title: Examining the relative effectiveness of different message framing strategies for child passenger safety: recommendations for increased comprehension and compliance.
abstract: BACKGROUND
  Age-appropriate child restraints and rear seating dramatically reduce injury in vehicle crashes. Yet parents and caregivers struggle to comply with child passenger safety (CPS) recommendations, and frequently make mistakes when choosing and installing restraints. The purpose of this research was to evaluate various methods of framing CPS recommendations, and to examine the relative effectiveness on parents' knowledge, attitudes, and behavioral intentions related to best practices and proper use of child restraints. Emphasis framing is a persuasion technique that involves placing focus on specific aspects of the content in order to encourage or discourage certain interpretations of the content.
  
  
  METHODS
  A 5 (flyer group) X 2 (time) randomized experiment was conducted in which 300 parent participants answered a pre-survey, viewed one of four flyer versions or a no-education control version, and completed a post-survey. Surveys measured CPS knowledge, attitudes, perceptions of efficacy and risk, and behavioral intentions. The four flyers compared in this study all communicated the same CPS recommendations, but several versions were tested which each employed a different emphasis frame: (1) recommendations organized by the natural progression of seat types; (2) recommendations which focused on avoiding premature graduation; (3) recommendations which explained the risk-reduction rationale behind the information given; or (4) recommendations which were organized by age. In a fifth no-education (control) condition, participants viewed marketing materials.
  
  
  RESULTS
  Analyses of covariance and pairwise comparisons indicated the risk-reduction rationale flyer outperformed other flyers for many subscales, and significantly differed from no-education control for the most subscales, including restraint selection, back seat knowledge, rear-facing knowledge and attitudes, total efficacy, overall attitudes, and stated intentions.
  
  
  CONCLUSIONS
  This research provides insight for increasing caregiver understanding and compliance with CPS information. Recommendations for the field include communicating the rationale behind the information given, using behavior-based directives in headers, avoiding age-based headers, and incorporating back-seat positioning directives throughout.
authors.affiliation: Department of Pediatrics, Eastern Virginia Medical School, 855 West Brambleton Avenue, Norfolk, VA 23510, USA. Electronic address: willke@evms.edu.
authors.forename: Kelli England
authors.initials: KE
authors.lastname: Will
authors.affiliation: TransAnalytics, 336 West Broad Street, Quakertown, PA 18951, USA. Electronic address: ledecina@transanalytics.com.
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Decina
authors.affiliation: Department of Pediatrics, Eastern Virginia Medical School, 855 West Brambleton Avenue, Norfolk, VA 23510, USA. Electronic address: mapleel@evms.edu.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Maple
authors.affiliation: Department of Pediatrics, Eastern Virginia Medical School, 855 West Brambleton Avenue, Norfolk, VA 23510, USA; Children's Hospital of The King's Daughters, 601Children's Lane, Norfolk, VA 23507, USA. Electronic address: amy.perkins@chkd.org.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Perkins
mesh_terms: D000056:Accident Prevention / Q000379:methods*; D000063:Accidents, Traffic / Q000517:prevention & control*; D000328:Adult; D017028:Caregivers / Q000193:education*; D002648:Child; D002675:Child, Preschool; D003258:Consumer Behavior; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D007223:Infant; D015370:Infant Equipment / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000193:education*; D010414:Pennsylvania; D040242:Risk Reduction Behavior; D012622:Seat Belts / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Child passenger safety; Child restraint; Injury; Risk communication; Transportation safety