Health Education, its Methods and Effects on Parents’ Knowledge, Attitudes, and Behaviours to Prevent Unintentional Child Injuries at Home: A Systematic Review

Figures & data

Table 1. Example search using Medline.

Medline (OVID) Search terms

1. unintentional, child, injury/ 2. unintentional, child, accidents/ 3. unintentional, child, home injury/ 4. "unintentional child injury" 5. "child home accidents" 6. "child home injury" 7. (unintentional adj3 child injur*).ab,ti. 8. (unintentional adj4 child injur*).ab,ti. 9. (unintentional adj5 child injur*).ab,ti. 10. (child adj3 accident*).ab,ti. 11. (child adj4 accident*).ab,ti. 12. (child adj5 accident*).ab,ti. 13. injury or unintentional injury or domestic injury or home injury or home accident or trauma or preventable injury. 14. injur* or unintentional injur* or domestic injur* or home injury* or home accident* or trauma or preventable injur* 15. children or pediatric or child or childhood 16. child* or p?diatric 17. "health education" 18. (heath adj3 education).ab,ti 19. (health adj4 education).ab,ti. 20. health education or heath awareness or health teaching or child safety education 21. 1or 2 or 3 &15 & 19. 22. 5 or 6 & 17 23. 17 &18 24. 13&16&19

Table 2. Risk of Bias (ROB) summary.

ROB 2 for RCT	Bias arising from the randomisation process	Bias due to deviations from intended interventions	–	–	Bias due to missing outcome data	Bias in measurement of the outcome	Bias in selection of the reported result	Overall ROB
Cheraghi et al. (2014)	Moderate	High			Low	Some concern	High	High
Ning et al., 2019	Some concern	Low			Low	Low	Some concern	Some concern
ROBINS-I for Non-RCT	Bias due to confounding	Bias in selection of participants into the study	Bias in classification of interventions	Bias due to deviations from intended interventions	Bias due to missing data	Bias in measurement of outcomes	Bias in selection of the reported result
Ihalahewage et al. (2018)	Low	Moderate	Low	Low	Low	Low	Low	Moderate
Afshari et al. (2017)	Low	Moderate	Low	Low	Moderate	Low	Moderate	Moderate
El Seifi et al. (2018)	Low	Moderate	Low	Low	Moderate	Low	Moderate	Moderate
Furman et al. (2020)	Low	Moderate	Low	Low	Low	Low	Low	Moderate
Setien et al. (2014)	Low	Moderate	Low	Low	Low	Low	Low	Moderate
Habermehl et al. (2019)	Low	Moderate	Low	Low	Low	Low	Low	Moderate
Silva et al. (2016)	Low	Moderate	Low	Low	Low	Low	Low	Moderate
Kahriman and Karadeniz (2018)	Low	Moderate	Low	Low	Low	Low	Low	Moderate
Fardazar et al. (2016)	Low	Moderate	Low	Low	Low	Low	Low	Moderate
Amini et al. (2021)	Low	Moderate	Low	Low	Low	Low	Low	Moderate

Figure 1. PRISMA flow chart of the search process.

Table 3. Summary of included studies.

Author, year & Country	Design + population	Sample and setting	Outcome measure(s)	Study duration/ Follow up (Drop out from follow up %)	Findings summary
Afshari et al. (2017) Twiserkan, Iran	Design: Pre- and post-intervention study	Mothers of under 5 children: Intervention group n = 36 Control group n = 36 Settings: Health House^1 Rural	Tool: Pre-post-test three parts questionnaire: Part 1: sociodemographic factors Part 2: Injury history Part 3 (based on PRECEDE) Knowledge: 14 MCQ Attitudes: 15 Likert scale range from (very much agree to – not at all agree) Behaviour: 30 Q (YES-NO). Validation. Validity: Pilot study on 30 mothers Reliability: alpha coefficient used to measure reliability	2 months (0%)	Effective in improving mothers’ awareness of injury prevention
Amini et al. (2021) Hamadan, Iran	Design: Pre- and post-intervention study	Mothers with toddlers. Intervention n = 58 Control n = 58 Setting: Comprehensive health centres^2 Urban	Tools: Awareness assessed using 23 items- 2-point score (correct – incorrect answer)  Behaviour: Perceived behaviour: assessed using 10 items- 4-point scale ranging from 1 (little control) to 4 (complete control). Behaviour intention: 9 items- 4 points scale ranging from 1 (strongly disagree) to 4 (strongly agree) Attitude: measured using 16 items 4-point scale ranging from 1 (strongly disagree) to 4 (strongly agree).	2 months (No data given)	Training using TPB is effective in making changes on mother behaviour towards prevention of UCI.
Cheraghi et al. (2014) Hamadan City, West Iran	Design: Randomised controlled trial	Mothers of children <5years. Intervention n = 60 Control n = 60 Settings: Local Health Centre^2 Urban	Tool: three parts questionnaires: Part 1: sociodemographic Part 2: mother knowledge (15) MCQ + 20 Yes/No question + 23 Q based on Health Belief Model designed using six points Likert scale (agree to disagree)  Validation: Validity assessed by experts Reliability measured using Cronbach's alpha coefficients of 0.84	Two months (0%)	Education health programme based on HBM can be used to promote safety in children aged <5 years
El Seifi et al. (2018) Zagazig district- Egypt	Design: Pre-post-test design	Mothers with at least one child <5 years n = 244 Settings: Home visit Rural	Measurement: Pre- and post-test self-administered questionnaire adopted from questionnaire used in previous studies. Part 1: sociodemographic characteristics Part 2: Knowledge measured with 25 Y/N/Don't know questions Attitudes: an elven 3 points Likert scale questions (agree-neutral- disagree). Validation: Validity: Pilot study done on 24 participants Reliability: Questionnaire reliability was measured in previous studies with a Cronbach's α coefficient equal to 0.82 & 0.85 for knowledge and attitude respectively.	Two months (no data given)	Health education improves knowledge and attitudes of home injury
Fardazar et al. (2016) Joibar city, Iran	Design: Controlled interventional study.	Mothers of children <5 years. Control n = 95 Interventional n = 95 Settings: Two Health centres^2 Urban	Tool: A questionnaire designed by the researcher. Knowledge: 23 questions based on Motivation Protection Theory. Behaviour: 15 questions. Validation: Validity checked using content analysis method. Reliability checked using Cronbach's alpha	Two months (no data given)	Health education guided by Motivation Protection Theory can improve injury prevention behaviours among mothers.
Furman et al. (2020) Pittsburgh, USA	Design: interventional study	Parents or guardians aged over 18 of children <18 years. n = 50 Setting: community events open to the public. Low-income neighbourhoods. Urban	Tool: Questionnaire modified from an assessment tool used to evaluate home safety knowledge at a hospital at the university of Pittsburgh, USA. It included: 12 Q demographics 5 Q: MCQ home safety knowledge 17 Q: home safety behaviour	1: 4 weeks (42%) 2: 6 months (40%)	Education programme through Mobile Safety Centre improves mother knowledge and behaviour.
Habermehl et al. (2019) Cleveland, Ohio, USA	Design: Interventional study	Caregivers of children aged 1–4 years. n = 200 Setting: waiting area in paediatric primary care clinic Urban	Tool: Survey administered post intervention 1st part immediately after intervention: demographic data, session satisfaction, new knowledge. (Other information not they would like to learn). 2nd part: to evaluate changes made at home	Two weeks (16%)	93% of participants made safety changes at home
Ihalahewage et al. (2018) Sri Lanka	Design: quasi experimental Population: 71 families. Intervention group: 36 families	Families with children <5 years. Control n = 36 Intervention n = 36 Setting: home visits Rural	Tool: Pre -post-test questionnaire Knowledge: questionnaire. Injury incidence: a history record index Household practice: a 30 Q Likert scale checklist (very attentive – not attentive at all)	Three months (0%)	1/3rd of caregivers reported and improve of UCI prevention knowledge, practice, and attitudes
Kahriman and Karadeniz (2018) Turkey	Design: A quasi-experimental single group	Mothers of children <6 years. n = 300 Setting: primary health centre Urban	Measurement Tools: Tool 1: 33 items questionnaire for sociodemographic factors Tool 2 attitudes: 40 items 5 points Likert scale - "The 0–6-year-old Children's Mothers' Identification Scale of Safety Precautions for the Prevention of Paediatric Injuries" (Cinar 1999). Cronbach’s alpha 0.78. Tool 3 a checklist- The Risk Assessment Form for Paediatric Injuries (no author details, possibly Cinar).	One month (No data given)	Training was effective to raise mother's awareness of child safety at home.
Ning et al. (2019) Changsha, China	Design: RCT	Primary caregivers of children aged 3–6 years. Control n = 1285 Intervention n = 1406 Setting: Home Urban	Scales Adapted from the Injury Behaviour Checklist (IBC) (Morrongiello and House 2004). Worry Assessment and Risk Estimation (WARE) (Will et al. 2009). Validation. Test-retest reliability Attitudes: rs=0.69, behaviours: rs=0.64,	Three months (Intervention 23% Control 24%) Six months (Intervention 31%, Control 39%)	Health education using phone app significantly improved caregiver's safety behaviours. The intervention had no significant change in attitudes.
Setien et al. (2014) Hidalgo County, Texas, USA	Design: Pre-post-test intervention.	Hispanic family with child aged 1-14years. n = 88 households Setting: Community centres. Urban.	Tool: Self-administered True/False questionnaire post-test: 10 questions	Two months (0%)	Changes in safety behaviours reported
Silva et al. (2016) Imperatriz, State of Maranhão, Brazil	Design: quasi-experimental intervention study- pre and post-test- no comparison group	Mothers of children <5 years. n = 155 Setting: Primary Care Centre^2 Urban	Tools: self-administered pre- post-test questionnaire MCQ for sociodemographic Knowledge and attitudes: Pre-post- "Mortality Reduction by Accidents and Violence" (Brazilian Ministry of Health 2001) Validation: Pilot Study	Immediate (0%)	Significant changes in participants knowledge

^a A health house is a local centre shared by a small number of villages in rural Iran focused mainly on health promotion and illness prevention. These are the first point of contact with the Iranian health service for most people.

^b Comprehensive health centres and/or local health centres affiliated with a university are primary care settings that manage greater complexity than a health house.

Table 4. Summary of Education Intervention

Study ID	Duration (group size)	Framework used in design or delivery of education	Delivery methods	Aim of intervention when discernible	Content if discernible
Afshari et al. (2017)	4 h	PRECEDE (Green and Kreuter, 2005)	Lecture Group Discussion Q&A Instructional booklet	To motivate and modify inappropriate performance.	Factors associated with injury in the home identified from Rezapur-Shahkolai et al. (2017)
Amini et al. (2021)	4 h (10–15)	Theory of Planned Behaviour (Ajzen 1991)	Lectures, Group discussion Q&A Instructional booklet		Developmental stages of toddlers, common injuries, preventative strategies, ability to control risk factors.
Cheraghi et al. (2014)	4 h	Health Belief Model (Rosenstock et al., 1988)	Lecture Group Discussion	To present factors affecting mothers’ practices and knowledge. To address perceived severity, perceived barriers, cues to action and self-efficacy regarding child safety.	Safety promotion and injury prevention informed by the scientific literature.
El Seifi et al. (2018)	45 min (8–10)	–	Lecture Group discussion Q&A Videos Instructional booklet	Increasing knowledge and self-efficacy.	Scientific message based on Centres for Disease Control and Prevention child safety and injury prevention guidance (Centres for Disease Control and Prevention 2019). Risk factors for injuries and methods of prevention.
Fardazar et al. (2016)	90 min (15)	Protection Motivation Theory (Rogers and Prentice-Dunn, 1997)	Lecture Q&A Video	Increase perceived vulnerability and severity in children under 5 years. Increase self-efficacy and behaviours in injury prevention.	Child development and injury risks, prevention strategies.
Furman et al. (2020)	20 min (Small groups or one-to-one)	Standardised curriculum developed by the Safety Centre at UPMC Children’s Hospital, Pittsburgh, US.	No detail of teaching method. Provision of safety equipment (smoke detector, outlet covers, doorknob covers, cabinet latches, gun lock).	Increased used of safety equipment including that provided as part of the programme
Habermehl et al. (2019)	10 min(One to one)	American Academy of Pediatrics recommendations.	No detail of teaching method but it involved a learned script. Provision of safety toolkit (handouts, poison control magnet, window locks, outlet covers)	Provision of age-specific injury prevention information	Car safety, fall safety, home safety, injury prevention, poison control.
Ihalahewage et al. (2018)	Two occasions, no duration given. (18)	Health Belief Model (Rosenstock et al., 1988)	Discussion stimulated by use of visual aids. Collation of knowledge	Improved understanding of the determinants of poor safety.	Risks in the home, role of family support, attitudes and beliefs relating to injuries.
Kahriman and Karadeniz (2018)	One occasion, no duration given. (One to one)	–	Discussion stimulated by use of visual aids.	Raising awareness and knowledge of prevention of injury	Dangerous situations and how to prevent them.
Ning et al. (2019)	No duration given. (One)	Theory of Planned Behaviour (Ajzen 1991) Haddon Matrix (Barnett et al., 2005) Framework for Rational Analysis of Mobile Education (FRAME) (Yin et al., 2013)	Information delivery (text, cartoons, video). Interactive games.	Effectiveness of using an app-based mobile phone intervention to prevent unintentional injury.	Parenting skills, unintentional injury prevention, paediatric disease risk.
Setien et al. (2014)	2 h.	Raising Safe Kids: One stage at a Time (Safe Kids USA 2009)	No detail	Improvement of knowledge and behaviour in parents.	Burns, falls, household fires, choking, suffocation, drowning, falls, vehicular accidents, poisoning, hazardous household products, firearms, sports.
Silva et al. (2016)	30 min	–	Information giving. Discussion with use of visual aids.	Understanding mothers’ knowledge about prevention of accidents.	Prevention of burns, poisoning, drowning and falls.

Table 5. Change in parent/caregiver knowledge, attitudes and behaviours associated with health education intervention.

	Intervention (I) Control (C)	KNOWLEDGE					ATTITUDE					BEHAVIOR
		Pre-Mean (SD)	Post Mean (SD)	% change	Within group p	Between group p	Pre Mean (SD)	Post Mean (SD)	% change	Within group p	Between group p	Pre Mean (SD)	Post Mean (SD)	% change	Within group p	Between group p
Afshari et al. (2017)	I	10.00 (2.44)	12.67 (0.99)	26	<0.001	<0.001	67.06 (5.77)	72.31 (3.12)	8	<0.001	<0.001	22.31(4.30)	29.17 (0.775)	30.7	<0.001	<0.001
	C	9.47 (3.26)	9.75 (1.67)	3	0.439		61.75 (6.35)	65.42 (5.3)	6	0.040		23.81 (5.35)	22.81 (4.452)	0	0.194
Amini et al. (2021)	I	18.4 (1.5)	20.2 (2.27)	9	<0.001	0.004	17.86 (3.62)	23.2 (6.82)	30	<0.001
	C	18.84 (1.73)	18.86 (1.85)	0	0.058		19.33 (5.86)	18.7 (5.68)	0	0.089
Cheraghi et al. (2014)	I	8.43 (3.77)	13.15 (1.09)	56	0.001	0.001
	C	7.17 (2.26)	7.90 (2.27)	10	0.028
El Seifi et al., 2018							4.05 (1.1)	8.05 (1.5)	99	<0.001
Fardazar et al. (2016)	I											7.89 (2.36)	12.91 (2.11)	63.6	0.001
	C											8 (2.46)	8.07 (2.38)	0.87	0.3
Furman et al. (2020)		3.9 (0.6)	4.4 (0.5)	13	0.01
Ihalahewage et al. (2018)^3	I	15 (46.16)	31.57 (87.35)	110			13.66 (43.42)	31.83 (87.96)	133			36.25 (5.7)	43.72 (6.3)	20.6	<0.001
	C	18.57 (58.66)	19.85 (63.20)	7			18 (53.49)	20 (62.05)	11			39.94 (4.98)	41.69 (5.12)	4.3%	<0.001
Kahriman and Karadeniz (2018)							165.81 (16.36)	176.76 (12.97)	7	<0.001		14.6 (9.8)	8.0 (2.0)	-	0.362
Ning et al. (2019)	I						6.6	6.8	3			47	48.9	4.04
	C						6.6	6.7	2			47.2	48	1.6
Setien et al. (2014)		12.4 (0.85)	12.9 (0.63)	4	< 0.001							83%	96%	13
Silva et al. (2016)		78.16%	90.7%	13	≤ 0.05

^a Blank cells denote that a technique was not directly mentioned or implied. A series of blank cells indicates that no methods of delivery were given.

^b [(post- pre)/pre] *100 (rounded to nearest integer).

^c Reasons for injury occurrence combined means and standard deviations using online software (http://www.obg.cuhk.edu.hk/ResearchSupport/StatTools/CombineMeansSDs_Pgm.php).

Cheraghi, P., Poorolajal, J., Hazavehi, S., & Rezapur-Shahkolai, F. (2014). Effect of educating mothers on injury prevention among children aged< 5 years using the health belief model: A randomized controlled trial. Public Health, 128(9), 825–830. https://doi.org/10.1016/j.puhe.2014.06.017

 PubMed Web of Science ®Google Scholar

Ning, P., Cheng, P., Schwebel, D. C., Yang, Y., Yu, R., Deng, J., Li, S., & Hu, G. (2019). An app-based intervention for caregivers to prevent unintentional injury among preschoolers: Cluster randomized controlled trial. JMIR MHealth and UHealth, 7(8), e13519. https://doi.org/10.2196/13519

 PubMed Web of Science ®Google Scholar

Ihalahewage, N., Fernando, W. M. S., & Weliange, A. A. S. S. (2018). Health promotion approach to reduce unintentional home injuries of young children in rural villages in the north central province of Sri Lanka. Sri Lanka Journal of Child Health, 47(1), 33–39. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85060114017&doi=10.4038%2fsljch.v47i1.8427&partnerID=40&md5=f2ca5ae7322238abe9d0cdfed264950b https://doi.org/10.4038/sljch.v47i1.8427

 Google Scholar

Afshari, M., Moghimbeigi, A., Hazavehei, S. M. M., & Rezapur-Shahkolai, F. (2017). Effect of a model-based educational program for mothers, on home-related injury prevention among under-five-year children in rural Twiserkan, Iran. The Turkish Journal of Pediatrics, 59(6), 648–656. https://doi.org/10.24953/turkjped.2017.06.005

 PubMed Web of Science ®Google Scholar

El Seifi, O. S., Mortada, E. M., & Abdo, N. M. (2018). Effect of community-based intervention on knowledge, attitude, and self-efficacy toward home injuries among Egyptian rural mothers having preschool children. PLoS One, 13(6), 1. https://search.proquest.com/docview/2058501785?accountid=8630 https://birmingham-primo.hosted.exlibrisgroup.com/openurl/44BIR/44BIR_Services?genre=article&issn=1932-6203&title=Effect+of+community-based+intervention+on+knowledge%2C+attitude%2C+and+self-efficacy+toward+home+injuries+among+Egyptian+rural+mothers+having+preschool+children.&volume=13&issue=6&date=2018&atitle=Effect+of+community-based+intervention+on+knowledge%2C+attitude%2C+and+self-efficacy+toward+home+injuries+among+Egyptian+rural+mothers+having+preschool+children.&spage=e0198964&sid=ProQ%3Amedline&author=El+Seifi https://doi.org/10.1371/journal.pone.0198964

 Web of Science ®Google Scholar

Furman, L., Strotmeyer, S., Vitale, C., & Gaines, B. A. (2020). Evaluation of a mobile safety center's impact on pediatric home safety knowledge and device use. Injury Epidemiology, 7(1), 1–9. https://doi.org/10.1186/s40621-019-0228-5

 PubMedGoogle Scholar

Setien, M. A., Han, D., Zuniga, G. C., Mier, N., Lucio, R. L., & Treviño, L. (2014). Does injury prevention education initiate household changes in a spanish-speaking minority population? Journal of Community Health, 39(1), 167–172. https://doi.org/10.1007/s10900-013-9755-0

 PubMed Web of Science ®Google Scholar

Habermehl, N., Diekroger, E., Lazebnik, R., & Kim, G. (2019). Injury prevention education in the waiting room of an underserved pediatric primary care clinic. Clinical Pediatrics, 58(1), 73–78. https://doi.org/10.1177/0009922818806315

 PubMed Web of Science ®Google Scholar

Silva, E. C. S., de Fátima Fernandes, M. N., Sá, M. C. N., de Souza, L. M., de Araújo Gordon, A. S., de Jesus Costa, A. C. P., de Araújo, T. S., da Silva Carvalho, Q. G., Maia, C. C., & Machado, A. L. G. (2016). The effect of educational intervention regarding the knowledge of mothers on prevention of accidents in childhood. The Open Nursing Journal, 10(1), 113–121. https://doi.org/10.2174/1874434601610010113

 PubMedGoogle Scholar

Kahriman, I. L., & Karadeniz, H. (2018). Effects of a safety-awareness-promoting program targeting mothers of children aged 0-6 years to prevent pediatric injuries in the home environment: Implications for nurses. Journal of Trauma Nursing: The Official Journal of the Society of Trauma Nurses, 25(5), 327-335. https://search.proquest.com/docview/2105041569?accountid=8630 https://birmingham-primo.hosted.exlibrisgroup.com/openurl/44BIR/44BIR_Services?genre=article&issn=10787496&title=Effects+of+a+Safety-Awareness-Promoting+Program+Targeting+Mothers+of+Children+Aged+0-6+Years+to+Prevent+Pediatric+Injuries+in+the+Home+Environment%3A+Implications+for+Nurses.&volume=25&issue=5&date=2018+Sep%2FOct&atitle=Effects+of+a+Safety-Awareness-Promoting+Program+Targeting+Mothers+of+Children+Aged+0-6+Years+to+Prevent+Pediatric+Injuries+in+the+Home+Environment%3A+Implications+for+Nurses.&spage=327&sid=ProQ%3Amedline&author=Kahriman https://doi.org/10.1097/JTN.0000000000000384

 PubMed Web of Science ®Google Scholar

Fardazar, E. F., Solhi, M., Mansori, K., Mansouri Hanis, S., & Hashemi, S. S. (2016). Assessment the effect of educational intervention on preventive behaviors of home accidents in mothers with children less than 5-year based on protection motivation theory (PMT). International Journal of Pediatrics, 4(7), 2051–2059. http://ijp.mums.ac.ir/article_6751.html

 Google Scholar

Amini, R., Kalvandi, N., Khodaveisi, M., & Tapak, L. (2021). Investigation of the effect of education based on the theory of planned behavior on the mothers’ preventive practices regarding toddler home injuries. Home Health Care Management & Practice, 33(4), 250–257. https://doi.org/10.1177/10848223211000048

 Web of Science ®Google Scholar

Green, L., & Kreuter, M. K. (2005). Health program planning: An educational and ecological approach. McGraw Hill.

 Google Scholar

Rezapur-Shahkolai, F., Afshari, M., Moghimbeigi, A., & Hazavehei, S. M. M. (2017). Home-related injuries among under-five-year children and mothers’ care regarding injury prevention in rural areas. International Journal of Injury Control and Safety Promotion, 24(3), 354–362. https://doi.org/10.1080/17457300.2016.1200628

 PubMed Web of Science ®Google Scholar

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T

 Web of Science ®Google Scholar

Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the health belief model. Health Education Quarterly, 15(2), 175–183. https://doi.org/10.1177/109019818801500203

 PubMedGoogle Scholar

Centres for Disease Control and Prevention. (2019). Protect the one's you love: Child Injuries are Preventable. US Department of Health and Human Services. Retrieved January 21, 2022, from https://www.cdc.gov/safechild/publications.html

 Google Scholar

Rogers, R. W., & Prentice-Dunn, S. (1997). Protection motivation theory. In D. S. Gochman (Ed.), Handbook of health behavior research 1: Personal and social determinants (pp. 113–132). Plenum Press.

 Google Scholar

Barnett, D. J., Balicer, R. D., Blodgett, D., Fews, A. L., Parker, C. L., & Links, J. M. (2005). The application of the haddon matrix to public health readiness and response planning." Environmental Health Perspectives, 113(5), 561–566. https://doi.org/10.1289/ehp.7491

 PubMed Web of Science ®Google Scholar

Yin, C., Song, Y., Tabata, Y., Ogata, H., & Hwang, G.-W. (2013). Developing and implementing a framework of participatory simulation for mobile learning using scaffolding. Educational Technology & Society, 16(2), 137–150. https://www.jstor.org/stable/10.2307/jeductechsoci.16.2.137

 Web of Science ®Google Scholar