Improving bicycle helmet research: examining intervention studies and parental experiences

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Michelle L. Cathorall (Creator)
Institution
The University of North Carolina at Greensboro (UNCG )
Web Site: http://library.uncg.edu/
Advisor
Tracy Nichols

Abstract: Despite the recognized protection provided by bicycle helmets, estimates indicate that only 25% of people wear one every time they ride. Although much research has focused on identifying determinants of bicycle helmet use, there has been limited success for increasing and sustaining children's bicycle helmet use. One potential reason for this is a limited understanding of how identified determinants of helmet use work together to impact behavior. The goal of this dissertation was to improve research and practice around children's bicycle helmet use to further an aim of ultimately reducing the number of head injuries among children. To accomplish this goal this dissertation is divided into two separate but related products that address critical issues in the field. The first product is a focused literature review on interventions designed to increase children's helmet use and the other is a qualitative study of parental perceptions of and experiences with children's bicycle riding. The aim of the focused literature review was to gain a better understanding of the bicycle helmet use research by identifying gaps in bicycle helmet intervention methodology and to recommend opportunities to strengthen the field. Identifying gaps in intervention research allows for recommendations that can have a direct impact on future interventions. Inclusion criteria included: articles published in English between 1986-2011 that focus on children under 18 years old, report on an intervention or the evaluation of an intervention, and have increased helmet use as one of the main outcomes. Thirty-five studies were included in the review. Findings indicated opportunities for improvement in three broad areas: measurement issues, group differences, and analytic techniques. Recommendations for increasing the accuracy of measurements, examining group differences and differential intervention effects, and the use of sophisticated analytic techniques to account for the data structure and identifying influential contextual variables were provided. The goal of the qualitative study was to develop a model that described processes associated with children's bicycle helmet use across intrapersonal, interpersonal, community, institutional, and political contexts. The aim was to gain an understanding of how parents assess and manage risks associated with their children's bicycle riding. Using a constructivist grounded theory approach; interviews with parents of children in 3rd - 5th grades were conducted. Interviews covering children's bike riding history and current habits were recorded and transcribed verbatim. Using a constant comparative approach, data were analyzed concurrent with data collection. Initial coding identified critical issues in the data and focused coding was used to further identify specific patterns of behavior. Theoretical sampling was then used to fully develop the categories that emerged. Theoretical coding also described how categories related to one another. A model emerged from the data that explained the cognitive and behavioral processes parents utilized to balance their anxiety around perceived dangers of bike-riding with their understanding of their children's developmental needs for autonomy. Findings also showed parents' primary concerns focused around more improbable risks (such as child-snatching) rather than higher probability risks such as falling and head injuries. Implications are discussed in terms of expanding theoretical foundations of intervention design and addressing parental concerns prior to introducing helmet use information. With refinement, findings from this dissertation study may be used to develop interventions to increase sustainable bicycle helmet use and reduce bicycle-related head injuries in children.

Additional Information

Publication
Dissertation
Language: English
Date: 2013
Keywords
Bicycle helmets, Children, Grounded theory, Injury prevention, Interventions

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