Background In the newly revised regulation on road traffic of Shanghai in 2017, children under four years old should be equipped with and use child safety seats properly in cars. At present, the legislation has not defined the violators and the rules of punishment, so it is difficult for the new law to be executed. There are problems that the law targets younger children and is not based on objective indicators such as height and weight of children, which indicate some differences with developed countries.
Objective This study is conducted to investigate the use of car child safety seats in Huangpu District after the legislation revised in Shanghai and to explore the influence factors based on health belief model (HBM).
Methods A questionnaire survey was conducted among 1868 fathers or mothers of 3-6 years old children from 13 kindergartens in Huangpu District of Shanghai from October to December 2018, including demographic characteristics, usage of child safety seats, and health belief scale. The scale had 20 items and 6 dimensions, and was scored by 5-point Likert method. T/F tests were used to analyse the mean scores of health beliefs in different dimensions of characteristics, and multiple logistic regression was used to explore potential influence factors.
Results According to the questionnaires, 79.4% (1 483/1 868) of the respondents owned child safety seats, 75.3% (1 406/1 868) children used child safety seats, the proportion of high frequency child safety seats use was 60.6% (1 132/1868), and the legislative awareness rate was 38.0% (709/1 868). The average scores of perceived severity, action cue, perceived susceptibility, perceived benefit, perceived barrier, and self-efficacy were 9.6±1.4, 7.7±2.0, 8.9±1.5, 8.9±1.6, 9.2±2.2, and 8.2±2.0, respectively. The high frequency group showed higher scores of HBM dimensions except perceived barrier than the low frequency group and the no usage group (P=0.000). The parents of children with Shanghai household registration showed higher scores of perceived susceptibility and self-efficacy than the those with nonShanghai household registration (t=3.821, P=0.000; t=2.223, P=0.000). Fathers showed a higher score of perceived barrier than mothers (t=2.165, P=0.031). The respondents with higher educational level showed higher scores of perceived severity, susceptibility, benefit, selfefficacy, and action cue (P < 0.05). Those with household per capita monthly income ≤ 3 000 yuan showed a higher score of perceived barrier and lower scores of the other HBM dimensions, except action cue, than those with > 3 000 yuan (P < 0.05). The only child families showed a higher score of perceived barrier than the multiple children families (t=-2.289, P=0.022). Younger child, child household registration in Shanghai, high educational level of the respondents, good family economic conditions, only child families, parents, with high scores of perceived susceptibility, benefit, action cue, high self-efficacy, and awareness of legislation were the factors to promote the high frequency usage of child safety seats, while perceived barrier was the adverse factor.
Conclusion After the legislation revised, the usage rate of child safety seats in Huangpu District has been improved. The health belief could be used to carry out targeted health education for parents, and enhancing parents' health belief and self-efficacy, reducing perceived barrier, strengthening legislation publicity, and promoting the improvement of legislation are conductive to further promote the usage of child safety seats.
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