Parental attitudes and behaviours concerning helmet use in childhood activities: Rural focus group interviews
Introduction
The prospect of head and brain injury varies depending on the nature of the sporting activity, age of the participant, equipment being worn, and the intensity of play. Children, in particular, are at an increased risk of suffering head injuries due to physiological factors such as large head size compared to body mass (McKee and Brady, 2004), strength, motor skill deficits, and cognitive immaturity (Levine et al., 2001). Further, children often lack the experience (Hagel et al., 2004) and judgment (Finn and MacDonlad, 2010) that adults may possess. The elevated risk of head injury in children is particularly disconcerting, as the younger developing brain is susceptible to lasting damage (Ponsford et al., 1999, Zimmerman and Bilaniuk, 1994).
Notwithstanding the body of evidence pertaining to the efficacy of helmets in preventing serious head injury, usage is still not universal. Low compliance with helmet recommendations for children has been reported for bicycles (Ehrlich et al., 2001, Finnoff et al., 2001), ATVs (Warda et al., 1998), toboggans (Juang et al., 2010, Noffsinger et al., 2008, Ortega et al., 2005), snowmobiles (DeCou et al., 2003, Nayci et al., 2006), in skiing and snowboarding (Cusimano and Kwok, 2010) horseback riding (Holland et al., 2001), and wheeled activities (Brudvik, 2006, Forjuoh et al., 2002, Konkin et al., 2006). The research is unequivocal that increasing helmet use among children is an important objective in a number of different activities.
Whether a child wears a helmet or not is largely influenced by the precedent that is set by the parents. For example, Miller et al. (1996) found that children whose parents enforced strict rules regarding bicycle helmet use reported wearing a helmet most or all of the time compared with children who either had a partial rule or no rule at all. Further, adults influence children's behavior not only through setting rules, but also through providing parental encouragement and role modeling of helmet use (Khambalia et al., 2005). Apart from bicycle helmets, however, little is understood about how parents’ rules, attitudes, and behavior impact their children's helmet use.
Despite good intentions, there are often barriers that impede parents from enacting and enforcing helmet rules. Reported barriers to helmet use include inhibitive costs, discomfort, lack of belief in the necessity, and an unpopular image of helmets among children and adolescents (Finch, 1996; Finnoff et al., 2001). Miller et al. (1996) reported that the most common reasons parents gave for lack of bicycle helmet ownership by children ages 5–14 were “never thought about purchasing” a helmet (35%), “never got around to purchasing” a helmet (29%), “child wouldn’t wear it anyway” (26%), and the helmet was “too expensive” (16%).
Previous research on helmet usage has been predominantly focused in urban settings. There has been very little investigation of rural helmet behaviors, although urban and rural communities have different demographic characteristics and different injury patterns (Ehrlich et al., 2001). One of the first studies to make this comparison was conducted in the province of Manitoba and compared patterns of bicycle helmet usage between urban and rural children (Harlos et al., 1999). The findings suggested that helmet usage contrasted in that rural children were less likely to wear a helmet than urban children. The authors concluded that further research into rural helmet wearing practices and attitudes is warranted and that it would be helpful to examine attitudes toward helmet use as well as the barriers and access to helmet use through focus group discussions.
Following the recommendation of Harlos et al. (1999) the current study expands on past research by qualitatively exploring parental attitudes, behaviors and rule enforcement of rural parents. However, the present study was not limited bicycle helmet use alone. Rather, the qualitative nature of the inquiry allowed parents to compare their perceptions of helmet use across a number of childhood activities in which their children participate.
Section snippets
Procedure
The study was inductive and exploratory in nature without specific hypotheses to be tested. Focus groups were selected as the data collection method to gain insight into participants’ attitudes and behaviors regarding helmet use. Eight focus groups were conducted during the summer of 2012 in seven different rural communities (population <5000), in the province of Saskatchewan, Canada, including two First Nations communities. It was important to ensure representation from First Nations
Helmet rules
When asked about helmet rules, participants in every focus group noted that they required their child to wear a helmet when bicycling. Beyond bicycling, there were seven other activities that were mentioned in at least half of the groups. The frequency with which different activities were mentioned across the focus groups is presented in Table 1. It is important to keep in mind that the responses to this question about helmet rules represent what was spontaneously generated, not a comprehensive
Discussion
According to research examining bicycle helmet use, rules established by a parent are a strong contributing factor in a child's decision to wear a helmet (Berg and Westerling, 2001, Khambalia et al., 2005, Keezer et al., 2007, Miller et al., 1996). The parents in the focus groups were aware that helmets can prevent brain injury and that their modeling and encouragement to wear a helmet ultimately have an influence on their children's behavior. In fact, setting the precedent for helmet use among
Acknowledgement
We express thanks to the staff of the Saskatchewan Prevention Institute for assisting with data preparation, providing helpful feedback, and helping with the manuscript preparation.
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