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.