摘要：We evaluated evidence of community interventions to improve Aboriginal child passenger safety (CPS) in terms of its scientific merit and cultural relevance. We included studies if they reported interventions to improve CPS in Aboriginal communities, compared at least pre- and postintervention conditions, and evaluated rates and severity of child passenger injuries, child restraint use, or knowledge of CPS. We also appraised quality and cultural relevance of studies. Study quality was associated with community participation and cultural relevance. Strong evidence showed that multicomponent interventions tailored to each community improves CPS. Interventions in Aboriginal communities should incorporate Aboriginal views of health, involve the community, and be multicomponent and tailored to the community’s circumstances and culture. According to the Centers for Disease Control and Prevention in the United States, motor vehicle crash (MVC)–related injury is the leading cause of death among American Indian and Alaska Natives aged 19 years and younger. 1 In Canada, results from the First Nations Regional Longitudinal Health Survey indicated that MVC is the fourth most common cause of injury among First Nations children. 2 In New Zealand, MVC-related injuries are the fourth most common cause of death for Māori children aged 1 to 4 years and the second most common for children aged 5 to 14 years. 3 Little is known about the prevalence of MVC injuries among Australian Aboriginal and Torres Strait Islander children; however, reports have indicated that these groups are particularly vulnerable to transport-related injuries because of poverty, geographical location, licensing, and nonuse of child restraints. 4,5 Moreover, other studies have identified nonuse of child safety seats as an important risk factor for MVC injury among Aboriginal children in North America. 6–8 Despite these figures, Aboriginal child passenger safety research is scarce and not readily available to researchers, policymakers, and other professionals. In effect, previous comparable systematic reviews have not included studies with Aboriginal populations and have not mentioned Indigenous groups at all. 9–15 (Note that for brevity, we use the terms “Aboriginal” or “Indigenous” to designate all First Nations, Inuit, Métis, Native Americans, Alaska Natives, Australian Aboriginals, Torres Islanders, and Māori peoples. However, when we use these terms, we are not implying that these groups belong to the same ethnic group or race, and we recognize that wide historical, cultural, and racial diversity exists among and within these groups.) This study we aimed to find, appraise, and synthesize all available evidence of community interventions to increase child safety seat use in Aboriginal populations. Specifically, we sought to answer 3 questions: (1) What are the best practices when conducting injury prevention research with Aboriginal communities? (2) How strong is the evidence that community interventions increase child safety seat use among Aboriginal passengers aged 0 to 12 years? and (3) How strong is the evidence that child safety seat laws increase use or reduce injuries among Aboriginal passengers aged 0 to 12 years? In addition, we set out to evaluate the cultural relevance of this evidence because we recognize that traditional systematic review methods are insufficient to evaluate Aboriginal research. Indeed, Indigenous views of legitimate knowledge and health differ from those of the Western scientific tradition. 16–18 Because culturally relevant Indigenous research implies that communities participate in theoretical and methodological decisions, 19,20 Aboriginal research that is culturally relevant is necessarily a distinct form of investigation. Consequently, we complemented Western standards of evidence quality with 2 characteristics of Indigenous health research found in the literature. First, the process is as important as the result. In Aboriginal research, the Western, result-focused approach of outcome evaluation should be extended to include the process: protocols of community engagement, relationships, and program dynamics. 17 These process components are important in Aboriginal research not only because they have an impact on long-term outcomes but also because the concept of “process” is akin to the idea of change and adaptation to circumstances. 17 In fact, Aboriginal programs are often described as a journey 2,21,22 in which no sharp distinction is made between input and output and in which the process is as important as the result. Second, health extends beyond the physical well-being of individuals and includes the social, emotional, and cultural well-being of the communities to which they belong. 5,18 This holistic view of health is prevalent across Indigenous peoples in North America and Oceania. 18,23,24 We acknowledge that this approach differs substantially from current scientific practice. Thus, we encourage readers to keep an open mind and, more important, to avoid analogies or equivalencies between components or characteristics of Aboriginal and Western epistemologies. To our knowledge, this systematic review is the first to evaluate population-level interventions to address child passenger safety in Aboriginal communities. Furthermore, this is the first time evidence-based interventions have been evaluated with a model that integrates Indigenous views of legitimate knowledge and health with the Western scientific tradition. In this way, we ensure that evidence is assessed not only for its scientific merit but also for its cultural relevance.
