The results showed that about 59% of mothers had an appropriate level of attitude towards home injury prevention. Also, mothers' injury prevention performance was estimated to be 66.59 (±12.85). Poisoning prevention performance got the highest score. Also, mothers' educational level, age, job, fathers' job and economic level of families emerged as mothers' injury prevention attitude and performance predictors.
Hatamabadi et al. (2012) study results revealed that 57% of the mothers, living in Tehran, had a positive attitude towards preventing the in-home injuries that are consistent with our study results (17). Bennet Murphy reported that none of the mothers participating in the study stated the injury prevention as a mothers' responsibility (14). Also, in the present study, 66.9% of mothers considered minor injuries to be normal; however, more than 85% of the mothers believed that in-home injuries could be prevented. This was similar to the findings of the Hooper et al. (2003) in New Zealand and the study conducted by Vincenten et al. (2005) in 14 European countries announcing that 84% and 75% of mothers believed that the in-home injuries could be avoidable, respectively (20, 21). On the other hand, the results of studies in Canada and America reported that most mothers believed that home injuries are unavoidable (13, 14). Regarding the fact that the mothers' attitude and performance are influenced by the community culture and the use of various methodologies in the studies, the difference in the results of studies could be discussed.
In the case of child sex, Sabely et al. (2014) reported that 58.7% of the in-home injuries occurred to boys (22). Similarly, the results of a study by Kamel et al., also indicated that boys were in the subject for injuries in 63% of cases (23). The previous literature also supported the same issue from Egypt, Turkey, and India such that more than 50% of the children injured in these studies were boys (16, 24, 25). Because the safety and health of the children under five years old mostly depend on their mothers; therefore, the mothers especially the mothers having sons should have better injury prevention knowledge, attitude, and performance. The results of our study showed that more than 55% of mothers having sons do not have an appropriate injury prevention attitude. No significant difference was observed between the mothers having sons and the mothers having a girl in injury prevention performance. A primary health care system as the first level of services delivery which has a continuous relation with mothers, needs to provide injury prevention knowledge promotion as part of their child care services.
Households' socioeconomic status is one of the main factors contributing to mothers' injury prevention attitude and performance. Hatamabadi et al. (2014) have introduced the salary of fewer than 300 dollars a month as one of the effective factors leading to low safety knowledge and attitude of mothers (17). Juhee Hong et al., (2010) stated the family's socioeconomic status including the educational levels of parents, residence place, occupation and income level as a determinant factor of home injury prevention attitude and performance of mothers (15). In the present study, a significant relationship was observed between the family's socioeconomic status and mothers' injury prevention performance and attitude. The job and educational level of the mother had a significant relationship with her attitude and performance in employing injury prevention strategies. Also, Sibley et al. had pointed out that mothers having higher educational levels have a higher knowledge about the ways to prevent in-home injuries than mothers with lower education (22).
Similarly, the significant relation between mothers' education and better home injury performance was pointed out in the study by Kamel et al. (23). However, according to the results of the study conducted by Lafta et al. (2014) in Iraq revealed some contrary results to the findings of the present and the previous studies, that mothers who possess higher educational levels, had a lower level of knowledge about home injuries prevention (26). Households' socioeconomic status is a function of community macro-policies. Therefore it is necessary that policy-makers be aware of their policies effects not only in child safety but also on families' general health. Improving building standards towards building child-friendly homes might be a good policy initiative to promote childhood quality in communities implementing safe community program.
Generally, it is expected that the attitude of individuals affects their behavior, but the lack of a significant relationship between the injury prevention attitude and mother’s performance was one of the most noticeable results of the study. In other words, the high levels of mothers' home injury prevention attitude would not necessarily result in better performance. This issue had been pointed out in previous studies that mothers high injury prevention knowledge leads to the high level of attitude; however, the high level of their knowledge and attitude would not result in their better performance or behavior in the prevention of the injuries (17). This finding shows the necessity to paying attention to the change in behavior and creating new behavior patterns resulting from the education provided for the mothers by PHC system. It should be considered that childhood quality, as one of the social determinants of health, can manifest throughout the lifetime of individuals. The important point is the adoption of proper educational and cultural policies to make changes in mothers' safety behavior to promote children quality of life (27). This would lead to a decrease in the injuries costs imposed on the families and the healthcare system. Using the mass media like TV, the radio and social networks to enhance mothers' knowledge and attitude, safety education to children at homes and kindergartens through drawing, animations etc. specially for the boys and the necessity to employ the safe equipment in leisure places and building houses are considered the items that can be taken into consideration in this regard.
Home safety and children safety are as essential initiatives in safe community program(28). As was evident with the study results, various factors contribute to home-injury prevention, and this requires intersectoral policy-making and collaboration for safety promotion which is followed in a safe community program.