How Confidentiality of the Human Subjects Review Protect a Father Giving an Infant a Bath

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Peer-reviewed

Research Article

Beginning-Time Parents Are Not Well Enough Prepared for the Condom of Their Infant

• Mirjam Eastward. J. van Beelen,
• Tinneke Grand. J. Beirens,
• Paul den Hertog,
• Eduard F. van Beeck,
• Hein Raat

ten

• Published: March 6, 2013
• https://doi.org/x.1371/periodical.pone.0058062

Figures

Abstract

Groundwork

Unintentional falls and poisonings are major causes of decease and inability amidst infants. Although guidelines are available to prevent these injuries, safety behaviours are not performed by parents, causing unnecessary risks. Little is known most safety behaviours of showtime-time parents and whether they acquit according to these guidelines.

Aims/Objectives/Purpose

The objective of this study was to compare rubber behaviours of first-time parents with those of not-outset-time parents and to determine correlates of unsafe behaviour of parents of infants. We used cocky-report questionnaires to assess safe behaviours in a cantankerous-sectional study sample.

Methods

A total of 1439 parents visiting a preventive youth healthcare centre in the netherlands were invited to consummate a questionnaire with regard to the prevention of falls and poisonings. Parents were categorized into first-fourth dimension parents and non-start-time parents. Correlates of parents' child safety behaviours were determined using multiple logistic regression analyses.

Results/Consequence

Virtually respondents were mothers (93.2%); 48.2% of families were first-fourth dimension parents. The mean historic period of the infants was 7.ii months (SD 1.1; range 4–12), 51.8% were boys, and 34.five% of infants could crawl. First-time parents were more likely not to have a stair gate installed (OR 16.46; 95% CI 12.36–21.93); were more likely to store cleaning products unsafely (OR 4.55; 95% CI 3.59–5.76); and were more than likely to store medicines unsafely (OR 2.ninety; 95% CI 2.31–iii.63) than not-first-time parents. First-time parents were more likely to non have a window guard installed (OR i.52; 95% CI one.08–ii.15) (all P<0.05).

Discussion/Conclusion

Get-go-time parents are not well prepared for the safety of their infant, causing unnecessary risks. The various parents' safety behaviours were influenced by dissimilar variables, for example, age of the infant, itch of the infant, mother's educational level, mother'due south ethnicity, self-efficacy, vulnerability, severity.

Commendation: van Beelen MEJ, Beirens TMJ, den Hertog P, van Beeck EF, Raat H (2013) First-Time Parents Are Not Well Enough Prepared for the Safety of Their Infant. PLoS 1 eight(three): e58062. https://doi.org/ten.1371/periodical.pone.0058062

Editor: James G. Scott, The University of Queensland, Australia

Received: October ix, 2012; Accepted: January 31, 2013; Published: March 6, 2013

Copyright: © 2013 van Beelen et al. This is an open up-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted utilize, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This written report is funded past a grant from ZonMw (project no. l-50205-98-25028000). Website: http://world wide web.zonmw.nl. The funders had no role in report pattern, data collection and assay, conclusion to publish, or preparation of the manuscript.

Competing interests: The authors accept declared that no competing interests exist.

Introduction

Unintentional injuries, such as falls and poisonings, are the fifth leading crusade of death amid infants [ane]. They are also a major source of morbidity and loss of quality of life [2]–[4]. Each yr worldwide 1.nine in 100,000 children under 20 years of age die due to falls, and ane.8 in 100,000 children dice due to poisonings [2].

The American Academy of Pediatrics (AAP) provides specific informative tools for parents about the prophylactic measures they tin have for infants from birth to twelve months of historic period [five]. To forestall falls, parents are brash to install and ever use stair gates on stairs and to install window guards. To prevent poisonings, they are advised to go on household products such as cleaners and chemicals, and medicines out of sight and attain [5].

Parents with several children have ofttimes taken various safe measures [6]–[8]. However, when they have their first kid many safety measures still demand to be taken. It is important for outset-time parents to be prepared to heighten their babe in a condom environment. Little is known about the safety behaviours of beginning-time parents en whether they behave co-ordinate to the recommendations of the AAP. For the purpose of developing strategies to reduce the number of injuries from falls and poisonings, information technology is important to know which preventive actions showtime-time parents really take. It is also useful to know which parent and child characteristics and other determinants are associated with these preventive actions, in order to develop effective intervention strategies. More information is needed on these determinants related to protecting infants against unintentional injuries in the home.

Behaviours are influenced by a complex, interrelated gear up of determinants, which include various demographic and psychosocial factors. To assess the influence of underlying psychosocial factors on behaviours, the Protection Motivation Theory (PMT) has been proven reliable in predicting behaviours [nine]–[11]. Protection Motivation Theory is a framework specially suited to interventions of protective, precautionary behaviours. According to this theory, safe behaviour is directly influenced by protection motivation, which is the effect of an evaluation of environmental and personal factors. It posits that the probability of safe behaviour, in this case preventing falls and poisoning, is increased by four behavior: 1) the personal abilities and self-conviction to always utilize a stair gate and store cleaning products and medicines safe, self-efficacy; 2) the perception of the adaptive response to use a stair gate and shop cleaning products and medicines condom, response efficacy; 3) the perception of personal relevance regarding falls from the staircase or of ingestion of cleaning products and medicines, vulnerability; and iv) the perception of severity in the event of a fall on the stairs or of ingesting cleaning products or medicines. In this written report we used demographic variables too as PMT constructs to assess the influence of underlying psychosocial factors on parents' child safety behaviours.

The objective of this study was to compare condom behaviours of first-time parents with safety behaviours of non-get-go-time parents and to determine correlates of unsafe behaviour parents of infants. We used self-report questionnaires on condom behaviour to assess these safety behaviours in a cross-sectional written report sample.

Materials and Methods

Participants and recruitment

The present study used data obtained at enrolment in the 'BeSAFE' report, a randomized controlled trial which aims to assess the effects of internet-based, tailored safety information combined with personal counselling on parents' child safety behaviours, as described in detail elsewhere [12]. An opportunity sample of five preventive youth health care centres in the Netherlands invited a total of 3147 parents of infants aged 5 to 12 months former (one parent per family) to participate in the study between 2009 and 2010. These 5 youth health care centres were located in urban and rural areas. Written informed consent was provided by 45.7% (northward = 1439), who also completed the questionnaire.

The Medical Ethics Committee of the Erasmus Medical Center gave a "annunciation of no objection" for this report (MEC-2008-370). The 'BeSAFE' report was registered in the Dutch Trial Registration (Current Controlled Trials NTR1836).

Measurements

Parents received written information well-nigh the report, were asked to provide informed consent and were asked to complete the questionnaire on home safety. Up to two reminders were sent. Parents were assured of confidentiality and the results were processed anonymously.

The questionnaire assessed family unit, babe and housing characteristics, parents' child safety behaviour, and 'Protection Motivation Theory'-constructs.

Family, infant, and housing characteristics.

Number of children was assessed and dichotomized every bit first-time parents (first child in family) and not-first-time parents (second child or more children in family unit). Parents' educational level was assessed and categorized as 'high', 'intermediate', and 'low'; high level being divers equally college professional person pedagogy or academic higher education; intermediate level equally senior secondary vocational pedagogy, senior general secondary instruction or academy preparatory education; depression educational level being divers as preparatory secondary vocational education or lower [xiii]. Parents' employment status was assesses and defined as "unemployed" if they had neither a part-time or full-time job. Parents' ethnicity was determined on the basis of their own parents' country of nascency (grandparents of the infant). A parent was of Dutch ethnicity if both grandparents had been born in The Netherlands; if one of the grandparents had been built-in in another Western country, a parent was of other Western ethnicity. If both grandparents had been born in another Western or non-Western state, ethnicity was determined by the grandmother'due south country of birth [thirteen].

Crawling was assessed and defined as an infant's power to: "crawl on hands and knees and/or clamber on their tummy and/or shuffle on their bottom".

Infant's medically attended injury was assessed and categorized as 'none' and 'one or more'; i or more was defined as ane or more injuries for which the kid was taken to a general practitioner, the emergency section of a infirmary, or both.

Protection Motivation Theory constructs.

The psychosocial correlates of safety behaviour were measured with regard to Protection Motivation Theory constructs [ix], [10]. Self-efficacy was measured from −2 = very difficult to +2 = very easy, response efficacy was measured from −two = not very helpful to +2 = very helpful, vulnerability was measured from −2 = low run a risk; +2 = loftier take chances, and severity was measured from −2 = not serious; +2 = very serious. All items related to the Protection Motivation Theory constructs were measured on bipolar five-point scales.

Parents' child safe behaviour with regard to falls.

Parents were asked whether there was a staircase between the floor with the living room and a split up floor with the bedrooms; if so, this was designated as the main staircase. The presence of a stair gate at the peak or bottom of the main staircase was assessed. The self-reported frequency of closing the stair gate of the main staircase was measured on a 5-point scale ('never' to 'always'); adequate use was defined every bit 'ever closing the stair gate'. The presence of windows which could exist opened, below the superlative of 1.20 thousand, was assessed, and parents were asked whether they had window guards on at least one of such windows.

Parents' child safety behaviour with regard to poisoning.

Parents were asked where they stored their cleaning products and medicines. 'Unsafe' storage of cleaning products was defined as stored in the bathroom, kitchen or shed/garage on the flooring or in a cupboard without a lock, at a peak below 1.50 m. 'Dangerous' storage of medicines was defined as stored in the bath, kitchen or sleeping room on the floor or in a cupboard without a lock, at a height below i.50 m.

Statistical analyses

Chiselled data were described using percentages and continuous information using mean (SD). Differences in the proportions and ways of all potential correlates were tested by chi-square exam and Mann-Whitney U examination. Starting time-time parents' safety behaviours and non-first-time parents' safety behaviours were compared betwixt infants who could not crawl and those who could crawl.

To decide significant correlates of parents' safety behaviour, multiple logistic regression analyses were performed, with unsafe behaviour equally the dependent variable and various factors (demographic and Protection Motivation Theory constructs) as independent variables. Five different sets of multiple logistic regression analyses were conducted, first for respondents who indicated the absence of a stair gate on their principal stairs, and second for the sub-group of respondents who had a stair gate but did non use information technology adequately. A 3rd set described the correlates of the absence of a window guard on windows beneath the top of one.twenty g. A 4th set was conducted with regard to the unsafe storage of cleaning products and a fifth on the unsafe storage of medicines. In model 1 of every set the number of children (e.g. kickoff-time parents vs. non-first-time parents, with regard to unsafe behaviour was entered. In model 2 other demographic variables that were considered to be more distal, these were non-modifiable potential correlates, were entered. Subsequently, in model 3, Protection Motivation Theory constructs were entered into the models.

Statistical analyses were performed using SPSS 17.0 (SPSS Inc., Chicago, IL.).

Results

Family, infant, and housing characteristics

Most respondents were mothers (93.2%); 48.2% were first-time parents; 97.two% of the families included two parents. Fewer kickoff-time mothers were unemployed than non-starting time-time mothers (13.iv% vs. 23.ii% respectively; P<0.001) (Table one). The mean historic period of the infants was 7.2 months (SD 1.one; range 4–12 months); 51.8% were boys; 34.5% could crawl, and 0.five% could walk independently. A chief staircase was present in 86.six% of houses; 36.6% of houses had a window below a height of one.20 yard, which could be opened. Fewer kickoff-time parents (82.seven%) had a main staircase present than not-kickoff-time parents (90.2%) (P<0.001).

Safety behaviour of get-go-time parents

If their infant could not crawl, more first-time parents had not installed a stair gate (89.4%) than kickoff-time parents with an babe that could crawl (75.0%) (P<0.05) (Table 2). If their infant could not clamber, more first-time parents stored medicines unsafely (54.three%) than first-fourth dimension parents with an infant that could crawl (43.6%) (P<0.05). At that place were no differences in the safe behaviours betwixt not-first-time parents whose infant could clamber and those whose infants could not clamber (P>0.05).

Table 2. First-fourth dimension and non-first-fourth dimension parents' rubber behaviour relevant to the prevention of falls and poisonings, compared between infants who cannot clamber and infants who tin crawl (n = 1439).

https://doi.org/x.1371/periodical.pone.0058062.t002

Get-go-time parents were more likely not to accept a stair gate installed (OR sixteen.46; 95% CI 12.36–21.93); were more probable to store cleaning products unsafely (OR 4.55; 95% CI three.59–v.76); and were more likely to store medicines unsafely (OR 2.ninety; 95% CI 2.31–3.63) than non-kickoff-fourth dimension parents (all P<0.05) (Tabular array 3). Furthermore beginning-fourth dimension parents were more than likely to non have a window guard installed (OR 1.52; 95% CI one.08–2.fifteen) than not-first-time parents (P<0.05) (Tables 3, 4, 5, vi, 7).

Table iii. Odds ratios (OR) and 95% conviction intervals from multiple logistic regression analyses with reported absence of stair gate as dependent variable and number of children (Model one), other demographic variables (Model ii) and Protection Motivation Theory (PMT) variables (Model iii) equally independent factors in a subgroup of parents with a master staircase present in their business firm (due north = 1245).

https://doi.org/10.1371/journal.pone.0058062.t003

Table 4. Odds ratios (OR) and 95% confidence intervals from multiple logistic regression analyses with no adequate use of the stair gate as dependent variable and number of children (Model 1), other demographic variables (Model ii) and Protection Motivation Theory (PMT) variables (Model iii) as independent factors in a subgroup of parents with a stair gate present at their staircase (n = 590).

https://doi.org/10.1371/journal.pone.0058062.t004

Tabular array 5. Odds ratios (OR), 95% confidence intervals and explained variance (Nagelkerke Rⁱⁱ) from multiple logistic regression analyses with reported absence of window guard as dependent variable and number of children (Model 1), other demographic variables (Model ii) and Protection Motivation Theory (PMT) variables (Model 3) equally contained factors in a subgroup of parents with windows that could be opened in their business firm (n = 526).

https://doi.org/10.1371/journal.pone.0058062.t005

Table 6. Odds ratios (OR), 95% confidence intervals and explained variance (Nagelkerke R²) from multiple logistic regression analyses with reported dangerous storage of cleaning products as dependent variable and number of children (Model 1), other demographic variables (Model 2) and Protection Motivation Theory (PMT) variables (Model 3) as independent factors (n = 1439).

https://doi.org/ten.1371/journal.pone.0058062.t006

Tabular array 7. Odds ratios (OR), 95% confidence intervals and explained variance (Nagelkerke R²) from multiple logistic regression analyses with reported dangerous storage medicines as dependent variable and number of children (Model ane), other demographic variables (Model 2) and Protection Motivation Theory (PMT) variables (Model iii) as independent factors (n = 1439).

https://doi.org/ten.1371/journal.pone.0058062.t007

Multiple correlates of safety behaviour

Number of children, crawling of their infant, vulnerability, and severity were significantly associated with the absence of a stair gate (P<0.05) (Table 3).

Educational level, mother'southward ethnicity, and self-efficacy were significantly associated with the inadequate use of a stair gate (P<0.05) (Table four). In this model number of children was not associated with the behaviour.

Only number of children was a significant variable (P<0.05) of the variance in the absence of a window guard (Table 5).

Number of children, mother's educational level, mother's ethnicity, self-efficacy, and vulnerability were significant variables (P<0.05) of the variance in the unsafe storage of cleaning products (Table half-dozen).

Number of children, infant'south age, mother's educational level, and self-efficacy were significant variables (P<0.05) of the variance in dangerous storage of medicines (Table 7).

Discussion

The results of this written report show that there is a divergence in rubber behaviour between offset-fourth dimension parents and non-first-time parents. Regarding having a stair gate at the master staircase at the firm and storage of medicines, more first-time parents with infants who cannot crawl deport dangerous than first-time parents with an baby that can clamber. Furthermore the results show that different demographic variables are associated with dangerous behaviour of parents of infants. From our study it can be concluded that PMT constructs are applicable to predict the absence of a stair gate, inadequate use of a stair gate, and unsafe storage of cleaning products and medicines.

This report shows that first-fourth dimension parents don't comport as recommended in the prevention of falls and poisonings. When infants of kickoff-time parents start crawling parents are probably more aware of the dangers in their home, and therefore start showing the required rubber behaviour just then when their child is already at risk. Earlier studies bear witness that these parents all the same practise not take enough rubber measures to foreclose injuries [7], [eight]. When infants are able to move around the house, they are able to explore their globe. It is recommended to prepare for a prophylactic home environment before infants can move themselves around [5]. Since one cannot predict exactly when each child develops these abilities it is important to first showing these safety behaviours at an early on stage.

Especially first-time parents are not well prepared for their itch infant compared to not-showtime-time parents. When older siblings are present in the home, safety behaviours with regard to the presence of stair gates are shown more often possibly based on their experience with their older kid or children. However parents still do not utilise the stair gate fairly. Or maybe they stop using the stair gate adequately, because their older sibling tin walk the stairs himself.

Earlier study on parents' safe behaviours of Brice, et al showed no significant differences on infant-safe homes between first-time mothers and non-get-go-fourth dimension mothers. This study however did not focus on prevention of falls or poisonings [xiv].

The associations included in our study were like to the results in previous studies on safety behaviour [half dozen], [15]–[17]. Notwithstanding, to our cognition, this is the showtime study to wait specifically at commencement-fourth dimension parents. Start-fourth dimension parents, infants that could not clamber, parents who perceived lower vulnerability of their child and parents who perceived lower severity were more likely not to have a stair gate present. Also, when a stair gate is nowadays mothers with an intermediate or high educational level, or mothers with lower self-efficacy are more probable to utilize the stair gate inadequately. Information technology could be beneficial to aim specific interventions at these parents in order to reduce the number of injures due to falls from stairs.

Injuries from falls from a window specially occur in children aged 0–4 years erstwhile, with a tiptop at one yr [18]. In our study we saw that number of children was correlated with absenteeism of a window guard and no other demographic characteristics or PMT constructs. It is therefore of import to point prevention strategies at all parents, not families with specific characteristics. Information technology is all the same recommended to specifically inform first-time parents almost the prevention of falls from windows and the use of window guards in order to improve the employ of these window guards.

First-fourth dimension parents, mothers with intermediate or loftier educational level, Non-Western ethnicity of the mother, lower self-efficacy and higher perceived vulnerability are correlated with unsafe storage of cleaning products. Furthermore first-time parents, younger children, high educational level of the mother and lower self-efficacy correlated with unsafe storage of medicines. These results indicate that the characteristics of parents who behave unsafely vary within the prevention of different types of injuries, in this case poisoning. Despite the decrease in the past years in the number of poisoning related injuries due to improved poisoning prevention strategies, yet also many of these injuries occur [nineteen]. Previous studies showed that parents practice not adopt the recommendations for safe storage of poisonings [20].

Methodological considerations

Some limitations of this study need to be addressed. First, considering our study relied on self-study of safe and unsafe behaviour by parents, misclassification might have occurred; parents might have given socially desirable answers (overstating their condom behaviour) [21], [22]. This might result in an underestimation of dangerous households, and bias in the assessment of significant correlates.

Of the 1439 participants that completed the questionnaire, just seven% were not born in the Netherlands. We assume that these participants had acceptable knowledge of the Dutch language to enable participation in the study and complete the questionnaire. We recommend future studies to address linguistic communication skills of participants in the study.

Non all PMT constructs were measured on all behaviours, for example cocky-efficacy and response efficacy in stair gate presence in the business firm and response efficacy, vulnerability and severity in utilise of a window guard on windows.

Participation rate in this written report, 46%, was depression. This study was function of a randomized controlled trial which aims to assess the effects of cyberspace-based, tailored safety information combined with personal counselling. Therefore, participants were invited to consummate more than i questionnaire. Also, this report required participants to have admission to the Internet. This may take contributed to the low participation rate.

At that place is no information available on the characteristics of parents who did not wish to participate in this study. It is difficult to define whether the associations plant would be dissimilar in non-responders.

This study used an opportunity sample of five preventive youth health care centres in the Netherlands. The participation charge per unit and the apply of an opportunity sample may accept acquired limited generalizability of our report results.

Hereafter enquiry

We suggest to measure out rubber behaviour and PMT constructs longitudinal in order to investigate when parents modify their behaviour and which variables are associated with the alter in rubber behaviour. Furthermore the study could be extended with habitation safety observations in lodge to eliminate possible misclassification.

Decision

First-time parents are not well prepared for the condom of their infant, causing unnecessary unsafe situations. Particularly when their baby cannot clamber yet, parents carry unsafely on not having a stair gate and the storage of medicines. The various parents' safety behaviours were influenced by unlike variables, e.yard. age of the infant, itch of the babe, mother'due south educational level, mother's ethnicity, self-efficacy vulnerability, and severity. These variables could be taken into business relationship when providing safety information to parents.

Author Contributions

Conceived and designed the experiments: 60 minutes MEJB TMJB PH EFB. Performed the experiments: MEJB. Analyzed the data: MEJB TMJB. Contributed reagents/materials/analysis tools: MEJB TMJB. Wrote the paper: HR MEJB TMJB PH EFB.

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