Barriers and facilitators in the implementation of a child restraint system discharge programme in Singapore: a qualitative study.

Objective: Child restraint systems (CRS) are essential in preventing injury during road traffic collisions, yet neonatal CRS discharge programmes are lacking worldwide. Trained healthcare providers have reported a lack of confidence in providing CRS advice during discharge. We aimed to study the barriers and facilitators in implementing a formal neonatal CRS discharge programme through the lens of healthcare providers.

Methods: We interviewed 10 allied health and nursing staff who received CRS training to find out the barriers and facilitators they perceived and experienced when engaging parents of newborns with CRS education prior to hospital discharge. Interviews were audio-recorded and transcribed verbatim. Inductive analysis sensitised by Billett's workplace-based learning theory was conducted using Braun and Clarke's thematic analysis.

Results: We constructed three themes. At the personal agency level, how participants viewed themselves and directed their cognition to the task affected their involvement in CRS education. At the social agency level, institutional and ward safety culture including the presence of ward CRS champions were powerful motivators for CRS education. Parental receptivity to CRS education was also important. Lastly, at the situational level, barriers to implementing a CRS discharge programme included factors such as competing duties at neonatal discharge.

Conclusion: Using a workplace learning theory, our study highlights that healthcare providers' commitment and delivery of CRS education at neonatal discharge is a complex interplay of personal agency, social agency and situational factors. Future efforts must address these factors to optimise the effectiveness of a neonatal CRS discharge programme.