(1) Background: Children in South Africa experience significant impacts from road injury due to the high frequency of road crashes and the low uptake of road safety measures (including the use of appropriate child restraints). The current study aimed to assess the feasibility of a child restraint program and to describe factors influencing child restraint use from the perspectives of clinicians, representatives of non-government agencies, and academics in Cape Town, South Africa. (2) Methods: Qualitative interviews were conducted with 13 experts from government, academic and clinical backgrounds. Findings were analyzed using the COM-B component of the Behaviour Change Wheel and were grouped by the layers of the social-ecological model (individual, relational, community and societal). (COM-B is a framework to explain behaviour change which has three key components; capability, opportunity and motivation), (3) Results: Experts believed that there was a need for a child restraint program that should be staged and multifactorial. Participants described knowledge gaps, perceptions of risk, mixed motivations and limited enforcement of child restraint legislation as key influences of restraint use. (4) Conclusions: The results demonstrate potential areas on which to focus interventions to increase child restraint use in Cape Town, South Africa. However, this will require a coordinated and consistent response across stakeholder groups.

Background: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5′s and 24.5 per 100,000 for 5–14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. Little is known about barriers to child restraint use especially in low- and middle-income countries. Methods: We carried out observation studies and parent/carer surveys in 7 suburbs of Cape Town over a three month period to assess usage rates and explore the knowledge and perceptions of parents towards child restraint legislation, ownership and cost; Results: Only 7.8% of child passengers were observed to be properly restrained in a CRS with driver seatbelt use and single child occupancy being associated with higher child restraint use. 92% of survey respondents claimed to have knowledge of current child restraint legislation, however, only 32% of those parents/carers were able to correctly identify the age requirements and penalty. Reasons given for not owning a child seat included high cost and the belief that seatbelts were a suitable alternative. Conclusions: These findings indicate the need for a tighter legislation with an increased fine paired with enhanced enforcement of both adult seatbelt and child restraint use. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS.

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BackgroundChildren pay little attention to safety signals when crossing the road with their caregivers and are given little opportunity to learn through supervised participation. Even though caregivers are seen as the key model of safe pedestrian behaviours, they do not involve their children in safe pedestrian decisions as they tend to traffic. Road safety education is recognized as central to teach children to interact with traffic safely.ObjectiveThe study evaluated the use of a simulated road environment to reinforce skill-based training for increasing safe pedestrian behaviours.MethodsOne hundred and fifty children aged 8–10 years participated and were recruited from a public primary school in Cape Town. Pre- and post-training tests evaluated the effectiveness of the training. Road traffic inspectors’ role modelled the pedestrian safety behaviours alongside the learners using a mobile pedestrian robot in the school road environment. Participants were educated on the management of the pedestrian robot and its related rules on crossing the intersection.FindingsChildren behaved more safely following training, demonstrating that brief training can produce short-term improvements in pedestrian behaviours. Significant reductions were found post-training for incorrect road-crossing responses (45%).ConclusionResults indicate that learners were receptive to the short and medium-term tasks, but long-term retention need to be promoted. Adult led learning are considered as powerful instruments due to the influence of social interaction on modelled behaviours. Caregiver involvement continues to be seen as influential agents in the practical application of a simple training procedure for pedestrian interventions.Policy implicationsA simulated road environment proved beneficial to transfer knowledge to promote children’s behaviour in the real environment; and bridging research into practice. An innovative approach to research and development is advocated for, and it must be transformed by practitioners to further promote the quality and utility of the disseminated road safety information.