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Interactive Virtual Presence to Remotely Assist Parents With Car Seat Installation
David C Schwebel1,2, Morag MacKay3, T Mark Beasley4
1Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama.
Insights
Remote assistance for child car seat installation is as effective as in-person help. This virtual approach can improve child passenger safety and reduce preventable deaths, especially for underserved populations.
Area of Science:
- Public Health
- Pediatric Safety
- Health Technology
Background:
- Motor vehicle crashes are a leading cause of preventable pediatric death.
- Incorrect installation and usage of child restraints (car seats) are common, affecting approximately 80% of users.
- Current access to certified child passenger safety technicians for individualized appointments is insufficient to meet demand.
Purpose of the Study:
- To evaluate the noninferiority of remote child restraint installation assistance compared to on-site assistance.
- To assess the accuracy of child restraint installation and usage following virtual versus in-person guidance from certified technicians.
Main Methods:
- A phase III randomized noninferiority clinical trial involving 1509 participants across 7 US locations.
- Participants were assigned to receive assistance from a certified technician either live and on-site or remotely via an interactive virtual presence smartphone application.
- Objective scoring was used to assess the accuracy of child restraint installation and usage.
Main Results:
- The on-site group achieved a mean of 97.7% correct installation/usage, while the remote group achieved 95.6%.
- The adjusted difference of 1.80% fell within the noninferiority margin of 2.5%, indicating comparable effectiveness (P=.006).
- Sensitivity analyses controlling for various demographic and installation factors confirmed these findings.
Conclusions:
- Remote assistance via interactive virtual presence is a noninferior method for educating caregivers on correct child restraint installation and usage compared to on-site assistance.
- Widespread adoption by various agencies could significantly enhance pediatric public health outcomes, particularly for underserved communities.
- This technology offers a scalable solution to improve child passenger safety nationwide.
Objectives:
Motor vehicle crashes are a leading cause of preventable pediatric death. Child restraints (car seats) reduce risk, but ∼80% are installed and/or used incorrectly. Individualized appointments with certified child passenger safety technicians improve installation and usage, but access is inadequate.
Methods:
A phase III randomized noninferiority clinical trial was conducted from 2020 to 2023 at 7 US locations with 1509 individuals who regularly drove vehicles with child restraints installed (booster seats excluded). Participants were randomly assigned to install a child restraint with assistance from a certified technician either live and on-site or remotely via interactive virtual presence, a smartphone app offering simultaneous verbal and visual communication plus the ability to interact virtually, telestrate, and freeze screens. The accuracy of restraint installation/usage was scored objectively.
Results:
Mixed model analyses were conducted with technicians nested in the research site as a random effect, and with technician, site, and child restraint installation type as covariates. The on-site group had an unadjusted mean of 97.7% (SD = 3.5) of installation/usage facets correct following the intervention, and the remote group had an unadjusted mean of 95.6% (SD = 5.8). The adjusted difference of 1.80 fell within the a priori noninferiority margin of 2.5% (upper bound = 2.34; P = .006). Sensitivity analyses controlling for demographics, how the restraint was previously installed, and installation type yielded comparable findings.
Conclusions:
The accuracy of restraint installation and usage following education with a remotely located technician via interactive virtual presence was not inferior to accuracy with an on-site technician. Uptake by industry, nonprofit, or government agencies could dramatically improve pediatric public health, especially among underserved populations.
