Abstract
Background. Road traffic injuries are a leading cause of mortality and hospitalization among children. The mortality rate from these accidents in Iran is approximately double the global average, with East Azerbaijan Province accounting for a significant proportion of the country's road fatalities. Given the substantial health, economic, and social burden of traffic accidents and the scarcity of comprehensive research in this area, this study aimed to conduct a qualitative content analysis study of the lived experiences and perspectives of emergency staff regarding the challenges and strategies for managing pediatric and adolescent traffic injuries over the past decade.
Methods. This qualitative study employed a content analysis approach. Participants were selected via purposive sampling. Inclusion criteria comprised emergency department staff with at least two years of experience managing traffic-related injuries in children and adolescents. Sampling continued until data saturation was achieved, which occurred after semi-structured interviews with 10 participants. The interviews focused on experiences with pediatric traffic injuries, barriers to prevention, and strategic recommendations for improving safety. All interviews were transcribed and subjected to content analysis using MAXQDA20 software.
Results. Based on content analysis approach, four main themes and 11 sub-themes emerged. The themes included: 1) Care-related challenges (sub-themes: staffing issues and equipment shortages); 2) Pediatric-specific issues (sub-themes: age-related challenges and lack of parental awareness); 3) Injury characteristics (sub-themes: severity, anatomic location, vehicle type, and timing of injury); and 4) Preventive strategies (sub-themes: education, promoting safety culture, and environmental safety improvements).
Conclusion. Road safety policies and education must incorporate targeted strategies to improve child safety, with specific goals for injury prevention and reduction in this demographic. Furthermore, hospital preparedness such as encompassing both equipment and staffing is a critical component in improving survival outcomes for injured children.
Extended Abstract
Background
Traffic accidents affect millions of individuals annually and are a leading cause of mortality and hospitalization among children and adolescents. Statistics indicate that the mortality rate from these accidents in Iran is approximately twice the global average. East Azerbaijan Province, one of the most populous regions in northwestern Iran, accounts for a significant share of the country's road fatalities. Given the substantial health, economic, and social burden of traffic accidents and the scarcity of comprehensive research in this field, this study aimed to conduct a qualitative content analysis of the perspectives, lived experiences, and interpretations of hospital personnel regarding the challenges and strategies for managing pediatric and adolescent traffic injuries over the past decade.
Methods
This qualitative study employed a content analysis approach to investigate stakeholder experiences regarding traffic injuries among children and adolescents in East Azerbaijan province over the last decade, as well as preventive strategies. Participants were selected via purposive sampling. Inclusion criteria required participants to have specific knowledge of pediatric traffic accidents and at least two years of work experience in emergency departments. Sampling continued until data saturation was achieved, defined as the point where no new codes or information emerged, which occurred after interviews with 10 participants.
Data were collected through semi-structured, face-to-face interviews conducted between May and December 2023. Prior to the interviews, the study objectives were explained to participants, and written informed consent was obtained. All sessions were audio-recorded. The interview guide was designed to explore three main areas: experiences regarding traffic injuries in children and adolescents; challenges and barriers to accident prevention; and strategic suggestions for improving safety in this demographic.
All interviews were transcribed verbatim and analyzed using MAXQDA20 software. Data analysis was conducted using a content analysis approach. Open-text coding with a word-by-word and paragraph-by-paragraph was immediately applied. The coding process was carried out in the form of meaning units, condensed meaning units, and then codes. The different codes were compared and categorized based on their similarities and differences. Then, the codes were analyzed and categorized to produce main categories, and finally, after comparing and analyzing the data, four main categories and eleven subcategories were identified.
To ensure the trustworthiness and validity of the research, methods such as member checking, peer debriefing, and field notes were utilized. Specifically, to validate the data, interview transcripts were returned to participants to obtain their feedback and confirmation. Additionally, data source triangulation and peer review were employed to verify accuracy. To ensure reliability (auditability), the details of the data collection and analysis process were reported with precision, and external experts (faculty members) served as auditors to review the extracted themes.
Results
In this study, 60% of the participants were male and 40% were female. The largest proportion of participants held a Bachelor's degree (40%); this group often included individuals with significant work experience and senior positions. Additionally, 20% of participants held a Master's Degree and 20% held a professional doctorate. The age range of participants was 29–49 years, with a mean age of 36.2 years and an average work experience of 11.8 years. The majority of participants were male nurses holding a Bachelor's degree.
Based on the thematic analysis using content analysis approach, four main themes and 11 sub-themes were extracted:
1. Care-related problems (Sub-themes: Personnel challenges, Equipment challenges)
2. Child injuries (Sub-themes: Age-related challenges, Lack of parental awareness)
3. Injury characteristics (Sub-themes: Injury severity, Location of injury, Type of vehicle, Time of injury)
4. Preventive measures (Sub-themes: Education, Promoting safety culture, Safety improvements)
1. Care-related problems:
Most participants reported staffing shortages in various areas, such as psychology, cast technicians, and active operating room staff. One participant described the emergency department shortages: "Challenges include a lack of surgical equipment such as bipolar sets, a shortage of operating rooms and physicians, insufficient nursing and support staff, occasional shortages of basic equipment such as IVs, and the absence of a hospital MRI department." (P5)
2. Child Injuries:
2-1. Age-Related Challenges: Participants emphasized age-specific vulnerabilities. Most cited smaller physical stature as a contributing factor to head injuries and a higher risk of intracranial hemorrhage.
2-2. Lack of parental awareness: Neglect, lack of information, and poor adherence to safety norms among parents were considered the primary factors in this sub-theme.
3. Injury characteristics:
3-1. Severity of injury: Most participants noted high injury severity among pedestrians.
3-2. Location of injury: Participants almost unanimously stated that head trauma was the most common injury type.
3-3. Type of vehicle: Participants noted that the vehicle type varied by age group, frequently citing motorcycles for adolescents, bicycles for children, and passenger cars for infants.
3-4. Time of injury: The majority of pediatric accidents were reported to occur during the summer season.
4. Preventive strategies:
4-1. Education: Education via mass media, schools, and hospitals was highlighted. One participant stated: "Public education for children, drivers, and parents, as well as compliance with traffic signs, especially warning drivers of the consequences of inattention, is vital." (P6)
4-2. Promoting Safety Culture: Promoting a culture of seat belt use and encouraging parents to hold children’s hands while crossing streets were mentioned as effective factors.
4-3. Safety Improvements: Suggestions included enhancing vehicle safety standards, mandating helmets, and improving road infrastructure safety.
Conclusion
Road safety policies must incorporate strategies to improve child safety, including specific targets for preventing and reducing injuries in this vulnerable group. Hospital preparedness, regarding both equipment and staffing, is essential for improving survival outcomes. Greater attention must be paid to child safety across all contexts, whether in vehicles, as pedestrians, or while cycling, through the design of safer vehicles and environments. Changes in attitudes, beliefs, and safety culture are required in all areas of road safety, ranging from environmental improvements to legislative changes. Furthermore, parents play a vital role in child and adolescent safety; therefore, continuous education is crucial for fostering a culture of safety.
Practical Implications of Research
Based on the study’s findings, it is recommended that the development and implementation of supportive programs and educational packages focusing on accident prevention for children and parents be prioritized. Furthermore, the identification of traffic-related hazards and the advancement of traffic safety initiatives by relevant authorities should be incorporated into strategic planning aimed at preventing traffic injuries among children and adolescents.