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

Objective: 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. Methods: 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. Results: 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. Conclusions: 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.