System providing automated feedback improves task learning outcomes during child restraint system (CRS) installations

Abstract Objectives The objective was to build and test an automated, interactive educational system to teach adults how to install a child restraint system (CRS) into a vehicle seat. Methods The automated feedback system (AFS) consisted of a mockup vehicle fixture, convertible CRS, and doll. Sensors were implemented into the equipment so that forward-facing (FF) CRS installation errors could be detected. An interactive display monitor guided users through the CRS installation process and alerted them when steps were done incorrectly. Sixty adult volunteers were recruited and randomized into either the treatment group or the control group. The treatment group used the AFS to guide them through a practice installation. The control group also completed a practice installation using the same equipment fixture without the feedback feature turned on; they only had standard printed instruction manuals to guide their tasks. Then, participants from both groups completed a second CRS installation in a real vehicle with standard instruction manuals only. The frequencies and types of errors in all the installations were evaluated by a Child Passenger Safety Technician (CPST). Error rates were compared between the treatment and control groups using lower-tailed t-tests and Pearson’s chi-square tests. Error rates were evaluated considering minor and serious errors together and also considering serious errors alone. Results Compared to the control group, participants who trained with the AFS exhibited fewer overall errors (minor and serious) in their fixture installations (p < 0.0001) as well as their follow-up vehicle installations (p < 0.0001). Specifically, participants in the treatment group had fewer errors in choosing an installation method, locking the seat belt (SB), tightening the SB or lower anchors (LA), and tightening the harness (p = 0.0002, p = 0.0003, p = 0.0084, and p = 0.0098, respectively, compared to control group during follow-up vehicle installations). The treatment group also performed significantly better than the control group when only serious errors were considered. Conclusions An automated feedback system is an effective way to teach basic CRS installation skills to users.

[1]  Karen Tessier Effectiveness of hands-on education for correct child restraint use by parents. , 2010, Accident; analysis and prevention.

[2]  W G Lane,et al.  The association between hands-on instruction and proper child safety seat installation. , 2000, Pediatrics.

[3]  Marianne Skjerven-Martinsen,et al.  In-Depth Evaluation of Real-World Car Collisions: Fatal and Severe Injuries in Children Are Predominantly Caused by Restraint Errors and Unstrapped Cargo , 2011, Traffic injury prevention.

[4]  Kristy B Arbogast,et al.  Field use patterns and performance of child restraints secured by lower anchors and tethers for children (LATCH). , 2007, Accident; analysis and prevention.

[5]  Michael L Nance,et al.  Evaluation of child safety seat checkpoint events. , 2008, Accident; analysis and prevention.

[6]  John H Bolte,et al.  Evaluation of interventions to make top tether hardware more visible during child restraint system (CRS) installations , 2019, Traffic injury prevention.

[7]  Yoganand Ghati,et al.  Misuse study of latch attachment: a series of frontal sled tests. , 2007, Annual proceedings. Association for the Advancement of Automotive Medicine.

[8]  K. Langwieder,et al.  INJURY RISKS, MISUSE RATES AND THE EFFECT OF MISUSE DEPENDING ON THE KIND OF CHILD RESTRAINT SYSTEM , 1997 .

[9]  Julie Brown,et al.  The performance of tethered and untethered forward facing child restraints , 1995 .

[10]  Amanda Muller,et al.  Teaching psychomotor skills in the twenty-first century: Revisiting and reviewing instructional approaches through the lens of contemporary literature , 2016, Medical teacher.

[11]  D. Schwebel,et al.  Supporting Caregiver Use of Child Restraints in Rural Communities via Interactive Virtual Presence , 2019, Health education & behavior : the official publication of the Society for Public Health Education.

[12]  Charles Mock,et al.  Childhood Crash Injury Patterns Associated with Restraint Misuse: Implications for Field Triage , 2008, Prehospital and Disaster Medicine.

[13]  Kristy B Arbogast,et al.  Field Investigation of Child Restraints in Side Impact Crashes , 2005, Traffic injury prevention.

[14]  Benjamin D Hoffman,et al.  Unsafe from the Start: Serious Misuse of Car Safety Seats at Newborn Discharge. , 2016, The Journal of pediatrics.

[15]  Philippe Lesire,et al.  Misuse of child restraint systems in crash situations - danger and possible consequences. , 2007, Annual proceedings. Association for the Advancement of Automotive Medicine.

[16]  Matthew P Reed,et al.  Effects of child restraint system features on installation errors. , 2014, Applied ergonomics.

[17]  Nichole R. Orton,et al.  Effects of child restraint misuse on dynamic performance , 2019, Traffic injury prevention.

[18]  John H Bolte,et al.  Usability of non-standard lower anchor configurations for child restraint system (CRS) installation , 2018, Traffic injury prevention.

[19]  F Legault,et al.  RELATIVE DEGRADATION OF SAFETY TO CHILDREN WHEN AUTOMOTIVE RESTRAINT SYSTEMS ARE MISUSED , 2003 .

[20]  Bill Gardner,et al.  The effect of top tether strap configurations on child restraint performance , 1997 .

[21]  Christina M. Rudin-Brown,et al.  Standardized error severity score (ESS) ratings to quantify risk associated with child restraint system (CRS) and booster seat misuse , 2017, Traffic injury prevention.

[22]  Kirsten McCaffery,et al.  Barriers to correct child restraint use: A qualitative study of child restraint users and their needs , 2018, Safety Science.