title: Program fidelity measures associated with an effective child restraint program: Buckle-Up Safely.
abstract: OBJECTIVE
  We sought to identify the program fidelity factors associated with successful implementation of the Buckle-Up Safely program, targeting correct use of age-appropriate child car restraints.
  
  
  METHODS
  In 2010, we conducted a cluster randomized controlled trial of 830 families with children attending preschools and long day care centers in South West Sydney, New South Wales, Australia. Families received the Buckle-Up Safely program in the intervention arm of the study (13 services). Independent observers assessed the type of restraint and whether it was used correctly.
  
  
  RESULTS
  This detailed process evaluation showed that the multifaceted program was implemented with high fidelity. Program protocols were adhered to and messaging was consistently delivered. Results from multilevel and logistic regression analyses show that age-appropriate restraint use was associated with attendance at a parent information session hosted at the center (adjusted odd ratio [AOR]=3.66; 95% confidence interval [CI]=1.61, 8.29) and adversely affected by the child being aged 2 to 3 years (AOR=0.14; 95% CI=0.07, 0.30) or being from a family with more than 2 children (AOR=0.34; 95% CI=0.17, 0.67).
  
  
  CONCLUSIONS
  Findings highlight the importance of parents receiving hands-on education regarding the proper use of age-appropriate child restraints.
authors.affiliation: Kate Hunter, Lisa Keay, and Rebecca Q. Ivers are with the Injury Division, The George Institute for Global Health, The University of Sydney, Sydney, Australia. Judy M. Simpson is with the Sydney Medical School, The University of Sydney, Sydney. Julie Brown and Lynne E. Bilston are with Neuroscience Research Australia, The University of New South Wales, Sydney, Australia. Louise Cosgrove and Maureen Fegan are with Kids and Traffic Road Safety Education Program, Macquarie University, Sydney, Australia. Mark Stevenson is with the Accident Research Center, Monash Injury Research Institute, Monash University, Melbourne, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Hunter
authors.forename: Lisa
authors.initials: L
authors.lastname: Keay
authors.forename: Judy M
authors.initials: JM
authors.lastname: Simpson
authors.forename: Julie
authors.initials: J
authors.lastname: Brown
authors.forename: Lynne E
authors.initials: LE
authors.lastname: Bilston
authors.forename: Maureen
authors.initials: M
authors.lastname: Fegan
authors.forename: Louise
authors.initials: L
authors.lastname: Cosgrove
authors.forename: Mark
authors.initials: M
authors.lastname: Stevenson
authors.forename: Rebecca Q
authors.initials: RQ
authors.lastname: Ivers
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control / Q000706:statistics & numerical data; D000367:Age Factors; D002656:Child Day Care Centers; D057207:Child Restraint Systems / Q000592:standards* / Q000706:statistics & numerical data; D002675:Child, Preschool; D006284:Health Plan Implementation; D006801:Humans; D016015:Logistic Models; D009517:New South Wales; D010290:Parents / Q000193:education*; D015397:Program Evaluation; D012449:Safety / Q000592:standards*; D012578:Schools, Nursery; D014947:Wounds and Injuries / Q000209:etiology / Q000517:prevention & control