Acceptability of virtual restraint fitting to extend the reach of child restraint fitting services: A pilot randomized controlled trial

Incorrect use of child restraints is a long-standing issue, limiting the protection offered by child restraints in the event of a crash. Child restraint fitting services are a measure to reduce incorrect use but have limited reach and availability to underserved populations. Virtual child restraint fitting services have the potential to increase the reach and availability, but as with any digital intervention, need to be acceptable to users to be effective. The acceptability of such interventions has not been studied before. Using a three-arm randomized controlled trial, this study evaluated the acceptability of: (1) a video with child restraint fitting advice (Control), (2) a traditional in-person child restraint fitting service (In-person), and (3) a virtual child restraint fitting service (Virtual). Additionally, the effectiveness in reducing incorrect use was evaluated. There was a significantly higher level of overall acceptability for the in-person service, and significantly fewer errors in child restraint use in this group compared to the control. There were no significant differences in overall acceptability or errors between the virtual service and the control. However in-depth analysis of the constructs of acceptability demonstrated participants in the in-person and virtual service groups held similar views on four of the seven constructs including the usefulness of the services and the impact of the service on comprehension of key information for correct restraint use. Areas where the views differed between these groups included perceived burden, appropriateness, and opportunity costs. Qualitative feedback suggested these negative perceptions on the virtual service may be remediated with some improvements to the technology. Overall, child restraint fitting services provided virtually show promise as an alternative to in-person but attention to how services are provided via this technology, together with technology improvement, might be needed to fully realize its potential.

儿童约束装置（child restraints）的不当使用是长期存在的共性问题，会削弱碰撞事故中此类装置所能提供的防护效能。儿童约束装置安装服务是减少不当使用行为的有效手段，但对于服务资源匮乏人群的覆盖范围与可及性均较为有限。虚拟儿童约束装置安装服务有望提升覆盖范围与可及性，但与所有数字化干预（digital intervention）措施一样，其需获得用户认可方能发挥实效。目前尚未有针对此类干预措施接受度的相关研究。本研究采用三臂随机对照试验（randomized controlled trial），对三类方案的接受度进行了评估：(1) 搭载儿童约束装置安装指导的视频（对照组）；(2) 传统线下儿童约束装置安装服务（线下组）；(3) 虚拟儿童约束装置安装服务（虚拟组）。此外，本研究同时评估了各方案在减少不当使用行为方面的有效性。结果显示，与对照组相比，线下组的整体接受度显著更高，且该组儿童约束装置不当使用的错误率显著更低。虚拟组与对照组在整体接受度与错误率上均无显著差异。不过对接受度构念（constructs）的深入分析显示，线下组与虚拟组参与者在7个构念中的4个维度上持有相似观点，包括服务实用性以及服务对正确安装所需关键信息理解程度的影响。两组观点存在分歧的构念包括感知负担、适宜性以及机会成本。质性反馈结果显示，通过对相关技术进行部分优化，可改善用户对虚拟服务的负面认知。总体而言，虚拟儿童约束装置安装服务有望作为线下服务的替代方案，但需关注此类技术载体的服务提供方式，并配合技术优化，方能充分发挥其应用潜力。