title: Identifying interventions that promote belt-positioning booster seat use for parents with low educational attainment.
abstract: BACKGROUND
  Many parents with low educational attainment prematurely graduate their children to seat belt restraint rather than use belt-positioning booster seats. This study aimed to identify interventions that promoted booster seat use among this population.
  
  
  METHODS
  This multi-site study used focus groups to elicit contributing factors to booster seat non-use, which informed subsequent intervention development. A first phase (10 focus groups, N = 117) identified parents' perceived barriers, benefits, and threats relating to belt-positioning booster seats. These findings were used to identify existing and create new interventions. A second phase (20 focus groups, n = 171) elicited parent's reactions to these interventions and provided parents with belt-positioning booster seats and education on their use. Follow-up interviews were conducted six weeks later.
  
  
  RESULTS
  Lack of education and fear of injury were the primary barriers to belt-positioning booster seat use. Parents were motivated by interventions that provided them with clear, concrete messaging relating to use. Parents favored the intervention that presented a real story detailing a child's severe injury that could have been prevented with appropriate restraint. At follow-up, parents credited this intervention with motivating booster seat use most often. Although parent's cited their child's lack of comfort and non-compliance as barriers to use, they were not as motivated by interventions that addressed these barriers.
  
  
  CONCLUSIONS
  Effective intervention programs can be created by identifying and addressing factors that contribute to a population's intention to use belt-positioning booster seats. In addition, successful programs must utilize messages that motivate the target population by addressing their perceived threats to booster seat non-use.
authors.affiliation: The Center for Injury Research and Prevention at The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. flaura@mail.med.upenn.edu
authors.forename: Flaura K
authors.initials: FK
authors.lastname: Winston
authors.forename: Danielle
authors.initials: D
authors.lastname: Erkoboni
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
mesh_terms: D000328:Adult; D001290:Attitude; D002648:Child; D002675:Child, Preschool; D004522:Educational Status; D005260:Female; D006266:Health Education; D006801:Humans; D015370:Infant Equipment; D008297:Male; D010290:Parents / Q000523:psychology*; D012622:Seat Belts; D014947:Wounds and Injuries / Q000517:prevention & control*