Paths and their implications of parents' health literacy on road traffic injuries in children aged 0-6 years in China: a mixed methods approach.

Background: Road traffic injuries are a major global public health concern. Community-based interventions are an effective way to prevent unintentional injury in children aged 0-6 years. Parental health literacy is closely associated with child safety. This study explores whether the relationship and impact between the components of parents' health literacy are related to children's road traffic injuries.

Methods: We conducted a mixed-methods study. The first component involved a questionnaire to 352 participants and identified the paths between the components of parents' health literacy related to children's road traffic injuries, using structural equation modelling. The second component conducted semi-structured interviews with 35 experts and parents.

Results: The average total score of parents' health literacy was 76.29±7.65. Components ranked by score: 'use', 'understand', 'belief', 'access' and strengthening 'communication'. Confirmatory factor analysis global model fit well (Comparative Fit Index（CFI）=0.991,Root Mean Square Error Approximation(RMSEA)=0.024, Standardized Root Mean Square Residual(SRMR)=0.029). Significant direct effects: 'access' had an effect on 'communication', 'understanding' influenced 'belief', 'communication' and 'belief' influenced 'use', and 'use' influenced the occurrence of road traffic injuries. The standardised path coefficients were 0.200, 0.051, 0.241, 0.419 and -0.009, respectively. Two paths identified: 'access→communication→use→road traffic injury' and 'understand→belief→use→road traffic injury'. The semistructured interview identified the community-based intervention measures for addressing five priority problems. Finally, a conceptual framework was developed.

Conclusions: Community health education can leverage direct effects while considering behavioural influencing factors and developing targeted interventions to improve parents' health literacy to reduce or prevent road traffic injuries among children worldwide, especially in developed cities.