Predicting pool safety habits and intentions of Australian parents and carers for their young children

This is a self-archived version of an original article. This version may differ from the original in pagination and typographic details. Author(s): Title: Year: Version: Copyright: Rights: Rights url: Please cite the original version: CC BY-NC-ND 4.0 https://creativecommons.org/licenses/by-nc-nd/4.0/ Predicting pool safety habits and intentions of Australian parents and carers for their young children © 2019 Elsevier Ltd Accepted version (Final draft) Hamilton, Kyra; Peden, Amy E.; Smith, Stephanie; Hagger, Martin S. Hamilton, K., Peden, A. E., Smith, S., & Hagger, M. S. (2019). Predicting pool safety habits and intentions of Australian parents and carers for their young children. Journal of Safety Research, 71, 285-294. https://doi.org/10.1016/j.jsr.2019.09.006 2019 See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/337254627 Predicting pool safety habits and intentions of Australian parents and carers for their young children ArticleinJournal of Safety Research · November 2019 DOI: 10.1016/j.jsr.2019.09.006 CITATIONS 0 READS 14 4 authors: Some of the authors of this publication are also working on these related projects: The epidemiology, risk factors and strategies for the prevention of unintentional fatal river drowning in Australia View project PETALS View project Kyra Hamilton Griffith University 146 PUBLICATIONS1,498 CITATIONS SEE PROFILE Amy Elizabeth Peden UNSW Sydney 82 PUBLICATIONS376 CITATIONS SEE PROFILE Stephanie Smith Griffith University 3 PUBLICATIONS5 CITATIONS SEE PROFILE Martin Hagger University of California, Merced 470 PUBLICATIONS15,017 CITATIONS SEE PROFILE All content following this page was uploaded by Kyra Hamilton on 17 November 2019. The user has requested enhancement of the downloaded file. RUNNING HEAD: Predicting Pool Safety Behaviors 1 RUNNING HEAD: Predicting Pool Safety Behaviors Predicting Pool Safety Habits and Intentions of Australian Parents and Carers for their Young Children Kyra Hamiltona,b, Amy E. Pedenc,d, Stephanie Smith a,, Martin S. Haggera,e,f aSchool of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia. bLaboratory of Self-Regulation and Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia. cRoyal Life Saving Society – Australia, Sydney, Australia. dCollege of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia ePsychological Sciences, University of California, Merced, USA fFaculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland Correspondence to: Kyra Hamilton, Health and Psychology Innovations (HaPI) laboratory, School of Applied Psychology, Griffith University, Mt Gravatt Campus, 176 Messines Ridge Road, Mt Gravatt, Queensland, QLD 4122, Australia, email: [email protected]u Acknowledgements. Martin S. Hagger’s contribution was supported by a Finland Distinguished Professor (FiDiPro) award (Dnro 1801/31/2105) from Business Finland. Funding. This project was jointly funded by Royal Life Saving Society – Australia and Royal Life Saving Society – New South Wales. The drowning prevention research of Royal Life Saving Society – Australia is supported by the Australian Government. Royal Life Saving Society – New South Wales received funding for this project from the New South Wales Government under the Water Safety Fund. The sponsor had no role in the design, methods, participant recruitment, data collection, analysis, preparation of this manuscript, or the decision to submit this article for publication. Competing interests. Author AEP is employed by Royal Life Saving Society – Australia and affiliated with the College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia. Data analysis and interpretation of findings was conducted independent of author AEP and Royal Life Saving Society – Australia. Suggested Citation: Hamilton, K., Peden, A., Smith, S., Hagger, M. S. (2019). Predicting pool safety habits and intentions of Australian parents and carers for their young children. Journal of Safety Research. RUNNING HEAD: Predicting Pool Safety Behaviors 2 Abstract Introduction. Children under five years are most at risk of experiencing fatal and non-fatal drowning. The highest proportion of drowning incidents occur in private swimming pools. Lapses in adult supervision and failures in pool barriers are leading contributory factors for pool drowning in this age group. Methods. We investigated the role of the theory of planned behavior social cognitions (attitude, subjective norm, and perceived behavioral control) as well as perceived barriers, planning, role construction, and anticipated regret on parents’ and carers’ intentions and habits towards two pool safety behaviors: restricting access and supervising children around private swimming pools. The study adopted a cross-sectional correlational design. Participants (N=509) comprised Australian parents or caregivers with children aged under five years and access to a swimming pool at their residence. Participants completed a battery of self-report measures of social cognitive variables with respect to the swimming pool safety behaviors for their children. Results. Path analytic models controlling for past behavior indicated that subjective norm, planning, anticipated regret, and role construction were important predictors of habit, and subjective norm was a consistent predictor of intentions, for both behaviors. Planning predicted intentions in the restricting access sample, while attitudes, barriers, and role construction also predicted intentions in the supervising sample. Both models controlled for past behavior. Conclusion. Current findings indicate the importance of psychological factors for restricting access and supervising behaviors, with normative factors prominent for both reasoned (intentions) and nonconscious (habits) behavioral antecedents. It seems factors guiding restricting access, which likely require regular enactment of routine behaviors (e.g., ensuring gate is not propped open, pool fence meets standards), may be governed by more habitual than intentional processes. Key words: drowning prevention; child injury; habit, intention, theory of planned behavior RUNNING HEAD: Predicting Pool Safety Behaviors 3 Introduction The World Health Organization (WHO) estimates 372,000 drowning deaths annually,1 although this is likely underestimated due to the International Classification of Diseases (ICD) codes and methodologies used.2 Data indicates that c hildren aged under five years are most at risk of unintentional drowning, both fatal and non-fatal. 3-8 In Australia, an average of 28 children under five years drown each year, 9 with the most recent data reporting 29 children under the age of five died from unintentional drowning in 2016/17. 9 A further 199 children under five years are hospitalised each year in Australia due to a non-fatal drowning incident. 10 Private swimming pools (also known as home swimming pools) are the leading location for drowning among children under five years, accounting for 44.8% of fatal drownings among children 0-4 years in Australia in 2016/17. 9 Common factors implicated in child drownings in private swimming pools include lapses in, or complete absence of, adult supervision and non-compliance of safety barriers such as gates deliberately propped open or faulty or poorly maintained pool fences and gates. 5 11 The strategies for preventing child drowning are well understood. For children under five years, the WHO recommends providing safe places, with adequate supervision, away from water, as well as installing barriers controlling access to water, and training bystanders in safe rescue and resuscitation. 12 In Australia, Royal Life Saving Society – Australia’s “Keep Watch” program aims to educate parents and carers of children under five years on the risk factors for drowning and strategies to reduce this risk. These strategies include active adult supervision, restricting access to water, and water awareness and resuscitation. 13 However, data indicates that drownings still occur as a result of supervision and restriction behaviors not being upheld by adults for young children. As these behaviors are modifiable, RUNNING HEAD: Predicting Pool Safety Behaviors 4 psychological processes are likely to guide parents’ and carers’ decisions for engaging in these pool safety behaviors for their young children. The theory of planned behavior (TPB) 14 is a widely-used decision making model that has been applied to understand health and safety behaviors, including drowning prevention behaviors in general 15-21 and, specifically, pool safety behaviors of parents. 22 The TPB proposes intention as the proximal predictor of behavior, with intention predicted by attitude (overall evaluations of the behavior), subjective norm (perceived social pressure to perform the behavior), and perceived behavioral control (perceived capacity and autonomy to carry out the behavior), with perceived behavioral control further hypothesised to moderate the intention-behavior relationship. Akin to perceived behavioral control is the concept of perceived barriers; however, this construct is usually conceptualised as individuals’ confidence to overcome barriers that may hinder behavioral performance. 23 Past behavior is also often included as an additional predictor of intention and behavior in the TPB. Although, in general, meta-analytic studies support the use of the TPB in behavioral prediction, 24 the model does not account for all variance in intentions and behavior. Thus, researchers have investigated other important constructs that may lead to more effective behavioral explanation in specific contexts, such as planning, role construction, and anticipated regret in the context of pool safety behaviors by parents and carers for their young children. Planning, Role Construction, and Anticipated Regret Behavioral action is more likely when individuals anticipate detailed plans and develop preparatory strategies for tackling a challenging task. 25 Planning is regarded as a prospective self-regulatory skill where an individual specifies the situational context in which one will enact to ensure behavioral performance is achieved. For example, “If my child is in the pool or around the pool area then I will ignore everthing else and strictly direct all my RUNNING HEAD: Predicting Pool Safety Behaviors 5 attention on supervising their behavior”. The context in this case provides the cue that is proposed to trigger the behavior. Plans are therefore not actions and planning requires a mental representation of how to achieve some future outcome that allows the individual to mentally link the intended behavior with a particular context for its enactment, thus connecting the individual with good opportunities to act via a task-facilitating strategy (i.e., specifying when, where, and how to enact a behavior). 25 26 Planning may also include the anticipation of barriers and the generation of alternative behaviors to overcome those, thus protecting individuals’ good intentions from anticipated obstacles via a distraction-inhibiting strategy.27 For example, if a parent anticipates that having a smartphone within reach may divert their attention away from supervising their child, then forming a plan to leave the smartphone somewhere out of reach while supervising their child swimming may prevent lapses in supervising (e.g., “If I take my child swimming in the pool then I will leave my smartphone inside the house so I will concentrate on supervising my child at all times”). Research investigating health behavior decisions for young children has also shown support for the effect of role construction on parental decision making. 28-31 Role construction is conceptualised as the interaction of beliefs about desired child outcomes, responsibility for these outcomes, perceptions of important others, and parental behaviors related to those beliefs and expectations. 32 Thus, the motivational roots of role construction derive from parents considering their responsibilities toward their child and the activities needed to be involved with their child, unlike subjective norm in the TPB where the motivational orientation for action is derived out of significant others’ approval. 14 This motivation arises from both self and social verifications to affirm their role as a parent and behave accordingly to fulfil these obligations and remain consistent with the standards attached to the role. Anticipated regret refers to beliefs about whether or not regret will follow from performing or not performing a certain behavior (i.e., considering the possibility of regret of RUNNING HEAD: Predicting Pool Safety Behaviors 6 supervising or not supervising young children in the pool). 33 34 Conceptually, anticipated regret should motivate behavior because regret is a pervasive, powerful, and unpleasant emotion that people, and in this context parents and carers of young children, wish to avoid. 35 Meta-analytic research has provided support for the inclusion of anticipated regret to the TPB, 36 with anticipated regret adding significantly to the prediction of intention independent of the other TPB constructs. Parents, in general, are aware that failing to supervise or restrict access of their young children around the pool has potentially negative shortand long-term health repercussions, 22 and thus, not performing these behaviors may result in parents experiencing negative emotions associated with anticipated regret. The Current Study The aim of this study was to develop a better understanding of the social cognitive factors that underpin the decisions of parents and carers toward two key water-safety behaviors around swimming pools: restricting young children’s access to private pools and supervising young children around private pools. The research is expected to provide further formative data that will inform future strategies for the prevention of drowning among this at-risk cohort. Drawing on psychological theories of social cognition, 14 25 we examined intentions as we predict that both these pool safety behaviors may be controlled by reasoned deliberation over the advantages and consequences of the behavior. This process is summarized by parents’ and carers’ intentions to perform the pool safety behaviors in future. However, it may be that these behaviors are also determined by processes that reflect non-conscious decision making, represented by habits. 37 Intentions reflect the amount of effort an individual is likely to invest in pursuing a target behavior in future14, whereas self-reported habits reflect the extent to which individuals experience the behavior as enacted beyond their awareness, efficiently and automatically, likely developed through frequent experience with the RUNNING HEAD: Predicting Pool Safety Behaviors 7 behavior in the presence of stable contexts (e.g., private swimming pool area) and cues (e.g., closing gate on entering and exiting pool area).37 38 In sum, we explored the role of the TPB social cognitions (attitude, subjective norm, and perceived behavioral control) as well as perceived barriers, planning, role construction, and anticipated regret on parents’ and carers’ intentions and habits to restrict young children’s access to private pools and supervise young children around private pools. This research directly links to the Australian Water Safety Strategy 2016-2020’s priority goal of reducing drowning among children aged 0-14 years 39 and builds on previous drowning prevention research, 15-21 including research targeting parents’ behavior around swimming pools, 22 specifically extending previous research by testing additional social cognitive factors of perceived barriers, planning, role construction, and anticipated regret on processes that reflect both reasoned (intentions) and more non-consciousness (habit) decision making and controlling for parents’ past behavior. Method Participants Participants (N = 509, 75% female) were Australian (New south Wales/Australian Capital Territory = 30.5%, Victoria = 24.2%, Queensland = 24.2%, Western Australia = 10.2%, Tasmania = 3.1%, Northern Territory = 0.2%) parents and carers of young children aged 0-4 years. Participants were recruited through Taverner Research, an Australian research panel company, and represented key demographic characteristics relatively proportional to the Australian population. The age of participants ranged from 18-75 years (M = 34.67, SD = 8.76). The majority of participants indicated that they had some form of employment (75.4%) and a greater than high-school-level education (71.7%), most (84.9%) exceeded the ‘low income’ threshold for annual household income (≤AU$37,000), and most RUNNING HEAD: Predicting Pool Safety Behaviors 14 how to achieve some future outcome that allows the individual to mentally link the intended behavior with a particular context for its enactment, thus connecting the individual with good opportunities to act.47 Emotion-based cues have also been suggested to aid in the building of habits.37 Anticipated regret, which encompasses beliefs about whether or not regret will follow from performing or not performing a certain behavior,33 34 motivates behavior because regret is a pervasive, powerful, and unpleasant emotion that people wish to avoid 35, and is consistent with a long line of research on the effect of anticipated affect on motivation to perform health promoting behaviors.48 Consistent with this evidence, it might be reasonable to theorise that anticipating this emotion when considering potential risks for children around private swimming pools might act as a cue for parents and carers to restrict access and supervise their young children in those situations. Current data therefore point to the potential utility of messages evoking anticipated regret or emotional consequences in promoting parents’ and carers’ adoption of, and adherence to, these pool safety behaviors. Barriers to enacting these pool safety behaviors was found to have an important role in the formation of intentions and habits for supervising only. It seems that barriers such as interfering with other commitments and having limited assistance may be more relevant to supervising than restricting access. To speculate, this might be because supervising likely requires greater vigilance, effort, and dedicated time relative to restricting, which effectively involves fewer actions by comparison. To overcome barriers to supervising, it might be useful if parents and carers build dedicated swimming time into the daily schedule along with their other commitments that need to be fulfilled. This might help to limit distractions that may derail one’s supervising intentions and habits and ensure that parents’ and carers’ attention is devoted to supervising their young children during this dedicated ‘swimming pool time’, and at all other times have contingencies in place to ensure children are always supervised to avoid children wandering off after swimming time is over. RUNNING HEAD: Predicting Pool Safety Behaviors 15 A final notable finding of the current study was the observation that the psychological factors were more strongly related to habits than intentions. This may be because habits are more important for effective restriction of access than intentions. Restricting access may require enactment of more regular, routine-type behaviors. For example, ensuring pool fences meet Australian Standards, ensuring there is an effective self-closing and self-latching gate, ensuring no climbable objects are left against pool fence, and ensuring the pool gate is not propped open all require regular inspection to ensure that these things are enforced and maintained. Making a plan for undertaking these restricting access behaviors and the monitoring of them may mean that these behaviors become more routinized and less likely to be governed by intentions. Strengths and Limitations A key strength of the current study is that it uses a large community sample of pool owners, providing potential opportunity to generalize results to other pool owners of young children beyond the current sample. Some limitations should also be raised. The crosssectional design precludes drawing causal inferences for relationships between the psychological factors and parents’ and carers’ intentions and habits with respect to pool safety behaviors for their children. Furthermore, the use of self-report measures may have been subject to socially desirable responses, a concern with all research relying on such measures. One means to mitigate this would be to collect observational data, such as observations of maintenance of pool safety equipment. However, such auditing would be difficult to do at the individual level. In addition, most participants indicated that they had taken their child or children to swimming or water familiarisation lessons (70.7%). This may indicate a degree of external validity if swimming or water familiarisation lessons are amenities predominantly enjoyed by higher income households. However, the RUNNING HEAD: Predicting Pool Safety Behaviors 16 generalizability of the findings may not extend to more socially disadvantaged groups where access and costs are potential barriers to engaging children in water familiarisation lessons. Conclusions Current findings provide preliminary indication of the social cognitive factors underpinning parents’ and carers’ intentions and habits with respect to restricting access and supervising young children around private swimming pools. These findings can inform future experimental research to test whether manipulating the key psychological constructs leads to changes in parents’ and carers’ intentions and habits toward these pool safety behaviors, which is important for drowning prevention. Findings may also point to the potential effectiveness of messages targeting social and normative factors in changing pool safety behaviors. RUNNING HEAD: Predicting Pool Safety Behaviors 17 References 1. World Health Organization. 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Health Psychology 2015;34(6):64252. doi:10.1037/hea0000143 RUNNING HEAD: Predicting Pool Safety Behaviors 20 Figure 1. Standardized parameter estimates and probability statistics for path analysis of hypothesized model for parents restricting child access to swimming pools. Barriers Habit R2 = .713 PBC Attitude Planning Subjective Norm Role Construction Anticipated Regret Intention R2 = .763 Past Behavior .719*** .755*** .492*** .454*** .506*** .660*** .557*** .303*** .253** .535*** .212** .188** .169* .169* .095* RUNNING HEAD: Predicting Pool Safety Behaviors 21 Figure 2. Standardized parameter estimates and probability statistics for path analysis of hypothesized model for parents supervising child around swimming pools. Barriers Habit R2 = .687 PBC Attitude Planning Subjective Norm Role Construction Anticipated Regret Intention R2 = 748 Past Behavior .141*** .501*** .695*** .696*** .610*** .493*** .534*** .721*** .139* .146* .169* .111* .212** .167* .236** .140* .236** .106* Table 1 Definitions Provided to Participants for Each Behavior Behavior Definition Restricting young children’s access to your pool Ensuring there is a barrier between child and pool; ensuring pool fence meets Australian Standards and is regularly inspected and maintained; ensuring there is an effective self-closing and selflatching gate; ensuring no climbable objects are left against pool fence; ensuring gate is not propped open Supervising young children around your pool Ensuring constant visual contact of the child, ensuring you are within arms’ reach of child at all times, ensuring an older child is not supervising a younger child Table 2 Items and Response Scales for Social Cognitive Constructs, Habit, and Behavior Measures for Each Behavior Construct Items Scoring Intention I plan to restrict young children’s access to my pool/supervise young children around my pool. I intend to restrict young children’s access to my pool/supervise young children around my pool. It is likely that I will restrict young children’s access to my pool/supervise young children around my pool. [1] extremely unlikely ‒ [7] extremely likely Attitude For me to restrict young children’s access to my pool/supervise young children around my pool in the next month would be… [1] bad ‒ [7] good [1] unwise ‒ [7] wise [1] worthless ‒ [7] valuable [1] negative ‒ [7] positive Subjective Norm Those people who are important to me would approve of me restricting young children’s access to my pool/supervising young children around my pool. Those people who are important to me would want me to restrict young children’s access to my pool/supervise young children around my pool. Those people who are important to me think I should restrict young children’s access to my pool/supervise young children around my pool. [1] strongly disagree ‒ [7] strongly agree Perceived Behavioral Control I have complete control over whether I restrict young children’s access to my pool/supervise young children around my pool. It is mostly up to me whether I restrict young children’s access to my pool/supervise young children around my pool. It would be easy for me to restrict young children’s access to my pool/supervise young children around my pool. I am confident I can r restrict young children’s access to my pool/supervise young children around my pool. [1] strongly disagree ‒ [7] strongly agree Perceived barriers I am confident that I can restrict young children’s access to my pool/supervise young children around my pool in the next month even if I have no assistance from others. I am confident that I can restrict young children’s access to my pool/supervise young children around my pool in the next month even if it is time consuming. I am confident that I can restrict young children’s access to my pool/supervise young children around my pool in the next month even if it interferes with my other commitments. I am confident that I can restrict young children’s access to my pool/supervise young children around my pool in the next month even if it is not easy for me. [1] strongly disagree ‒ [7] strongly agree Planning I have made a plan regarding when to restrict young children’s access to my pool/supervise young children around my pool. I have made a plan regarding where to restrict young children’s access to my pool/supervise young children around my pool. I have made a plan regarding how to restrict young children’s access to my pool/supervise young children around my pool. [1] strongly disagree ‒ [7] strongly agree