Abstract
Background:
Over the past 5 years, the accident rate for children aged 1 to 6 has shown a decreasing trend, whereas the rate for infants (0–1 year) has been increasing in South Korea. This study aims to implement an intervention to improve infant safety among Vietnamese immigrant mothers in South Korea.
Design and methods:
This study utilized a pre- and post-test design with 15 Vietnamese immigrant mothers who were recruited from the Multicultural Family Support Center in C city, Korea. The research tools were safety knowledge, safety beliefs, and safety self-efficacy, and data collection was conducted through written surveys before and after the intervention. Then the collected data were analyzed using a Z-test for statistical analysis.
Results:
The intervention resulted in a significant improvement in participants’ safety knowledge, safety beliefs, and safety self-efficacy (all p = 0.001).
Conclusions:
These results demonstrate that the immigrant mothers are effective in preventing infant safety accidents and unintended injuries.
Introduction
Safety is one of the most fundamental human needs, everyone seeks a life free from danger and accidents. 1 Infant safety refers to the measures, practices, and precautions taken to protect infants (children from birth to 1 year of age) from harm, injury, or accidents. This includes safeguarding them from physical hazards and monitoring their activities to prevent potential accidents or injuries. 2 According to the dictionary definition, a safety accident is defined as an accident that occurs due to lack of safety education or carelessness. 3
Recent safety accident reports indicate that child-related safety accidents account for 28.2% of all safety accidents. This is notable considering the decreasing proportion of children in the total population, highlighting children’s vulnerability to safety risks. Among these, safety accidents in infants have shown a continuous increase over the past 5 years, in contrast to the declining trends observed in toddlers and preschoolers. 4 In South Korea, the child safety accident mortality rate is 2.3 per 100,000 children, which represents a decrease compared to previous years. However, this rate remains relatively high when compared to other countries in the Organisation for Economic Co-operation and Development (OECD). 5
According to the most recent statistics on child safety accidents, the most common place where safety accidents occurred was at home (65%), highlighting children’s vulnerability to safety risks within the home environment. 4 This suggests the need to enhance home safety environments and improve caregivers’ awareness. 6 In particular, infant safety accidents are closely linked to the upbringing environment and cultural practices. 7 Proper preparation and appropriate response can prevent these accidents and minimize subsequent damage and disability. 8 Therefore, parents who deeply understand risk factors and accident prevention strategies are better equipped to effectively prevent safety accidents and injuries. 9 To this end, interventions designed to prevent infant home safety accidents and injuries, specifically targeting mothers as primary caregivers, should be actively implemented.
In 2023, Vietnamese women comprised 27.9% of all marriage immigrant, surpassing those from China (17.4%) and Thailand (9.9%), making a 4.9% increase from the previous year. 10 Vietnamese immigrant women in Korea often undergo pregnancy and childbirth without sufficient time to stabilize and integrate into Korean society, and face challenges due cultural differences during childrearing. 11 Due to communication difficulties, they often lack access to essential information and education for child-rearing, and the imposition of Korean parenting styles frequently overlooks their cultural backgrounds.12,13 In particular, the economic, socio-demographic, and ecological characteristics of multicultural families in Korea present vulnerabilities, 14 thus appropriate education and social support are essential to address these issues and ensure the health and safety of infants.
However, existing safety education for parents in Korea of infants has mainly been conducted for parents of toddlers, not infants. 15 In addition, existing education is limited to single topics such as burns, sleep safety, and first aid which do not cover the full spectrum of infant home safety education. 15 Most notably, infant safety education is rarely provided for immigrant mothers in Korea. Prior research suggests that the optimal timing for home safety education for infants and young children is during pregnancy. Accordingly, educational interventions should be designed to include the transition to parenthood. 16 Therefore, there is a need for a comprehensive educational program for Vietnamese immigrant mothers in Korea that addresses the full range of safety accidents and injuries that can occur in the home, and provides effective, culturally relevant education.
The purpose of this study, therefore, was to implement an infant home safety education program for Vietnamese immigrant mothers.
Design and methods
Design
This study is a preliminary study to determine the effectiveness of an infant home education program on Vietnamese immigrant mothers’ knowledge, beliefs, and self-efficacy in infant safety. The research design is a one group pretest-posttest design. The knowledge, beliefs, and self-efficacy regarding infant safety were measured at baseline, and then the same variables were measured after the intervention was delivered.
Participants and setting
Participants’ inclusion criteria were: (1) Vietnamese immigrant women married to Korean husbands, (2) Vietnamese immigrant women who were currently pregnant or raising an infant child, and (3) those who had never participated in an infant home safety education program in Korea. Vietnamese women who were currently pregnant or preparing for pregnancy were included to reflect a preventive approach and to support the future scalability and practical implementation of the program.
There are two Multicultural Family Support Centers in C city. The researcher selected one of them because it has approximately 500 registered Vietnamese mothers (for reference, according to the 2023 statistics, there are 2198 Vietnamese residents in C city) and provided superior accessibility compared to other place. Thus, Participants were recruited through the Multicultural Family Support Center.
Those who met the inclusion criteria were invited to participate through public announcements and individual outreach by center staff. The purpose and procedures of the study were clearly explained, and informed consent was obtained from those who agreed to participate. Individuals who completed the consent form were included in the study. There were no formal non-responders, as all approached individuals who met the criteria and were available during the recruitment period agreed to participate. Additionally, a snowball sampling method was used, where initial participants introduced other eligible individuals within their social networks.
The Multicultural Family Support Center in C city was selected based on the researchers’ prior collaboration with the center and its expressed interest in participating in culturally tailored education programs. While similar centers exist throughout Korean, this location was chosen for convenience and feasibility in this exploratory phase of the study. The educational program was conducted at one of the branch offices of the center, providing a familiar and accessible environment for participants.
The sample size was calculated using G*power 3.1.3. for a Wilcoxon signed-rank test, with a significance level of 0.05, an effect size of 0.5, and a power (1 − β) of 0.8. The minimum required number of participants was 13. To account for a potential dropout rate, a total of 15 participants were recruited between September and October 2024, including through snowball sampling. Ethical approval was obtained from the Chungcheong university ethics committee.
Interventions
The contents of the infant home education program were developed based on a literature review,17,18 and included four sessions covering a safe sleeping environment, safe home environment, accident prevention, and first aid, as well as vaccination and infant check-ups (Table 1). Each session lasted 40–50 minutes and was conducted for 2 weeks in a group-based format. The entire program spanned 6 weeks, with five participants per group between November and December 2024.
Topics of infant home safety education program.
The first session was on a safe sleeping environment covered infant sleep location, position and surroundings. The second session focused on a safe home environment including bathing, playing, feeding, diaper changing area, as well as kitchen safety. It also covered the use of safety equipment such as car seats, carriers and strollers. The third session addressed accident prevention, including falls, burns, foreign body ingestion, suffocation, and first aid practice, prioritizing the most common household accidents. The fourth session focused on immunization and infant check-ups.
In the first session, an icebreaker activity called “Getting to Know Each Other” was conducted, followed by case-based education using videos. In the second session, participants drew their home environment and discussed its safety. In the third session, they practiced first aid for airway obstruction using an infant model. In the fourth session, they reviewed immunizations and discussed infant check-up questions related to safety.
Some educational sessions were designed to reflect cultural differences between Vietnam and Korea in raising infants. For example, time was set aside to discuss differences in infant sleep environments in Vietnam and Korea, as well as factors affecting infant safety due to variations in weather.
At the end of the first and second sessions, participants were given a home assignment and discussed it the following week. The validity of the educational program content was assessed by an infant health nurse and a pediatric nursing specialist. A Vietnamese interpreter facilitated the sessions, and the purpose of the study was explained to the participants through the multicultural family support center. Signed informed consent was obtained from all participants.
Evaluation measures
Infant safety knowledge
To measure infant knowledge in this study, this study used the infant safety knowledge tool adapted and modified from Han. 19 The infant safety knowledge tool was scored as “correct,” “incorrect,” or “not sure,” with one point for correct answers and 0 points for incorrect and not sure answers. The higher the sum of the scores for each question, the higher the level of knowledge related to infant safety. There were 18 total questions, with scores ranging from 0 to 18, including burns, sleeps, suffocation, car seats, and falls.
Infant safety beliefs
Infant safety beliefs in this study were measured using an instrument modified by Han. 19 The infant safety beliefs instrument is a 5-point Likert scale ranging from 1 for strongly disagree to 5 for strongly agree, with four subscales: mothers perceived sensitivity, severity, and benefits and barriers to practicing safety prevention behaviors. It consisted of 19 items with a total score range of 19–95, including four sensitivity, five severity, four benefits, and six barriers items.
Infant safety self-efficacy
To measure infant safety self-efficacy in this study, this study used the infant safety knowledge tool adapted and modified from Han. 19 The self-efficacy for infant safety tool is a 15-item, 6-point Likert scale ranging from 1 for “very much” to 6 for “very not much,” with scores ranging from 15 to 90. The higher the total score of items, the better the parents believe they are able to prevent their child’s safety accidents.
Satisfaction tool
The program satisfaction tool consisted of 17 questions, including two questions on overall evaluation of the program, nine questions on operational evaluation, and six questions on program effectiveness. The questions are answered on a 5-point Likert scale ranging from “not at all” to “definitely yes,” with scores ranging from 17 to 85. The higher scores indicating greater satisfaction with the program for each question.
In this study, the evaluations of the infant safety education program were conducted using measures of infant safety knowledge, infant safety belief, and infant safety self-efficacy. All measurements were taken pre-and post-intervention. Additionally, a satisfaction survey was administered after the education.
Data collection
Data were collected using questionnaires written in both Vietnamese and Korean, which were administered at both pre- and post-intervention time points. Additionally, a satisfaction survey was administered after the education
Data analysis
The collected data were statistically analyzed using IBM SPSS for Windows (version 26). Descriptive statistics, including frequencies and percentages, were used to summarize participants’ general characteristics.
Normality of the data was assessed using the Shapiro-Wilk test and visual inspection (Q-Q plot), which indicated that the data did not follow a normal distribution. Given the non-normal distribution of the data, the evaluation of the intervention was assessed using the Wilcoxon signed ranks test (Z), a non-parametric statistical method.
Results
General and infant safety-related characteristics of participants
The general and infant safety-related characteristics of the participants are as follows (Table 2). The majority of participants were in their 20s (N = 9), representing more than half of the sample. Most participants were primipara (N = 11). More than half of the mothers had an education level below high school. Furthermore, the majority of mothers lived with their husbands (N = 12), and has resided in Korea for over 3 years. None of the mothers smoked or drank alcohol, and none had previously attended any infant home safety education.
General and infant safety-related characteristics of participants.
Evaluation of infant home safety education program
The results of the infant home safety education program are shown in Table 3 and Figure 1. Infant safety knowledge showed a significant improvement between pre-and post-program (Z = −3.44, p = 0.001), indicating an increase in knowledge of infant safety. All sub categories showed significant differences.
Evaluation of infant home safety education program.
M: mean; SD: standard deviation.
Note. Wilcoxon signed-rank test was used. Significance level p < 0.05.
Comparison of scores in safety knowledge, safety beliefs, and safety self-efficacy.
Infant safety beliefs demonstrated a significant difference between pre-and post- program (Z = −3.81, p = 0.001), reflecting changes in beliefs about infant safety. In the sub categories, all but severity were significantly different.
Self-efficacy for infant safety also showed significant improvement from pre-and post-program (Z = −3.19, p = 0.001), indicating an increase in self-efficacy for infant safety. Additionally, satisfaction with the infant safety education program was 82.6 out of 85 points (97.2%).
Discussion
In this study, an infant home safety education program was implemented to enhance Vietnamese immigrant mothers’ knowledge, beliefs, self-efficacy regarding infant safety. The program addressed key topics including safe sleeping environments, safe home environments, accident prevention, and vaccination & infant check-ups. The results demonstrated significant improvements in participants’ knowledge, beliefs, and self-efficacy, suggesting that the program was effective and may contribute to promoting infant health. Furthermore, this group-based education approach provided valuable social support 20 for mothers raising children in a culturally different environment.
However, several potential drawbacks should be considered. The program content may not have fully addressed the diverse needs of mothers with varying levels of prior experience and knowledge. The program structures, which consisted of a limited number of sessions, may not have been sufficient to ensure long-term retention of information or sustained behavioral change. Additionally, while the group-based format fostered peer interaction and support, it may have limited opportunities for personalized feedback or individualized learning, which some participants may have required. Moreover, it should be noted that the one-group pretest-posttest design carries the potential for pretest sensitization effects, whereby exposure to the pretest itself may have heightened participants’ awareness of infant safety issues and contributed to the observed improvements. These limitations should be considered when interpreting the findings. Future program development could benefit from incorporating more tailored content, extending the duration of the program, and including individual follow-up components to enhance personalization.
Limitations
This study has several limitations. First, the participants included both mothers with and without prior experience raising infants, which may have influenced their baseline knowledge and responsiveness to the intervention. Second, the study did not assess whether participants actually implemented infant safety behaviors following the education program, limiting conclusions regarding behavioral change. Third, there is a possibility of selection bias, as participants were recruited through snowball sampling from a single Multicultural Family Support Center, which may have attracted mothers who were more motivated or interested in infant safety education. Additionally, the one-group pretest-posttest may have influenced participants’ awareness and learning outcomes. These factors should be considered when interpreting the findings.
Future implications and next steps
The results of this study showed positive outcomes in the infant home safety education for Vietnamese marriage immigrant mothers in Korea. The role of community health nurses is important because the growing number of multicultural immigrant mothers in Korea requires social support for their childbirth and parenting. 21 Therefore, community health nurses should systematically develop and implement infant safety education programs for multicultural mothers. These early intervention in the infant period reduces costs in socio-economic, 22 so early education to prevent infant safety accidents and injuries should be applied in the community.
The next steps is to develop an infant home safety education program grounded in theoretical frameworks. The effectiveness of the program will be evaluated by dividing participants into an experimental group and a control group. Since interaction with mothers is especially crucial during infancy, educational materials based on mother-infant interaction will be developed and applied to the program. 23
Footnotes
Acknowledgements
Not applicable.
Ethical considerations
The study design was approved by the appropriate ethics review board (IRB No. A-1st-2024-001 by Chungcheong University).
Author contributions
Conceptualization, SH.P, MH.K, MS,K, and J.L; Data curation, SH.L.; Formal Analysis, J.L. and MH.K.; Funding acquisition, SH.P.; Investigation, MS.K. and SH.L; Methodology, MH.K. and J.L.; Project administration, SH.P.; Resources, SH.L.; Software, MS.K.; Supervision, SH.P.; Validation, MH.K., MS.K., and J.L.; Visualization, SH.L.; Writing – original draft, MH.K. and MS.K.; Writing – review & editing, J.L. and SH.P. All authors have read and agreed to the published version of the manuscript.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT; RS-2023-00272660).
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data availability statement
This article’s data will be shared by the corresponding author on request.