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Study protocol: a randomised non-inferiority trial using interactive virtual presence to remotely assist parents with child restraint installations
  1. David C Schwebel1,
  2. Jennifer Morag MacKay2,
  3. David Redden3
  1. 1Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  2. 2Safe Kids Worldwide, Washington, District of Columbia, USA
  3. 3Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr David C Schwebel, Psychology, University of Alabama at Birmingham, Birmingham, AL 35294, USA; schwebel{at}


Background Motor vehicle crashes are the third-leading cause of death to American children aged 1–5 years. When installed correctly, child restraints (car seats) reduce risk of serious injury and death. However, most restraints are installed incorrectly. The current gold standard for correct installation is systematic car seat checks, where certified technicians help parents, but car seat checks are highly underused due to barriers in access, scheduling and resources.

Methods The present study protocol describes plans to evaluate use of interactive virtual presence technology (interactive merged reality)—joint, simultaneous remote verbal and visual interaction and exposure to the same 3D stimuli—to assist remotely located parents installing child restraints. If effective, this technology could supplement or replace in-person checks and revolutionise how government, industry and non-profits help parents install child restraints properly. Building from preliminary studies, we propose a randomised non-inferiority trial to evaluate whether parents who install child restraints while communicating with remote expert technicians via interactive virtual presence on their smartphones achieve installations and learning not inferior in safety to parents who install restraints with on-site technicians. We will randomly assign 1476 caregivers at 7 US sites to install child restraints either via interactive virtual presence or live technicians. Correctness of installation will be assessed using objective checklists, both following installation and again 4 months later.

Conclusion We aim to demonstrate that child restraint installation is accurate (>90% correct) when conducted remotely, that such installations are not inferior to installation accuracy with live experts and that parents learn and retain information about child restraint installation.

  • behavior change
  • restraints
  • motor vehicle occupant
  • randomized trial
  • child
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  • Contributors The study was conceived by DCS and JMM. All authors contributed to drafting and critically reviewing the manuscript, and all approved the final version of the manuscript.

  • Funding Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD099131. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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