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. When installed correctly, car
seats (also called “child restraints”) reduce risk of serious injury and death to infants and young children in a
crash roughly threefold. Unfortunately, a very large portion of child restraints traveling on American roadways
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 cooperate 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 preliminary studies on the topic, we 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 on-site. 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 our goals, we 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 4 months later. We 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.
