough patience to teach their kids. It is the parent giving up first. Price is not the obstacle for using.
— mothers in CSS group
4. Mandatory legislation on child safety restraint use could be an effective approach
All the parents affirmed their agreement and approval with mandatory legislation on child safety restraint use in the future in China. They thought the most effective way to implement this policy would be to incorporate a fine or deduct points in the current driver’s license point system for non-use. Most parents reported that they knew the Chinese law forbids children to sit in the front seat, but were not sure at what age. They also knew that in other countries, especially western countries, CSS use is mandatory.
How the law can be effectively enforced depends on the executive department. People may not act unless severe punishment is in place, just like current strict punishment on drunk driving or traffic light violations. A fine is needed in the current Chinese society.
— mother E in CSS group
I can accept that, it is a trend, but we need a long-term process. To better implement the regulation, punishment should be effected to fine violators. However, this is not solely the responsibility for the traffic department; educational institutions should also be involved.
— father E in non-use group