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Abstract
Sub-optimal child restraint use, particularly the misuse of restraints, is a significant and widespread problem increasing the risk of injury and death to child passengers in motor vehicle crashes in developed countries. The aim of this thesis was to increase the understanding of misuse and the relationship between misuse and child restraint information, and to develop an intervention to increase correct use through existing product information. The thesis consists of six related studies.
A systematic review was conducted to identify effective interventions for misuse, finding a paucity of high quality randomised controlled trials to provide evidence for strategies to increase correct use. Focus groups with culturally and linguistically diverse child restraint users showed that users have low perceived capability relating to comprehending product information, and cite lack of specific information and feedback on misuse as important barriers to correct use. Users also show low self-efficacy and low perceptions of risk related to correctly using their restraints. A novel method of user-input and user-testing was used to design and optimise a new set of child restraint instructions, labels, and videos to reduce misuse. The novel method of user-input and testing ensures that materials are evidence-based and user-centred. The intervention was later enhanced using a framework for behaviour change.
A controlled pilot laboratory trial was conducted, showing that user-centred instructions were more effective than manufacturer instructions at increasing the correct installation and use of a child restraint system and increasing comprehension of information. There is some evidence to suggest that user-centred instructions can be optimised to further reduce specific errors in use through the guided application of behaviour change theory.
The results of the project as a whole indicate that errors in use of a child restraint system can be reduced by re-designing product information so that it aligns to user needs. Novel evidence-based and user-centred recommendations for designing child restraint product information to reduce misuse were also generated from this work. Proposals are made for updating both the current Australian Child Restraint Evaluation Program particularly concerning the ease of use criteria and the current mandatory design standard for product information in Australia (AS/NZS 1754:2013).