Parental awareness of schoolbag carriage: A comparative study of Irish and United States parents

1Introduction

Carrying a schoolbag is a worldwide activity that is undertaken by children from the age of approximately four to 18 years. Given the ubiquitous nature of the activity, there has been extensive research on schoolbag use with resultant guidance on many aspects of carrying a schoolbag such as the optimum type of bag, schoolbag features, method of carriage, and the weight of the schoolbag. In Europe and Australia the guidelines state that children can carry a schoolbag that weighs up to 10% of their body weight (BW) [1–5]. In the United States, the American Occupational Therapy Association (AOTA) (2014) [6], recommends 10% BW as the upper limit, the American Physical Therapy Association (APTA) (2014) [7], recommends 10–15% BW and the American Academy of Pediatrics (AAP) (2014) [8], recommends 10–20% BW.

From a review of the literature, it appears that children and their parents do not generally adhere to the advice of health care professionals on guidance related to schoolbag use. Regardless of the lack of consensus, and the use of unsubstantiated schoolbag weight limits that are based on a child’s body weight, guideline load limits still exist [9, 10]. But extensive research has demonstrated poor compliance with specific schoolbag weight guidelines [3, 11–13]. However adherence implies the person’s agreement and willingness to follow a recommended plan [14, 15]. In order to adhere or be compliant, a person needs an understanding about what it is they are expected to be compliant with [16] and have the ability to be compliant [17]. In the case of schoolbag carriage, although there is a large body of research on the compliance or adherence of children to the guidelines, there is limited research to validate that children or their parents have ever received information or advice about schoolbags [18] and are therefore not aware of schoolbag issues [19].

Only a small number of studies have investigated parents’ awareness of schoolbag carriage [19–23]. Parents’ awareness of recommended schoolbag weight has been reported to be low [20, 21] with less than half aware of the recommended weight limit (48.4% and 45.5% respectively). In contrast, it was found that over two-thirds (67.6%) of parents were aware of schoolbag load limits [23] and Magrabi et al (2015), reported that 83.9% of parents stated that the ideal schoolbag weight should be <15% of the child’s BW [22]. However, in all studies a binary response (Yes/No) was required and hence parents had a 50/50 chance of giving the correct answer. Gender differences in levels of awareness were also reported with fathers being more aware than mothers of the recommended weight limit [20, 21].

A proposed strategy to control schoolbag weight could be the involvement of parents to monitor the contents of their child’s schoolbag, as it has been found that parental awareness is associated with schoolbag weight [21]. Yet, it has been reported that many parents never check their child’s bag weight [19, 22]. Forjuoh et al (2003), also reported that significantly heavier schoolbags were carried by children whose bags had never been checked [19]. However, a limitation of their study is the data collected was based on the children’s self-reports.

The level of parental awareness of the type of bag has been shown to be satisfactory with the majority of parents choosing a backpack [21, 22]. It has also been found, with one exception (Magrabi et al. 2015), that parents are aware of the optimum method of carriage [20, 21, 23], with fathers significantly more knowledgeable about the method of schoolbag carriage than mothers [20, 21]. Furthermore, it was reported that parents with lower educational levels had lower awareness of optimal schoolbag use [21]. Poor awareness of the correct size of a schoolbag has been reported [20, 22] with only 10.9% and 10.4% respectively of parents being aware that the schoolbag should fit the child.

Knowledge translation has been defined as ‘ensuring that stakeholders are aware of and use research evidence to inform their health and healthcare decision-making’ [24, p.2] but there is limited evidence of this for schoolbag carriage. It seems reasonable that advice on best practice for schoolbag carriage should be provided to parents, children and teachers. Carrying a well-designed and correctly-fitted backpack over both shoulders has been accepted by the research community and professional organizations as the optimum method of schoolbag carriage in the real-world setting. Therefore, the focus of research on schoolbag characteristics and carriage should be on what is required to improve parental adherence to schoolbag-related advice, given that parents are the best-placed advocates for their childrens’ health. The dearth of research in this area means that it has not been established what parents already know about schoolbag carriage. Nor have the platforms for knowledge translation to parents been identified. The objectives of this study were to establish the level of parental awareness about: (i) schoolbag type and design features; (ii) schoolbag use; and (iii) the effects of wearing a schoolbag. Further objectives were to: (iv) establish the sources of acquired information if appropriate and (v) establish the preferred platforms of the parents for receiving information about schoolbag use.

2Method

3Results

A total of 700 questionnaires were completed by Irish (n = 444) and United States (n = 256) parents representing response rates of 64.6% and 25.6% respectively.

3.5Information

Only 7.4% (n = 33) of Irish parents and 19.5% (n = 50) of United States parents had ever received information on appropriate schoolbag use, most commonly through media platforms (n = 18 [n = 16]), school (n = 11 [n = 10]), online (n = 8 [n = 10]) and other (n = 11 [n = 12]). Parental educational level was not significantly associated with whether or not parents had received information (p = 0.216 [p = 0.728]).

A significantly greater proportion of Irish parents expressed interest in receiving guidance than US parents (70.8% vs 55.1%; p < 0.0001). A handout and online were the preferred educational platforms (Fig. 1). Parental age (<40: ≥40 years) was not associated with preference for a handout (p = 0.076; [p = 0.134]). Age was not associated with preference for online information among Irish parents (p = 0.769), but older US parents were significantly more likely to request online information than younger parents (p = 0.005).

Fig.1

Preferred platforms for receiving information (n = 313 [141]). *Respondents could choose more than one option.

4Discussion

This study investigated parental awareness of factors related to schoolbag carriage, and made comparisons between Irish and United States parents. In keeping with the findings of previous studies [21, 22], most children owned a backpack. However despite this, fewer parents identified it as the most suitable schoolbag, suggesting that although backpacks were purchased, parental awareness was lower regarding their suitability. A minority of children owned a wheeled bag, but a greater proportion of Irish parents reported it as being the most suitable schoolbag. This finding is a cause for some concern because parents may perceive that wheeled bags relieve the load to be carried, but they may not be aware that the bags must be lifted using awkward postures [27] when the child is negotiating stairs and kerbs (curbs) [28]. It was also found that owning a wheeled bag was significantly associated with having a heavy bag (≥10% BW) [28]. In the current study, younger Irish children were significantly more likely to own wheeled bags and older children backpacks, which may suggest that older children play a role in the schoolbag selection. This illustrates the need for parental education to aid schoolbag selection for younger children. Parents who are better informed would be able to choose a suitable bag despite the marketing strategies that may encourage them to do otherwise. Furthermore, it highlights the need for education of those involved in design, production, marketing and retailing of school bags.

A positive finding was that the majority of parents identified the ideal mode of carriage as having straps on both shoulders [29], implying adequate parental knowledge. This finding is in keeping with one previous study [23] but is in contrast to others [21, 22] who reported that awareness of method of schoolbag carriage was low. It has been identified that a lower level of education was associated with lower parental awareness of method of carriage [21], but the current study found no difference in awareness across educational levels. The proportion of parents with a third level education was significantly higher in the current study (67.3% [86.5%]) than in Dianat and Karimi’s study (25.7%) [21], and this may account for the discrepancy between the two findings. A further positive finding was that parental awareness of the importance of specific schoolbag features was excellent, and consistent with the findings of others [20, 23]. The hip strap was the exception with only 37.2% and 21.9% of Irish and United States parents aware of its importance, similar to previous observations [22, 23]. Although considered important for backpacks worn by adults [30] as it helps to distribute the load, it appears that the hip strap is not thought to be an important schoolbag feature.

Parental interest and involvement in their child’s schoolbag use has been proposed as a strategy to reduce the loads carried by children [19, 21] and to promote safe and optimum schoolbag carriage [20]. It has been found previously that parental involvement in monitoring the schoolbag contents of 6–12 year olds was low [19, 22]. However, in stark contrast only 1.1% of Irish parents in this study had never checked the contents, with 90.5% checking the contents at least once a week. Younger children were significantly more likely to have their schoolbag checked by a parent, which is an expected finding as their level of parental dependence would be higher than that of older children. This association was not tested in previous studies and therefore no comparisons could be made.

Notwithstanding the limited scientific evidence, the European schoolbag load limit is up to 10% of the child’s bodyweight [1]. As the standard European recommendation, it could be assumed that parents would be informed, but only 17.8% of Irish parents selected this response. A significantly greater proportion of the United States parents (52.3%) chose a correct response. Both groups of parents were presented with the same eight possible response options, however only one answer (<10% BW) was correct for Irish parents, whereas the United States parents could choose from one of 3 correct answers (<10%, <15%, <20% BW) as all were in keeping with various United States guideline schoolbag weights [6–8]. The proportion of Irish parents who choose the correct load limit was also considerably lower than parents in any other study [20–23]. However the number of response options was greater in the current study than in previous studies, making it more difficult for the participants to identify the correct answer. Awareness of the United States parents in this study was in keeping with others [20, 21] and was considered to be generally low. In other studies, good awareness of schoolbag weight has been demonstrated [22, 23]. However, the fact that the guideline weight limits are not supported in the literature raises the bigger question of why they persist as part of the guidelines for schoolbag carriage. Schoolbag weight limits that are based on a percentage of the child’s bodyweight are unfounded [10, 31, 32] and therefore should be removed from guidelines disseminated to parents. Advice from academics, health promotion units and professional organizations should be evidence-based and include the broader factors such as schoolbag type, features and method of carriage, with less emphasis on the schoolbag weight.

Parents were largely unaware that there may be positive effects of schoolbag carriage. Carrying a schoolbag is a form of regular physical activity and as such could have some positive health benefits for the child, yet few Irish and no United States parents identified schoolbag carriage as exercise. Parents with a lower education level were less aware of positive and negative effects of schoolbag carriage, suggesting the need for better education on the benefits and consequences of schoolbag carriage. This was consistent with Dianat and Karimi who also found an association between awareness of schoolbag use and parental level of education [21]. A greater proportion of parents stated that schoolbag carriage could have a negative effect on their child. Back pain (75.1%) was more frequently cited as a negative consequence than shoulder pain (22%). It is interesting that there was a much greater perceived association between schoolbag carriage and back pain, as it has been found that schoolbag-related discomfort was more often reported in the shoulders than in the back [12, 31, 33]. Although not investigated in the study, the effects of schoolbag carriage could be influenced by adherence to ergonomic principles such as the correct adjustment of the shoulder straps.

The majority of parents had never received information on schoolbags, and more Irish parents than United States expressed an interest in receiving information on schoolbag carriage. An interesting finding was that despite living in a technological society, the majority of parents chose a handout as the preferred platform for receiving information, followed by on-line information. With the predominant age range of parents 30–49 years, it was speculated that parents would choose an online source and that there would be an age-related difference in the preference. However, parental age and the preferred platform for receiving information were mostly unrelated. The parents stated that they would like more information, but given that their level of schoolbag awareness was satisfactory, this may not be necessary. Additionally, it has been shown that increasing knowledge alone does not always improve adherence [34]. It is also acknowledged that it is difficult to give advice about preventive strategies because the immediate beneficial effects are not obvious [14]. The current study did not investigate schoolbag-related behavior of the children, but it has been shown that the level of parental awareness about schoolbags was not reflected in the child’s behavioral practice [22, 23].

Although purposive sampling was used to ensure a representative sample of the population, the homogeneity of the demographic characteristics of the participants may have affected the results. It is possible that the low United States response rate and responder bias contributed to these sample characteristics. The sample may therefore not be representative and the results may not be extrapolated to the general population. A further limitation is the cross-sectional study design, as causal inferences cannot be made.

5Conclusion

Despite gaps identified, Irish and US parents have satisfactory knowledge of appropriate schoolbag type and carriage. However, there is an overall poor level of knowledge translation from professional organizations to the key stakeholders, such as parents, as they were not identified as a source of acquired information. A significant proportion of Irish parents considered a wheeled bag to be the optimum type of bag for their child and the exact sources of this advice are unknown. Channels for the dissemination of evidence-based information, tailored to suit the understanding of all parents, should be established, as there remains a need for education through credible sources. The information should also be distributed to other stakeholders such as schoolbag designers, manufacturers, marketing and retailing personnel in order to promote the availability and preference of the optimum bag choice. Informed teachers also have a role to play as they may influence parents’ bag choice. In this study, the parents’ demand for further information was high, and the ideal platforms, such as handouts or online, were identified. Parental awareness of schoolbag carriage, although satisfactory, could be enhanced through continuing to emphasise the broad ergonomic principles of schoolbag carriage such as type, features and their optimum use, with less emphasis on schoolbag weight alone.

Conflict of interest

None to report.