A qualitative study on the vulnerability factors of unintentional injuries among children aged 3-12 in Guizhou Province, China, based on the social-ecological model.

Background: Unintentional injuries represent a primary cause of child mortality worldwide. However, child injury research in China exhibits a distinct disparity in research coverage; while studies on urban populations are abundant, deep qualitative research exploring multi-level vulnerability factors among children in rural southwestern regions remains scarce. Objective: This study aimed to explore and conceptualize the multi-level vulnerability factors for unintentional injuries among children aged 3-12 years in Guizhou Province. Methods: Semi-structured interviews were conducted with 290 participants, including children, their caregivers, teachers, and local social workers across three regions in Guizhou. Data collection involved focus group discussions with children and in-depth interviews with adults. We conducted thematic analysis using NVivo 15 software. Results: Data analysis yielded four overarching themes encompassing 16 sub-themes: (1) Family vulnerability factors (absence of guardianship, inadequate parental safety initiative, emotional alienation, hazards in the home environment, and economic constraints); (2) Children's individual vulnerability factors (weak safety awareness, risks of daily activities in the absence of supervision, personality traits, and disabilities); (3) Community vulnerability factors (safety hazards in the community environment and facilities, inadequate safety promotion, Insufficient interdepartmental collaboration, insufficient social attention, and imbalance of power and responsibility); (4) School vulnerability factors (safety hazards in the school environment and facilities, and inadequate safety education). Among these, the absence of family supervision, inadequate parental safety initiative, and home environmental hazards exacerbated by economic pressure emerged as core vulnerability factors. Furthermore, this study identified the cultural phenomenon of "filial silence," reflecting how traditional filial piety influences injury concealment among children. Conclusion: Unintentional childhood injuries in Guizhou stem from intersecting multi-level vulnerabilities. The phenomenon of "filial silence" presents unique cultural challenges for injury surveillance. Interventions must integrate immediate environmental modifications, collaborative guardianship networks, and long-term rural revitalization strategies.