Facilitators and barriers of life jacket use for drowning prevention: Qualitative evidence synthesis

Background: Drowning is a public health problem globally. Despite substantial evidence on the effectiveness of life jackets, their use for drowning prevention has remained low. This study aims to understand the barriers and facilitators of life jacket use. Methods: We searched four major electronic databases, contacted experts, hand-searched conference abstracts and screened reference lists to identify primary qualitative studies. We used the Critical Appraisal Skills Programme Checklist for quality appraisal and the PROGRESS Plus framework to understand equity issues. Thematic analysis was conducted. Results: We retrieved 1153 records and finally included ten studies that met eligibility criteria. All except two studies were from high-income countries. Four key themes were identified. Firstly, life jacket use was shaped through complex interactions between lived experience and cultural norms which influenced the risk-perception of life jacket utility in preventing deaths. Secondly, the high cost of life jackets was almost always a barrier for its usage. Thirdly, adoption of laws and its subsequent enforcement was perceived to be an important facilitator for life jacket use. Lastly, design issues around comfort, fashion-sense, and shelf life influenced usage. Conclusion: The results of this qualitative evidence synthesis should be considered for health promotion, legal and policy interventions to promote the uptake of life jackets. There is a need for better understanding of perceptions and their role in the uptake of safety behaviours in different countries including the role of equity issues on the use of life jackets.