Teaching infant car seat installation via interactive visual presence: An experimental trial

Child passenger safety: Implementation and evaluation of a virtual educational intervention for parents and caregivers

OBJECTIVE

The objective of this project was to determine how a virtual educational intervention on Child Passenger Safety (CPS) impacts post-intervention knowledge and self-efficacy levels.

METHODS

The intervention included watching a video related to CPS and completing a virtual car seat check with a certified Child Passenger Safety Technician (CPST). A quantitative pre- and post-test project design was utilized. Self-efficacy was measured using a confidence assessment and knowledge level was measured with a comprehension test. Participants were included if they had access to the internet, were English speaking, and parents or caregivers of children aged 12 years or younger. The program was active between February and April of 2021. Out of 58 individuals who expressed interest in participating in the program, the completion rate was 41 %. There were 24 participants who completed all steps of the intervention with a range in days to completion of 59 days.

RESULTS

A video-based education intervention combined with completing a virtual car seat check with a CPST was shown to have a statistically significant impact on the knowledge and self-efficacy levels surrounding the use and installation of Child Safety Seats (CSSs) by parents and caregivers. There were a total of 34 car seats that were assessed during the virtual car seat checks and results showed that 65.6% of the car seats that were assessed on arrival had at least 1 error present. In whole, there were 34 car seat errors identified by the CPSTs throughout this project timeline.

CONCLUSIONS

A video-based educational intervention combined with a virtual car seat check with a certified CPST has a positive impact on the knowledge and self-efficacy levels of participants. The data analysis shows the project was a successful and meaningful intervention to promote improvements in the field of CPS. This study design allows for the implementation of additional resources and supports for CPS within rural areas and at-risk populations and can help to address public health issues related to a lack of resources based on geographic location.

Slicing Through the Layers of Pediatric Unintentional Injury With the Swiss Cheese Model: A Topical Review

Pediatric unintentional injury significantly burdens children, families, and society. Behavioral researchers have examined the problem for decades, identifying many risk factors and greatly enhancing knowledge of the injury antecedent process. Approaches using theories and models to guide inquiry into etiology and prevention are still needed. We offer an approach borrowed from the field of human factors to enhance understanding and prevention. We focus our exploration on an error modeling and accident investigation tool called the Swiss Cheese Model. We first introduce the basic elements of the model. Next, we apply error modeling concepts to example scenarios drawn from real unintentional incidents and discuss the implications for understanding etiology and prevention. Finally, potential future directions are discussed to illustrate paths for the advancement of injury etiology and prevention.

Randomised feasibility trial of a virtual intervention to address infant car seat misuse

BACKGROUND

Serious car seat installation errors occur at high rates in infants and children. These errors significantly increase the risk of child injury in a motor vehicle crash, and few interventions have addressed the challenge longitudinally.

METHODS

This was a pilot randomised controlled feasibility trial of virtual car seat safety checks for caregivers of newborns recruited from an urban newborn nursery. The control (enhanced usual care (EUC)) group received an in-person car seat check as a newborn and virtual check at 9 months. The intervention group received two additional virtual checks at 3 and 6 months. Installation and infant positioning errors were documented and corrected by a child passenger safety technician (CPST). We measured feasibility and acceptability by tracking caregiver and CPST challenges, and caregiver retention. Group differences were tested for statistical significance using χ2 or Fisher's exact test for categorical variables, and two sample t-tests for continuous variables.

RESULTS

33 caregivers were randomised to the EUC and 28 to the intervention group. Virtual checks were feasible, with variable participation levels at each quarter. Wi-Fi and app challenges noted in 30%. There was satisfaction with the virtual car seat checks. At baseline, car seat installation and infant positioning errors occurred at equal frequency, and at 9 months the intervention group had a significantly lower mean proportion than the EUC group in all categories of errors. In summary, virtual seat checks are feasible and the optimal timing of repeat checks requires additional study. A larger study is needed to further evaluate the effect of longitudinal virtual checks on errors.

Merged virtual reality teaching of the fundamentals of laparoscopic surgery: a randomized controlled trial

Background

The COVID-19 pandemic challenges our ability to provide surgical education, as our ability to gather and train together has been restricted due to safety concerns. However, the importance of quality surgical education has remained. High-fidelity simulation platforms have been developed that merge virtual reality video streams to allow for remote instruction and collaboration. This study sought to validate the use of a merged virtual reality (MVR) platform for the instruction and assessment of the fundamentals of laparoscopic surgery (FLS) skills.

Methods

This was a prospective randomized controlled non-inferiority study. Thirty participants were randomized between three groups: The standard group received in-person instruction and expert feedback, the experimental group received identical training via the MVR platform, and the control group practiced on their own, but received no feedback. All participants were pre-tested for baseline performance at the beginning of the study. Change in performance was evaluated immediately after training and one month later for retention. Ordinary one-way analysis of variance was used to evaluate the effects of time, group, and time-on-group.

Results

The pre-test confirmed baseline homogeneity between the groups. MVR was non-inferior to standard in-person training for total FLS times on either the post-test (p = 0.632) or the retention test (p = 0.829). Performance was also identical between MVR and standard training groups for each of the individual FLS tasks. Each group improved significantly in nearly all tasks after practice; however, the standard and MVR training groups both improved significantly more than controls for the ligating loop, extracorporeal suturing, intracorporeal suturing, and total FLS task training but did not reach statistical significance for peg transfer and pattern cut tasks.

Conclusion

This randomized, controlled trial has demonstrated the use of an MVR platform as non-inferior to in-person instruction for the FLS program, forming the foundation for future work on remote instruction and collaboration.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00464-021-08939-4.

Measuring the effectiveness of a car seat program in an urban, level one pediatric trauma center

Background

Motor vehicle collisions (MVCs) are a significant safety issue in the United States. Young children are disproportionally impacted by car accidents and suffer high rates of injuries and mortality. When used properly, car seats have been found to reduce the severity of injuries. However, individuals from low-income areas often do not have access to education or car seats compared to those in suburban or higher income areas. Therefore, the goal of the present study was to measure the effectiveness of a car seat program in an urban, Level I Pediatric Trauma Center on caregiver car seat knowledge.

Methods

Caregivers (N = 200) attended a single, one-hour car seat educational program with a Child Passenger Safety Technician (CPST). The sessions included educational and hands-on components, where caregivers were asked to complete a seven-item pre-post knowledge assessment. For completion of the course, caregivers received a car seat for their child.

Results

A paired t-test revealed that the workshop significantly increased caregiver knowledge from pre-post: t (199) = − 12.56, p < .001; d = 1.27. McNemar’s Chi-Square analyses displayed that caregivers increased in all knowledge categories (p < .001).

Conclusions

While caregivers in urban areas or in low-income areas may have less access to resources, hospital-led car seat courses can increase knowledge of proper car seat usage in these communities. These findings should be used to establish programs in hospitals in areas where these resources are not readily available to caregivers.

Virtual car seat checks during a pandemic

Motor vehicle collisions are one of the leading causes of death and morbidity in children and young adults in the USA, and suboptimal child restraint use is an important risk factor for severe childhood injury and death. The restrictions due to the COVID-19 pandemic have presented unique challenges to the public health community, including how to use certified child passenger safety technicians through car seat checks. This case series assessed the feasibility of performing remote car seat checks and parental satisfaction with them. It provides preliminary evidence that remote car seat checks are feasible in a real-world environment and acceptable to caregivers during times in which in-person car seat checks are not safe or accessible.

Infant car seat use in Japan after the antepartum distribution of an educational leaflet: A prospective, nonrandomized controlled trial with a questionnaire survey

Objective: To determine whether an antepartum educational leaflet distributed to parents before infant delivery affected the rate of infant car-seat (ICS) use 1 month after delivery, because to the best of our knowledge, only few reports have evaluated systematic attempts to improve the rate of always ICS use by mothers driving infantsMethods: A multicenter questionnaire survey targeting pregnant Japanese women seeking antenatal care at the outpatient clinics of eight hospitals was designed. Women enrolled during the first half of the study period did not receive leaflets describing ICS safety guidelines (control group). Women enrolled during the latter half of the study period received the leaflet between gestational week 35 and 37 (intervention group). All women were requested to anonymously respond to the questionnaires within 1 month postpartum. The rates of ICS use, position, and direction after delivery were compared between both groups.Results: Of the 3534 women who responded to the questionnaire survey (response rate, 81.9%), 1772 women (50.1%) were assigned to the intervention group and 1762 (49.9%) women to the control group. The rates of ICS attachments (86.8% vs. 82.4% in the intervention and control groups, respectively, p = 0.0003), always ICS use (80.5% vs. 76.2%, respectively, p = 0.0019), ICS placement on the rear seat (78.6% vs. 74.1%, respectively, p = 0.0020), and ICS placement in a rear-facing position (62.2% vs. 56.7%, respectively, p = 0.0008) were significantly higher in the intervention group than those in the control group. The motor vehicle accident (MVA) rates within 1 month postpartum were similar between the intervention and control groups (0.51% vs. 0.57%, respectively, p = 0.8229).Conclusions: Antepartum minimal intervention via the distribution of an educational leaflet recommending ICS safety guidelines was associated with increased rates of ICS attachments, always ICS use, and ICS placement on the rear seat and in rear-facing positions; however, it did not contribute to reduced MVA rates after delivery.

Supporting Caregiver Use of Child Restraints in Rural Communities via Interactive Virtual Presence

When used correctly, child restraint systems (CRS) effectively reduce the risk of serious injury and death to child passengers in motor vehicle crashes. However, error rates in CRS use among caregivers are extremely high. Consultation with child passenger safety technicians (CPST) reduces misuse rates, but access to CPST is limited, particularly in rural areas. Remote consultation via interactive virtual presence (IVP) may increase access to CPST. One hundred and fifty caregivers in Southeast Montana completed remote consultation with CPST via IVP. Errors in CRS selection, installation, and child positioning were coded at baseline and postintervention in a within-subjects, pretest–posttest design. The proportion of caregivers making one or more errors in CRS selection (McNemar’s test p < .001) and installation (McNemar’s test p < .001), but not child positioning, significantly decreased following remote consultation. IVP is a promising mobile health (mHealth) strategy for providing remote consultation with CPST to improve rates of correct CRS use and mitigate child injury risk.

Study protocol: a randomised non-inferiority trial using interactive virtual presence to remotely assist parents with child restraint installations

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.

Using interactive virtual presence to support accurate installation of child restraints: Efficacy and parental perceptions

INTRODUCTION

Child restraint systems (car seats) reduce injury risk for young children involved in motor-vehicle crashes, but parents experience significant difficulty installing child restraints correctly. Installation by certified child passenger safety (CPS) technicians yields more accurate installation, but is impractical for broad distribution. A potential solution is use of interactive virtual presence via smartphone application (app), which permits "hands on" teaching through simultaneous and remote joint exposure to 3-dimensional images.

METHOD

In two studies, we examined the efficacy of remote communication via interactive virtual presence to help parents install child restraints. Study 1 was conducted at existing car seat checkpoints and Study 2 at preschools/daycare centers. In both cases, existing installations were assessed by certified CPS technicians using an objective coding scheme. Participants then communicated with remotely-located certified CPS technicians via a smartphone app offering interactive virtual presence. Technicians instructed participants to install child restraints and then the installation was inspected by on-site technicians. Both before and after the remote interaction, participants completed questionnaires concerning perception of child restraints and child restraint installation, self-efficacy to install child restraints, and perceived risk of injury to children if they were in a crash.

RESULTS

In both studies, accuracy of child restraint installations improved following the remote interaction between participants and certified CPS technicians. Together, the two samples achieved a weighted average of 90% correct installations across a multi-point inspection. Both samples reported increased self-efficacy to install child restraints and altered perceptions about the accuracy of the child restraint installations in their vehicles.

CONCLUSIONS

Findings support use of interactive virtual presence as a strategy to realize accurate installation of child restraints.

PRACTICAL APPLICATIONS

Interactive virtual presence between certified CPS technicians and the public via smartphone app has potential to improve proper child restraint installations broadly, including to vulnerable and underserved rural populations.