Using Interactive Virtual Presence to Remotely Assist Parents With Child Restraint Installations

Motor vehicle crashes cause the death of an American child every 3 hours, more than any other
cause. When installed correctly, car seats (also called "child restraints") reduce risk of
serious injury and death to infants and young children roughly threefold. Unfortunately, a
large portion of child restraints is installed incorrectly. A network of trained technicians,
many affiliated with Safe Kids Worldwide, work across the country to assist parents in
achieving correct use of child restraints through scheduled "car seat checks," where
technicians work with parents to install restraints in their vehicles. Car seat checks are
effective in reducing errors in child restraint installations. However, the services are
highly underutilized due to barriers in access, scheduling complications, and resources to
staff the car seat checks sufficiently to meet demand.

The present study evaluates use of interactive virtual presence technology (also called
interactive merged reality) - joint and simultaneous remote verbal and visual interaction and
exposure to the same 3D stimuli - to remotely assist parents to install child restraints
correctly into their vehicles. If effective, this technology could supplement or replace car
seat checks, significantly reduce the number of errors made in car seat installations
nationwide, and revolutionize how government, industry, and non-profit agencies help parents
install restraints.

Building from small pilot studies on the topic, the investigators propose a large randomized
non-inferiority trial to evaluate whether parents, including especially underserved parents
in rural areas and/or of underrepresented racial or ethnic minority background, who install
child restraints while communicating with a remote expert technician via interactive virtual
presence achieve installations and learning that are not inferior in their safety to parents
who install restraints live with a remote technician onsite. Non-inferiority trials are a
type of randomized trial whereby a novel treatment (in this case, interactive virtual
presence to install child restraints) is compared to an existing treatment known to be
effective (in this case, live one-on-one installation of restraints) to demonstrate the novel
treatment does not perform inferiorly to the existing treatment known to be effective.

To accomplish the study goals, the investigators will recruit 1476 parents at 7 Safe Kids
locations nationwide and randomly assign consenting parents to install their child restraint
either via interactive virtual presence or with a live technician. The correctness of
installation safety will be assessed using objective checklists, both following installation
and again four months later. The investigators aim to demonstrate that child restraint
installation is accurate (>90% correct) when conducted remotely via interactive virtual
presence, that such installations are not inferior to the accuracy of installation with a
live on-site expert, and that parents learn and retain information about correct child
restraint installation.

Inclusion Criteria:

- own a vehicle and have a child who rides in that vehicle using a child restraint
fastened with a harness.

Exclusion Criteria:

- not physically capable of installing a child restraint into a vehicle, which may
exclude individuals with various disabilities.

- not able to communicate orally in English or Spanish, although significant demand for
training in other languages may alter this exclusion criteria in the future