Barriers to caregiver involvement in a child safety intervention in South Africa

Abstract

Injuries are a global threat to children's health and are disproportionately prevalent in Sub-Saharan Africa. Despite the rates of childhood injuries, research into prevention and the community and family conditions required for such interventions have been largely under-researched. This article reviews international work highlighting caregiver involvement in the implementation of interventions in a number of sectors, including the health, education, and safety domains. This work, based largely on experiences in high-income countries, indicates that there are considerable challenges inhibiting caregiver involvement in such interventions. This article explores caregiver understandings of the personal, familial, and contextual barriers to their participation in child safety initiatives. It highlights the obstacles to involvement in a community-centred child safety promotion intervention that was implemented in a low-income setting in the Western Cape. A narrative approach was employed with study data captured in individual interviews and analysed using guidelines for conducting narrative analysis. In total, 11 caregivers were interviewed. Caregiver understandings of the impediments to greater involvement in safety interventions included the multifaceted nature of their personal and social difficulties. These included the prioritisation of work opportunities; conflict and estrangement from partners, family, and the community; and adverse living conditions. In such situations, many reported constrained personal choices and disengagement from many aspects of community relationships. Despite this stance, caregivers recognised the community connectedness, belonging, and responsibility needed to achieve a safer and healthier community.

Fatal drowning in the Western Cape, South Africa: a 7-year retrospective, epidemiological study

“…The lowest male-to-female ratio was observed in young children (0–4 years), with high differentials observed in older children and young adult men. Injury vulnerability in South African boys has been associated with differing temperament, impulsivity, higher activity levels and less restraint of exploratory behaviour by parents 21 24 25. The current study specifically identifies young adult men (20–34 years) as a high-risk group for fatal drowning.…”

“…However, the distribution of risk factors observed in this age group suggests that improved supervision presents a key area for drowning prevention efforts in the Western Cape. In particular, fatal drowning incidents in this age group frequently occurred in the early evening on weekdays, when care givers are likely to be preoccupied with caring for multiple children and performing household chores21 and were more likely to occur in swimming pools, baths and other water in and around the home. Increased awareness of the importance of adequate supervision at home may significantly reduce drowning risk in this age group.…”

Community, intervention and provider support influences on implementation: reflections from a South African illustration of safety, peace and health promotion

“…The UCS was implemented in a South African community that is under-resourced and faced with a range of considerable obstacles when trying to access public health and social services [ 22 , 23 ]. Throughout the implementation of the UCS the authors observed that the community faced multiple demands and priorities related to employment, basic municipal services, welfare, health and family safety.…”

“…These families and breadwinners often have precarious employment with little control over work schedules, which may include weekends. Other breadwinners may have more than one job, leaving minimal time for involvement in community activities [ 22 , 24 ]. Over the course of the UCS, the authors also noted sporadic episodes of tension and violence in the community, including gang-related violence, and the violence associated with the subsequent funerals of gang members, which disrupted several of the intervention events.…”

“…Adult participation in the intervention campaigns was minimal, and in some cases absent. Instead, the strongest and most consistent participation in the intervention activities was by unaccompanied children, who were observed to be keenly engaged in the campaign themes, through the interaction modalities used at the events [ 22 ]. The periodic threats of violence, in combination with the multiple pressures arising from the everyday demands of child care, family and household duties, and work responsibilities, restricted the extent to which residents could operate efficaciously as a community in intervention activities that required their active engagement [ 22 ].…”