Randomized Control Trial of Booster Seat Education Material to Increase Perceived Benefit Among Parents
Condition: Wounds and Injuries
MeSH terms: Wounds and Injuries
Study type: Interventional

Summary: 
      Seat belts protect people from injuries by diverting crash forces to stronger anatomical
      structures: the rib cage and the pelvis. Children between the ages of 4 and 8 years are
      typically not tall enough to wear the seat belt correctly across the chest and hips, and
      instead wear it on their abdomen and neck. When worn in this way, seat belts direct crash
      forces to these parts of the body, potentially causing serious damage to internal organs and
      the spine. For this reason, children of these ages need to use a booster seat; a safety
      device that prevents seat belt related injuries by raising the child and ensuring the straps
      are correctly worn across the thorax and hips. In Canada, half of the children who should be
      using booster seats are prematurely restrained using only the seat belt. The present research
      project seeks to develop and test a novel intervention to encourage booster seat use.

      Many Canadian provinces have enacted laws mandating use, and have developed and implemented
      evidence-based education programs. Despite these efforts, new approaches to encourage booster
      seat use are required. In 2010, more than 10 years after booster seats became mandatory, the
      rate of utilization in the Canadian provinces of Ontario and Quebec was still low (25%).
      Furthermore, recent research indicates that parents' perception of the safety benefit of
      booster seats is the strongest predictor of use, yet no study to date has tested an education
      intervention that increases perceived benefit; instead, these interventions focus on teaching
      guidelines (i.e., minimum and maximum age, height, and weight to determine when a child
      should use a booster seat, and when it is safe for a child to use only the seat belt).

      The present approach to encouraging booster seat use is novel, because it increases perceived
      benefit by teaching two principles: (1) seat belts prevent injuries by redirecting crash
      forces to stronger parts of the body (rib cage and pelvis); and (2), without booster seats,
      children would wear the seat belt on their abdomen and neck, which directs crash forces to
      more vulnerable anatomical structures (internal organs and spine). Once parents grasp these
      two principles, they are expected to better appreciate the safety benefit of booster seats
      and, thus, be more likely to use them.
    

Detailed description: 
      The education material currently available in the Transport Canada website will be enhanced,
      by adding an introduction that describes how seat belts and booster seats work (i.e., these
      devices help redirect crash forces to stronger parts to the body: rib cage and pelvis).

      Objective of the trial: To determine if the enhanced material is better than the current
      Transport Canada information at increasing perceived safety benefit and intention to use
      booster seats.

      Design: Concurrent two-group parallel randomized controlled trial.

      Randomization: Block randomization will be used to assign participants to either intervention
      or control groups. Participants and researchers will be blinded to allocation.

      Participants. 303 mothers and 303 fathers of children 4 to 8 years old will be invited to
      participate, irrespective of whether they use booster seats always, occasionally, or never. A
      sample of 606 participants provides sufficient power to detect a mean difference in perceived
      benefit that separates those parents who consistently restrain their child in booster seats
      from those who do not. Sample size was estimated with the TwoSampleMean function for trials
      that test superiority of interventions (TrialSize package for R). Participants in the trial
      will receive $1/each for the completion of the survey. Based on information from studies with
      similar characteristics, the expected response rate is 40%.

      Setting and Procedures. The trial will be conducted entirely online. Participants will be
      recruited through an online market research firm, Maru/Matchbox, which maintains a nationwide
      panel of 130,000 individuals whose distribution represents the Canadian population.
      Maru/Matchbox will send an email invitation to participate along with a link to the online
      survey. The landing page of the survey will provide description of the study for parents to
      read. The online survey will be set up in such a way that participants won't be able to start
      answering questions, unless they consent by clicking the "I agree" button. Participants, will
      be advised to print and keep a copy of the consent form either as PDF or as hard copy. After
      consenting to participate, the online trial will proceed as follows:

        1. Participants will complete a baseline questionnaire.

        2. The system will randomly assign the participant to either the intervention or the
           control group. Randomization will be stratified by sex, child age, and jurisdiction to
           ensure both groups are equal.

        3. Participants in the intervention group will be presented the enhanced booster seat
           material, while participants in the control group will be presented the current
           Transport Canada booster seat material. Material provided to both groups will be
           stripped of logos (Transport Canada logos and corporate identity), but will be properly
           cited.

        4. Participants will complete post-intervention questionnaire.

        5. Participants in the intervention group will be asked one or two questions to ensure they
           did not misunderstood the information in an unintended way. If a parent answers
           incorrectly, the system will clarify the information immediately after.

        6. Participants in the control group will be given the option to view the enhanced booster
           seat material, in order to give them the opportunity to benefit from the intervention.
    

Intervention name(s): Transport Canada material; Enhanced material
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The current Transport Canada booster seat education material focuses on imparting guidelines; that is, it describes, in plain language, the minimum and maximum ages, heights, and weights to determine when a child should use a booster seat, and when it is safe for a child to use only the seat belt. This material does not describe the principle of operation of seat belts (i.e., redirecting crash forces to the rib cage and pelvis), nor the principle of operation of booster seats (i.e., ensuring the seat belt is placed correctly across the chest and hips).; Enhancements to the booster seat education material were developed based on the hypothesis that parents would better appreciate the additional injury risk reduction afforded by booster seats, if they understand that: (1) seat belts prevent injuries by redirecting crash forces to stronger parts of the body (i.e., rib cage and pelvis); and (2), without booster seats, children would wear the seat belt on their abdomen and neck, which directs crash forces to more vulnerable anatomical structures (i.e., internal organs and spine).
Other intervention name(s): Current Transport Canada material; Enhanced Transport Canada material
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Child Passenger Injury; Child Restraint Systems; Traffic Accidents