Drivers’ Knowledge and Attitudes Towards Child Restraint System (CRS) Usage
Last reviewed: March 2026
Key Findings
- The study assessed Malaysian drivers’ knowledge and attitudes regarding child restraint system usage prior to the mandatory CRS legislation.
- Belted drivers were approximately four times more likely to use CRS for their children, demonstrating a strong link between adult and child restraint behaviours.
- Respondents in Kuala Lumpur and younger guardians were twice as likely to report CRS usage, highlighting urban-rural and generational divides.
- Graduate-level education was associated with 1.5 times higher likelihood of CRS use, indicating the role of education in safety behaviour adoption.
Background and Context
The adoption of child restraint systems (CRS) among Malaysian drivers has historically been influenced by a complex interplay of knowledge, attitudes, cultural norms, economic factors, and the regulatory environment. Understanding these determinants is essential for designing effective interventions to increase CRS uptake and, ultimately, reduce child occupant injuries and fatalities on Malaysian roads.
Malaysia’s road traffic environment presents distinctive challenges for child passenger safety. The country has one of the highest vehicle ownership rates in Southeast Asia, with the majority of households owning at least one private vehicle. Road traffic injuries have consistently ranked among the top causes of premature death in Malaysia, and children represent a particularly vulnerable demographic. Data from the Malaysian Institute of Road Safety Research (MIROS) have indicated that children transported as passengers in private vehicles account for the largest proportion of road traffic casualties among children aged 1 to 4 years (43.8%) and 5 to 9 years (30.2%).
Prior to the enforcement of mandatory CRS legislation on 1 January 2020, CRS use in Malaysia was voluntary, and usage rates were notably low by international standards. A roadside observation study in the Klang Valley documented CRS usage at approximately 27% among surveyed vehicles carrying child passengers. This low uptake reflected multiple barriers including limited awareness of CRS benefits, perceptions of high cost, difficulty with installation, and cultural preferences for holding children on laps during vehicle travel.
Knowledge and Attitude Determinants
This study examined the specific knowledge gaps and attitudinal factors that influenced CRS usage decisions among Malaysian drivers. The research design employed structured surveys to assess participants’ understanding of CRS types, appropriate selection criteria based on child age and size, correct installation procedures, and awareness of the injury prevention benefits of CRS use.
Several significant associations emerged from the analysis. Geographic location was a strong predictor: respondents based in Kuala Lumpur — the national capital and most urbanised area — were approximately twice as likely to use CRS compared to respondents from other areas. This urban-rural gradient likely reflects multiple factors including greater exposure to road safety messaging, higher average educational attainment, better access to CRS retail outlets, and more frequent encounters with enforcement and awareness activities.
Age of the guardian was another significant determinant, with younger guardians showing higher CRS usage rates. This generational pattern is consistent with international observations and may reflect the greater exposure of younger parents to contemporary child safety messaging through social media and digital platforms, as well as evolving cultural norms around child-rearing practices.
Education level emerged as an independent predictor, with guardians holding graduate-level qualifications being 1.5 times more likely to use CRS. This association underscores the role of general educational attainment — not just targeted road safety education — in shaping health-protective behaviours. The finding also highlights a potential equity concern: if CRS adoption is strongly correlated with education and urban residence, children in lower socioeconomic and rural settings may face disproportionate injury risk.
The Link Between Adult and Child Restraint Behaviour
One of the most robust findings in the Malaysian CRS literature, reinforced by this study, is the strong association between drivers’ own seatbelt use and their use of CRS for child passengers. Belted drivers were approximately four times more likely to have their children in appropriate CRS compared to unbelted drivers. This finding has important programmatic implications: interventions that increase adult seatbelt compliance may have spillover benefits for child restraint use. Conversely, it suggests that in the significant proportion of Malaysian vehicles where the driver remains unbelted, child passengers are also likely to be unrestrained.
Barriers to CRS Adoption
The study identified several key barriers to CRS adoption that align with broader research findings. Cost was the most frequently cited impediment, particularly among lower-income families. At the time of the study, quality CRS units complying with international safety standards typically cost between RM200 and RM1,500, representing a significant expenditure for B40 households. The perceived inconvenience of installing and transferring CRS between vehicles, combined with uncertainty about correct installation, also deterred usage. Some respondents expressed the belief that holding a child on an adult’s lap provided adequate protection — a dangerous misconception, as unrestrained children can be subjected to forces far exceeding an adult’s ability to maintain grip during a collision.
Implications and Recommendations
The knowledge and attitude data from this study informed the design of Malaysia’s CRS awareness and subsidy programmes that accompanied the 2020 legislation. Targeted communication strategies addressing specific misconceptions — particularly regarding the adequacy of lap-holding and the perceived safety of short journeys — are essential components of effective CRS promotion. The strong association between education level and CRS use argues for embedding child vehicle safety education within broader public health and parenting education programmes, rather than relying solely on standalone road safety campaigns.
Limitations
Self-reported survey data on safety behaviours are subject to social desirability bias, where respondents may overreport desired behaviours such as CRS use. The study’s geographic scope and sampling methodology may limit generalisability to the broader Malaysian population. Additionally, the pre-legislation timing means the findings reflect attitudes and behaviours in a voluntary CRS environment, which may have shifted substantially following mandatory enforcement.
Content shared under CC BY-NC 4.0 licence. © Malaysian Journal of Public Health Medicine.