Sense and susceptibility: how mothers view accidental injury risk and develop safety strategies for pre-school children

The prevailing rates of morbidity and mortality resulting from accidents in the youngest and most vulnerable members of our population are a cause for concern. Reducing childhood accidents has been identified as a priority for improving health in the United Kingdom and in many other countries. Despite mothers being identified as the main carers for pre-school children, relatively little research has examined mothers' perceptions of childhood accidents or explored their experiences and expectations of health professionals in promoting safety. This study examines mothers' perceptions of childhood injury risk, the ways in which mothers develop knowledge and skills for keeping their children safe and how they are motivated to adopt accident prevention strategies. The mothers' perceptions of the health visitor role in promoting the safety of pre-school children are also examined.This study was undertaken within one Health Board district in Scotland, using a combination of quantitative and qualitative survey methods. A questionnaire was posted to eight hundred mothers of pre-school children, randomly selected from the Primary Health Care Data Base and to two hundred mothers whose pre-school children had attended the Accident and Emergency Department as a result of an accident within three months prior to the survey. From the survey respondents, forty mothers were selected as key informants and participated in qualitative, in-depth interviews. Quantitative data were analysed using the Statistical Package for Social Scientists. The interviews were tape recorded and transcribed to facilitate a systematic approach to content analysis.The combined results reveal the complexity of caring for children safely, although certain aspects of this process can be understood by recognising distinct but interacting knowledge, perceptions and motivations. Mothers believed that much of their knowledge for protecting their children was common sense, indicating how many safety practices were socially constructed according to the norms of their social network. Mothers' perceptions of childhood injury risk were influenced by their families' accident experiences. However, new or unfamiliar risks were often not anticipated by mothers. This lack of generalisation from accident experiences and from prior knowledge may limit maternal motivation to adopt specific safety practices.Mothers describe their motivation to adopt safety actions as being informed by a rational process of weighing up the risk of injury against the resources they had available. Mothers' perceptions of the susceptibility and severity of injury to their child were found to differ from the more objective measures of accident epidemiology. The mothers were most concerned about dramatic, but rare accidents outside the home, whilst severe and common accidents in the home concerned them less. This tendency to sensationalise certain injuries arguably detracted them from developing protective strategies to reduce the greatest causes of morbidity and mortality in pre-school children. Health visitors who could relate to the mothers social context were valued, particularly by lone mothers and others in situations of multiple disadvantage, who had specific needs for proactive social support.The implications of these findings are discussed in relation to accident prevention approaches and the role of the health visitor. The value of an integrated research method for investigating the accident problem and for understanding mothers' perceptions is discussed and directions for future research are suggested