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

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.