Interactive Virtual Presence to Remotely Assist Parents With Car Seat Installation

Abstract

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.