Consumer awareness, trust and cultural challenges in the use of child car seats in Iran: Current status and improvement strategies.

Nasirabadi, EZ; Yazdani, S; Shirini, B; Yazdani, M · 2026 · PubMed Central

DOI: 10.1371/journal.pone.0351222

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Summary

This study investigates the determinants of child car seat usage among parents in Tabriz, Iran, addressing the gap between high vehicle ownership and low adherence to child passenger safety guidelines. Motivated by the high prevalence of road traffic injuries among children and the inconsistent use of restraint systems in low- and middle-income countries, the research aims to assess parental awareness, trust in safety equipment, and cultural barriers influencing behavior. The authors seek to identify specific cognitive, social, and structural factors that hinder proper car seat utilization to inform targeted public health interventions. The researchers conducted a cross-sectional study involving approximately 750 parents of children aged 1–3 years, recruited via convenience sampling from 19 public health centers in Tabriz between April and August 2025. Data were collected using a structured, researcher-developed questionnaire validated by a multidisciplinary expert panel (CVI = 0.89) and pilot-tested for internal consistency (Cronbach’s alpha = 0.82). The instrument measured demographic data, knowledge of safety guidelines, trust in product quality and professional advice, cultural norms, and perceived barriers. Statistical analyses included descriptive statistics, chi-square tests, t-tests, and regression models to identify predictors of usage and correct installation. Key findings reveal a significant discrepancy between car ownership (92%) and child car seat ownership (47%), with 55% of participants rarely or never using a seat. While awareness of age and weight recommendations was high (85%), knowledge of correct installation was lower (62%). Usage patterns varied significantly by trip type: only 45% of parents used car seats for city trips, compared to 82% for out-of-city trips, reflecting higher risk perception for long-distance travel. Consistent seatbelt fastening during city trips was notably low at 28%. Regression analysis identified trust in safety guidelines (β = 0.45), parental education (β = 0.30), and risk perception as significant predictors of proper restraint use. Major barriers cited included high cost (62%), lack of awareness (55%), and cultural practices such as holding children on laps (50%). Additionally, trust in the quality of locally available seats was weaker than trust in professional recommendations. The study concludes that high vehicle ownership does not ensure child safety, and that interventions must address multilevel determinants. The authors recommend a combination of skills-based education, affordability measures such as subsidies, product quality assurance, and policy enforcement to improve usage rates. They emphasize the need to shift social norms and correct misconceptions regarding the safety of short trips, suggesting that targeted strategies addressing both cognitive trust and structural barriers are essential for improving child passenger safety in Iran.

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Summary generated by qwen3.6-27b-prismaquant on 2026-06-26; verification: verified.

Topics

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• child passenger safety
• seat belt use

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• Empirical Findings: observational prevalence