Table 1 Issues surrounding use of child car seats grouped into barriers and facilitating factors for the stages of behaviour change

Awareness

Lack of awareness of the law and confusion about the age and seat types required

‘No ideas, haven’t heard’ and confusion about the age and seat types required.

‘Most people don’t know, like my sister thinks only if they are little -like toddlers - once they hit school she thinks it is the right thing.’

Having an understanding of exactly what happens in a crash Having visible pictures/posters to inform

Engaged

Adults do not think about safety on day to day journeys ‘Some just don’t even care - not worried. Just get in the car’

Conceding for short trips ‘What do I do, I am only going down the road…’

‘if you drove around all day thinking about crash, you won’t get in the car’

Involving children in safety: doing workshops with children to educate children about why car seats are important. Kids can see better—sitting up high ‘I say it is his ‘special seat’

Involving peers in safety benefits: buy a seat for use with children, you drive in cars that are not your own and loan to peers when required. set example to peers and sharing a story of someone who has had a child injured in a crash (visual)

Getting the right restraint

Confusion: large children concern that large children do not fit in the seat they need by law. ‘Eyes over or head over. What do I do?’

Confusion over age, weight and height guidelines for selecting the right seat

Individual advice ‘they need to show people if your kids are bigger, then you should get a different car seat, should be a bit wider. Just get a different seat

Good product range and advice ‘The booster ones - some can be really big, with the seatbelt. They are not all small’

Height markings so you know when they have grown out of the seat

Lack of resources/cost: do not own car seats, cost was a major barrier, especially with more children and currently having no seats, cost of restraint fitters also acknowledged. ‘paying a ridiculous amount for just a foam chair’

Supportive of hire scheme or subsidised purchase

Large families: problems fitting seats across back seat and doing seat belt up with tight fitting seats

New baby need the car seat, so we need to move the toddler on to a booster seat before he technically should. ‘I want him in a seat before the next baby comes’

Appeal of seats that will last across greater age range

Simple tick system favoured as a way to get better seat. ‘As long as you have the tick, cheapest one with that tick on it. Means I am safe and abiding by the rules.’

Using correctly

Multiple vehicles: taxis not having seats, and having to have car seats to put in other people’s cars, difficult to move between cars. ‘Taking in and out, in and out. It’s such a headache’

Ease of use: group felt that once familiar, seats are easy enough to get in and out of a car

Children resistant to using child restraints: children do not like to sit in ‘baby’ car seats, seats not comfortable

Other carers not understanding need for child restraints

Unplanned passengers: while participants knew children needed to be in restraints, they were conflicted when asked to carry extra passengers ‘you might be going to pick somebody up and they might bring 2 kids out to the car and you only have one seat. What do I do?’

Being consistent with children—if you are not in the seat, we do not drive anywhere. Making sure other adults who may take the kids in their car have the same rules.

Being consistent with peers, child cannot travel without restraint, own seats for your vehicle and loan out. ‘I made her pull over and I just started walking, because she didn’t do it. ‘

Threat of police enforcement: ‘Not much you can do without getting in trouble’ ‘Can’t afford a fine’

Fitting challenges: cars without the right anchor points—vans, problems with two door cars

Restraint checks are useful: understood importance of restraint check, knew about fitting checks

Demonstration favoured getting a practical demonstration and thought it should be at point of sale/supply. ‘Demonstration would be best, better than reading a book. You pay attention to someone actually standing there’