Table 2 Sub-themes from specific topics under four key themes

1)

Having a child safety restraint installed in the rear seat with an adult sitting next to the restrained child is ideal, and child safety restraint is an alternative when adult accompaniment is not available.

Both parents in CSS user group and non-use group indicated that infants are not suitable to sit in CSS; they need to be secured in the arm of an adult. When children are old enough to school age, CSS is no longer necessary.

I would like to have an adult, my mother or my wife, to hold my baby in arm and sit on the left side of the back seat. CSS is the second choice since it is not ready available for use. (father E in CSS non-use group)

B. For non-user group, parents often explained that short distance and slow speed in the city would not cause serious injury even in a crash; CSS is not that important.

We don’t ask my child to wear the seat belt because most of the time we are driving in the downtown area. (mother D in CSS non-use group)

2)

Having effective parental strategies could help make a difference in child safety restraint use.

A. Parents in CSS user groups would make every effort to seat their children in the CSS as long as possible.

I tried to convince him by saying that if he sits in the CSS, he could go anywhere or get a candy. (mother D in CSS group)

B. Parents in CSS non-user groups would persuade their children sitting in the rear. What they worry most is their children would not like to sit in the CSS if they buy it.

I heard that children don’t like to sit in the CSS, even if they do, the time they can use CSS is not long. So it is impractical. It is a waste even if I buy it.(mother B in CSS non-use group)

3)

Inadequate promotion and parents’ poor safety awareness contribute to the low rate of child safety restraint in China.

A. All of the parents reported that they have once seen the car crash video in which children were thrown out of the car. Most parents in CSS user groups indicated that using the safety restraint could possibly reduce the harm. Most parents in the other groups indicated that strictly obeying the traffic law is the way to prevent it.

No one knows it, how can we use it. I heard it and want to buy it, but I fail to persuade my husband because I don’t know much about it. (mother A in CSS non-use group)

B. Parents in the user group focused on the quality of CSS, as bad quality of CSS would harm the child if a crash occurred.

I would like to choose a better CSS for my baby because I know from TV that a bad quality CSS might not protect the child in a crash when compared to a good one.(mother A in CSS group)

4)

Mandatory legislation on child safety restraint use could be an effective approach.

Only severe punishment could constrain people from dangerous behavior, whether they have high safety consciousness or not.

People may not act unless severe punishment is in place. A fine is needed in the current Chinese society.(mother E in CSS group)

Law enforcement could be better carried out if in combination with public education on child safety traveling.

This is not solely the responsibility for the traffic department; educational institutions should also be involved. (father E in non-use group)