The study included 487 participants who met the inclusion criteria and completed the questionnaire. The mean age of participants was 36.1 ± 12.8 years old, and the majority of the respondents were females (295, 60.6%) and of Saudi nationality (432, 88.7%).

In terms of education level, 352 (72.3%) had a bachelor’s degree or diploma;196 (40.2%) earned 11,000–20,000 SR monthly; and 68.4% had at least one child aged under 3 years (Table 1).

Table 2 shows that 108 (22.2%) participants knew about the 300–500 Saudi Riyals penalty for children under 10 years sitting in the front seat or not using CSSs, while 252 (51.7%) were aware of it but unsure of the amount. Additionally, 113 (23.2%) knew about the 150–300 Saudi Riyals fine for children not using seat belts, while 216 (44.4%) were aware of it but uncertain of the amount.

A total of 144 (29.6%) participants already used seat belts before the penalties were implemented, 101 (20.7%) started using them since the implementation, and 31 (6.4%) stated they would never use them. More than half, 318 (65.3%), reported that they will maintain the same behavior towards using CSSs when driving outside Saudi Arabia. Moreover, the majority, 452 (92.8%), believed that governmental financial support towards CSS costs will increase usage and compliance.

A total of 68.6% of the study participants recognized the importance of car safety for children, and 59.5% acknowledged that CSSs consistently provide protection in the event of accidents. Only 4.3% knew that children should use a CSS until they are 12 years.

Regarding seat positioning, 46.4% were aware that children aged 1–3 years should use rear-facing child seats, 6.4% knew that children aged 4–7 years should use forward-facing seats, while 19.7% understood that belt-positioning booster seats are suitable for children in the same age range. Regarding seat placement, 59.8% of participants believed that the CSS should be placed in the back seat on the side. Additionally, 78.6% were aware that there are different types of CSSs depending on a child’s age (Table 3).

Figure 1 illustrates that only 140 (28.7%) participants had a good knowledge level regarding CSSs, while 347 (71.3%) demonstrated a poor knowledge level.

Overall public knowledge level regarding child’s car safety seats in Makkah region, Saudi Arabia

Table 4 shows that 293 (60.2%) of the participants reported using CSS. Among them, 129 (44%) always used the seats, 46 (15.7%) occasionally used them, and 26 (8.9%) rarely used them. When asked about the age at which they stopped using CSSs, 46 (15.7%) reported stopping at the age of 12 years. Reasons for not using CSSs included the seat taking up too much space in the car (24.2%), being expensive (19.1%), a lack of information about the seat (13.9%), believing there is no strict law regarding CSS use (9.3%), and feeling it is not important (4.6%).

Table 5 demonstrates that participants aged 31–40 years, females, those having postgraduate education, with the highest monthly income (> 20,000 SR), those having 2 children less than 3 years, or having no child aged 8–12 years had a significant higher percent of those who had a good knowledge level (p =  < 0.05). The good knowledge level was also significantly higher among participants who were aware and knew that there has been an irregularity of about 300–500 Saudi Riyal for children under 10 years and sitting in the front seat/not using child car seats in Saudi Arabia (p =  < 0.05). Good knowledge was also significantly higher among participants who knew that there has been an irregularity of about 150–300 Saudi Riyal if a child is not using the seat belt in Saudi Arabia and who were using a child car safety seat (p =  < 0.05).

Multivariate logistic regression analysis was done to assess the independent predictors of good knowledge among studied participants. It was found that having an age ranging from 31 to 40 years, having a postgraduate education, being aware about that there has been an irregularity of about 300–500 Saudi Riyal for children under 10 years and sitting in the front seat/not using child car seats in Saudi Arabia, having knowledge that there has been an irregularity of about 150–300 Saudi Riyal if a child is not using the seat belt in Saudi Arabia, and using a child car safety seat were independent predictors of good knowledge among studied participants (p =  < 0.05) (Table 6).