A Qualitative Approach to Understanding Factors that Influence Child safety Seat Use in Three Northwest American Indian Communities

Background: American Indian children experience the highest risk of fatal and non-fatal injuries in motor vehicle crashes since many ride unrestrained or improperly restrained in motor vehicles. Further investigation was needed to determine effective, culturally competent intervention approaches to increase child passenger restraint use in three Northwest tribes. Methods: Semi-structured elicitation interviews were conducted among parents, grandparents and child caregivers of children 0-8 year of age, as well as professionals from tribal programs who serve families. The interview included open-ended questions about child safety, personal restraint use, barriers and facilitators of restraint use, cultural traditions, and ideas for community interventions. Interviews were transcribed and coded in Atlas.ti using apriori and invivo codes, and inter-coder agreement was evaluated to refine and establish a coding guide. Axial and selective coding were conducted, generating a list of main themes to guide the intervention development process. Results: Forty-seven interviews were completed. Five main themes were identified including: 1) non-parent drivers, 2) local trips and driving on reservation/off reservation, 3) community responsibility for children,4) laws and law enforcement and 5) consistent use of restraints. In addition, suggested interventions were reviewed to help gauge acceptance of intervention methods in the tribes. Discussion: Qualitative data from these interviews guided the development of interventions to improve child safety seat use. Tribes determined appropriate intervention strategies including policy development, health education, awareness and behavior change. In addition, quotes and themes from these interviews were incorporated into tribe-specific health education and awareness campaigns.