Journal article
Retention of learning from onsite versus remote child restraint check-up visits: A randomized noninferiority clinical trial
Accident analysis and prevention, Vol.224, 108303
01/2026
DOI: 10.1016/j.aap.2025.108303
PMCID: PMC12699478
PMID: 41213195
Abstract
•A randomized noninferiority clinical trial was conducted with 931 parents.•Parents were randomly assigned to live or remote (interactive presence) technician.•4 months later, remote parents arrived with noninferior installation vs live.•Remote parents installed restraints unassisted noninferiorly also.•Certified technicians, either live or remote, train parents effectively.
Background
Child restraints (car seats) reduce pediatric injury and death. Assistance and education from certified car seat technicians, either onsite or remotely, improves immediate restraint installation/use, but evaluation of whether caregivers learn to independently install restraints following technician interactions is lacking. This study evaluated whether caregivers learn to install/use child restraints following interaction with certified technicians.
Methods
From 2020 to 2024, 931 individuals in 7 US cities interacted with certified technicians to install restraints either onsite or remotely via interactive virtual presence. Four months later, restraint installation/use was assessed twice: (a) upon arrival, assessing restraints as traveling on roadways, and (b) after uninstallation and unassisted re-installation by caregivers, assessing caregiver capacity to install restraints 4 months post-training.
Results
Upon arrival, participants assigned four months earlier to onsite and in-person interactions had mean = 90.56 % (SD = 10.74) installation/use components correct; participants randomized to remote interactions had 92.19 % (SD = 9.02) correct, a significant difference (−1.591, SE = 0.632, p < 0.001). After uninstallation and unassisted reinstallation, onsite participants had mean = 92.64 % (SD = 10.14) correct and remote 94.11 % (SD = 7.88), also significant (−1.809, SE = 0.508, p < 0.001).
Conclusions
Child restraint installation/use was good but not perfect both four months following engagement with technicians and after reinstallation. Participants assigned to remote technician interactions achieved noninferior and, in fact, superior scores, perhaps reflecting the value of physically completing installation tasks themselves rather than relying on technicians to help. Results confirm the value of interaction with certified technicians not just to assure proper immediate installation/use of child restraints but also to train caregivers on proper installation/use.
Details
- Title: Subtitle
- Retention of learning from onsite versus remote child restraint check-up visits: A randomized noninferiority clinical trial
- Creators
- David C. Schwebel - University of Alabama at BirminghamMorag MacKay - Safe Kids WorldwideT. Mark Beasley - University of Alabama at BirminghamAnna Johnston - University of Alabama at BirminghamJanice Williams - Carolinas Medical CenterSanny Rivera - Texas Children's HospitalKristen Beckworth - Texas Children's HospitalMarie Crew - Children's of Alabama
- Resource Type
- Journal article
- Publication Details
- Accident analysis and prevention, Vol.224, 108303
- DOI
- 10.1016/j.aap.2025.108303
- PMID
- 41213195
- PMCID
- PMC12699478
- NLM abbreviation
- Accid Anal Prev
- ISSN
- 0001-4575
- eISSN
- 1879-2057
- Publisher
- Elsevier Ltd
- Grant note
- Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health: R01HD099131
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.
- Language
- English
- Electronic publication date
- 11/09/2025
- Date published
- 01/2026
- Academic Unit
- Research Administration; Psychological and Brain Sciences
- Record Identifier
- 9985026457202771
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