Methods used with children

Various methods for developing risk information have been used within the risk communication and warning literature. This review collates the sources that are most relevant to designing risk communications for young children. The table below compares the approaches, groups involved, age ranges, and gender of children included in studies to date. The findings and limitations of each of the studies are discussed in this section to provide a comprehensive overview of the research that has been done and the gaps that exist.

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Table 2.4 Age ranges and methods

Literature Source and Keywords

Purpose and Aims Methods Participant

Numbers and Gender

Age Ranges Findings and Limitations of Study/Applicability to UK Boto et al., 2015. (Portugal) Warnings; Children; Safety; Design; Ergonomics

Focus is the design of a warning regarding a poisoning hazard targeting children from 9 to 12 years old. Investigates how children interoperate current warnings and what the principal characteristics are that children search for in a warning to interpret it correctly.

4 focus group sessions (4–5 children per group). Suggests that 4 or 5 participants are probably the ideal number of participants, especially if they are younger children.

(N = 20) 11 females and 9 males. 9 boys were divided into 2 sessions, one consisting of 4 and the second

of 5 participants. 11 girls were divided into 2 sessions of 5 and 6 individuals.

Children’s ages varied between 9 and 12 years old. Average age of 10.60 years (SD = 0.99). Girls: aged between 10 and 12 years old (10.36 years) (SD = 0.67).

Boys were aged between 9 and 12 years (10.89 years) (SD = 1.27).

Findings: Children had difficulties in correctly expressing the warning’s meaning, especially in terms of vocabulary.

Some guidelines for designing new poisoning warnings are provided. Limitations: It does not specify the duration of the focus groups.

Morrongiello et al., 2016. (Canada) Children; Unintentional Injury; Diving; Warning Signs

Addresses the lack of research on children. The study examines children’s understanding of both text and image features on ‘No Diving’ warning signs.

Structured interviews.

Children were asked questions to assess their understanding of text, images, and main messages on ‘No Diving’ warning signs. Parent filled out questionnaires regarding family demographics, child’s history of swim lessons, and experience in diving.

(N = 120) children. Equal number of males and females in each group.

One group of normally developing 7–10-year- olds (N = 62, 7.0 to 8.5 years, M age = 7.52 years, SD = 0.68 years) and an older group (N = 58, 8.8 to 10 years, M = 9.16 years; SD = 0.64 years).

Findings: Children do not routinely consider that permanent injury can result from diving into shallow water. Explicitly outlining consequences that you can “break your neck” may improve effectiveness.

Active supervision is particularly important to the safety of children with prior positive diving experiences, as this seems to constitute a “high risk” group.

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Literature Source and Keywords

Purpose and Aims Methods Participant

Numbers and Gender

Age Ranges Findings and Limitations of Study/Applicability to UK

Limitations: The sample in the study was mainly Caucasian, middle-income, well-educated families. A diverse sample should be tested in future because exposure to factors that could influence children’s understanding of diving risks (e.g., recreational water experiences, news stories/discussion about diving injuries) is expected to vary with income and parent education levels.

Morrongiello et al., 2010. (Canada) Children; Unintentional Injury; Risk Assessment; Questionnaire

The objective of this study was to develop a standardised questionnaire (BACKIE) that would assess the Behaviours (B), Attitudes (A), Cognitions (C), Knowledge (K), and Injury Experiences (IE) of elementary school children pertaining to seven types of injuries, including falls, motor vehicle collisions, burns, drowning, choking/suffocation, poisoning, and bicycle/pedestrian injuries.

20–30-minute activities during physical education classes so the children would understand that it was related to health and well- being. (N = 512) children (53% male). All children were fluent in English and none had any physical or mental disability or delay.

7 to 12 years.

There was good variation in scores across the ages tested, meaning that the

BACKIE items were

well suited to children 7 through 12 years of age.

Findings: Results indicated that this measure provides a reliable and valid indicator of elementary-school-aged children’s safety attitudes, cognitions, knowledge, and behaviour relevant to 7 broad types of injuries. It also clarified that it was easy to use: children readily understood the instructions and items, with very few asking clarification questions during administration. The BACKIE allows investigators to examine the relative importance of these factors in predicting risk and safety behaviours in children aged 7 through 12 years of age and allows for intervention planning.

Limitations: The questionnaire lacks evaluation.

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Literature Source and Keywords

Purpose and Aims Methods Participant

Numbers and Gender

Age Ranges Findings and Limitations of Study/Applicability to UK Siu et al., 2017 (Hong Kong) Colour Association; Colour; Ergonomics; Safety Signs; Children; Warnings; Reasoning; Participatory Ergonomics; Public; Design

To address a lack of recent research focusing on children and their colour association in the context of safety signs Different combinations of colours were also considered in view of the research gap identified in the literature review.

Analysis of children’s drawings and design to understand how children use colour in drawing different safety signs and how they associate colours with different concepts and objects that appear in the signs. Researchers observed and analysed colour in children’s drawings to understand children’s thoughts about sign design.

(N = 32) 16 male and 16 females.

7–11 years old. (The study conforms to Piaget’s stages of cognitive

development.)

Findings: Significant associations were found between red and ‘don’t’, orange and ‘hands’, and blue and ‘water’. The participants could explain the reasons for the use of certain colours based on concrete identification and concrete and abstract associations.

The children were unable to distinguish between referents’ different levels of hazard or to relate orange and yellow to lower levels of hazard such as warnings, as they also used red in some warning signs. The child participants were only able to identify the reasons for the use of yellow, green, blue, and black through concrete identification and concrete association, and red through abstract association.

Limitations: The study is applicable to the UK as the children’s knowledge of colours was assessed against ISO- registered signs. A small number of children participated in the study, Waterson and

Monk (2014). (UK)

Provides further development and refinement of a set of guidelines (Waterson et al., 2012) for the design and evaluation of warning signs and other visual material for

Set of 11 semi-structured interviews and 6 focus groups involving various experts for the evaluation of guidelines developed by Waterson et al. (2012). (N = 38) parents of young children, teachers, human-factors

N/A Findings: Models of sign comprehension and communication, e.g. the C-HIP model (Wogalter et al. 1999), need to be modified to accommodate adult-child interaction and involvement in the

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Literature Source and Keywords

Purpose and Aims Methods Participant

Numbers and Gender

Age Ranges Findings and Limitations of Study/Applicability to UK

Warnings; Signs; Children; Safety; Railways

young children (aged 5–11 years).

experts, and other groups.

process of building a negotiated mutual understanding.

Limitations: Need for a broader application of the guidelines and further behavioural testing with children. Waterson et al. (2012). (UK) Warnings, Signs, Children, Safety, Railway

To obtain children’s opinions on existing and novel safety signs.

The study involved the analysis of industry accident incidence data and a set of classroom discussions which lasted on average between 20–30 minutes with 4–6-year olds. With older children (7–10 years) the workshops lasted longer (45–60 minutes). (N = 210) children across 7 different classes. Males and females. Younger children (4–6 years) and older children (7–10 years). A small number of children in the reception class were 4 years old and a similar number in the Year 6 class were 11 years old.

Findings: A set of guidelines for the design of safety signs for young children. Need for summative assessment. Limitations: Conducting research with and extracting comments from children is challenging. Evaluation was carried out on the same group of children due to time constraints. Liu et al. (2015) (Taiwan) Young Children; injury burns; 5- Factor Accident Sequence; Story Telling

To analyse the within-corpus differences in the narratives of 60 6- and 7-year-old children. Specifically investigated whether illustrations (5-factor accident sequence) were or were not employed to assist children’s narration of a home accident in which a child received a burn injury from hot soup.

Storytelling. The researcher built a connection with the children by playing games. In step 2, to make the children focus on the experiment, they were told they would need to retell the story to their parents, who were not present. In step 3, the burn story was told. In step 4, the children were allowed to play games for 15 min after the storytelling. In step 5, the researcher asked the children to

(N = 60) children. Male and females were split evenly into 2 groups. (Ages 6–7) Normally developing children. (IQ of children was assessed)

Findings: Employing the combined oral storytelling and pictures approach can help 6- and 7-year-old children memorize the story and its specific content, such as “the dangerous objects that caused the burn injury”, “the reason why the protagonist committed the unsafe act”, “the unsafe act committed by the protagonist”, “the protagonist’s attitude toward the unsafe act that caused the burn”, and “feelings about the severity of the burn”.

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Literature Source and Keywords

Purpose and Aims Methods Participant

Numbers and Gender

Age Ranges Findings and Limitations of Study/Applicability to UK

retell the story to their parents, which was recorded on tape.

This study utilised the “story grammar” approach (Stein and Glenn, 1979). Limitations: This study only explored one risk situation. Other injury circumstances need to be assessed. There is a need for further testing with children. The authors recommend behavioural testing to examine the influence of presenting unsafe actions (i.e., critical factors for accident prevention) in warning information to promote behaviour changes.

Ricketts et al., 2010. USA Health communication; Injury prevention; Stories; Anecdotes; Safety Warnings; Accident prevention.

To examine the impact of injury stories on actual safety behaviour in a controlled experiment to assess how safety messages might be redesigned to have a greater impact on risky behaviour.

Using Story-based messages to convey risk communication messages.

Male and Female University students

N/A Findings: Story-based messages resulted in a 19% improvement in safety behaviour compared with non-narrative communications. Importantly, injury stories did not create undue fear of the message object, demonstrating that brief anecdotes about accident victims can convince people to take reasonable precautions without creating unwarranted alarm about risks.

Limitations: This study involved adults and no children.

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Discussion

This section discusses factors that may influence a child’s understanding of the communicated message based on the findings in the literature. The most up-to-date research is presented in the table above. From the review of the above literature sources, it is clear that there is insufficient empirical research on the development of effective risk communications aimed at young children. However, the studies that have been included are relevant to aid the researcher in further developing methods for the design and evaluation of risk communications aimed at 5- to 11-year-old children. The varying nature of these studies assists in gaining a broader understanding of risk communications.

The table above compares the limitations of some of the included studies. It highlights for example the varying age ranges and various countries that have been studied. The limited amount of research that has been conducted in the UK also limits the generalisability of these findings to the UK. The main limitations are summarised below:

• Age ranges vary

• Group sizes vary

• Ratio of male to female participants varies

• Few studies have been carried out in the UK

• Varying methods are used, although these are mainly qualitative rather than quantitative

• Need for further evaluation and behavioural testing

Research with adults has identified several factors that affect viewers’ understanding of the message communicated by a warning sign, including the language used (e.g., word choice, explicitness) and images contained within the message (Morrongiello et al., 2016). Boto et al. (2015) found that children’s vocabulary may limit their ability to understand and express the meaning of a warning. However, various studies show that storytelling is a method that has been effective in engaging both adults and children in understanding risk and promoting effective ways to communicate risk information to the end user (Ricketts et al., 2010; Liu et al., 2015). Ricketts., 2010 used storytelling

49 methods with adults, including using brief anecdotes about accident victims, and found that this can convince adults to take reasonable precautions. In addition, findings have shown that story-based safety messages result in a greater improvement in safety behaviour compared with non-narrative communications, suggesting that this method may also be suited for use with children. Liu et al. (2015) used storytelling methods with 60 normally developed children aged 6 to 7 years to research children and burn injuries in the home. The “story grammar” approach described by Stein and Glenn., 1979, was used in the study. The children were told a story involving a burn injury and subsequently asked to imagine that they were narrating the story to their parents, as the parents were not present during the data collection. The aim was to analyse the differences in the way that the children recounted the burns story. The study’s limitations include that the research only explored one injury circumstance. Hence, there is a need for a more comprehensive understanding of its applications in a variety of other circumstances relevant to young children. Similar to Waterson and Monk’s 2014 research outcomes, one of the outcomes from this research was the identification of a need for further behavioural testing with children.