Determinants of Child Restraint System Compliance among Malaysian Parents: A Health Belief Model Approach

This study examined the behavioural and practical factors associated with Child Restraint System (CRS) compliance among Malaysian parents using the Health Belief Model. A cross-sectional online survey was conducted among 500 parents or primary caregivers with at least one child aged 12 years or younger and access to a private passenger vehicle. Respondents were classified as CRS users or non-users based on their self-reported frequency of CRS use. Descriptive statistics and Mann–Whitney U tests were used to compare Health Belief Model constructs between the two groups. Overall, 67% of respondents were classified as CRS users, while 33% were non-users. CRS users reported significantly higher perceived susceptibility, perceived severity, perceived benefits, and self-efficacy than non-users (p < 0.001), although the effect sizes were generally small. In contrast, non-users reported significantly greater financial and usability barriers, including CRS cost, installation difficulty, child discomfort, and limited vehicle space (p < 0.001). Child discomfort showed the largest effect size, though only moderate (r = 0.35). Significant differences were also observed for selected enforcement-related and financial cues, but the effect sizes were small, while campaign- and social norm-related cues did not differ significantly between the groups. These findings indicate that improving CRS compliance requires more than increasing awareness or relying on enforcement alone. Interventions should prioritise affordability, practical installation support, user guidance, and strategies that strengthen parents’ confidence in selecting and using an appropriate CRS. Addressing both behavioural and structural barriers may support more consistent use of CRS and improve child occupant safety in Malaysia.

Child restraint system; road safety; child traffic safety; Health Belief Model

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