The Promise of Digital Communication Technology to Advance Car Seat Installation

Principal Investigator: Linda Fleisher, PhD, MPH, Children’s Hospital of Philadelphia

Below is an executive summary of this project. Please note that this summary describes results and interpretation that may not be final. Final interpretation of results will be in the peer-reviewed literature.

This chart highlights the perceptions of parents and caregivers regarding the value of a mobile app toimprove the installation and proper use of CRS.

Misuse of child restraint systems (CRS) through improper installation or inappropriate use continues to be a major contributor to child fatalities in motor vehicle collisions. Addressing misuse is an important step toward injury prevention, as prior research conducted at CHOP indicates that most caregivers do not install CRS correctly, regardless of their confidence in doing so.

This formative CChIPS research project aimed to gain insights into the use of both manufacturer’s user manuals and online information by parents and other caregivers for information on appropriate CRS installation, to understand perceptions about the use of smartphone applications to support improved installation, and to lay a foundation for the development of a mobile, smartphone-based tool prototype specifically geared to support parents and caretakers in these efforts.

Researchers used a mixed-methods approach to investigate the perceptions of parents and caretakers, including conducting focus groups and a national survey to understand information needs, installation challenges, and perceptions of using new smartphone or Web technology for information delivery. Additionally, investigators observed and debriefed parents and caregivers who reviewed a prototype of a mobile smartphone-based tool designed to provide information about installation and other CRS safety resources, such as local car seat inspection site locations and the Safe Kids Worldwide installation checklist.

Twenty-one caregivers of children treated at urban, suburban and rural practices participated in the focus groups, and 1,322 participated in the online national survey. In addition to reporting that CRS are physically difficult to install, caregivers showed general confusion and lack of knowledge about the appropriate time points in a child’s development continuum to switch CRS, use of car seat check programs, national resources, and how to check to ensure that the child is in the proper seat and that the CRS is being used correctly.

Participant responses revealed a potential opportunity for a mobile tool to support the CRS installation process. All caregivers owned a mobile device, and over 90 percent owned smartphones, with most using their phones to access the Internet. Caregivers generally go online to find information about CRS, using social media, Google search, news media, and CRS manufacturer websites. Caregivers indicated that they would use a CRS installation application during each phase of their child’s CRS transition. When asked for top suggestions for the tool, they suggested installation videos, troubleshooting tools, car seat check clinic finders, and tools to find the right CRS for their child.

These findings support the need for a mobile tool to assist caregivers in CRS installation. Next steps for this project include further development and testing of a mobile tool in a randomized trial to evaluate its effectiveness in improving CRS installation and use.

Project Team Members

Katherine Halkyard, MPH, Children’s Hospital of Philadelphia; Jessica Mirman, PhD, Children’s Hospital of Philadelphia; Flaura Winston, MD, PhD, Children’s Hospital of Philadelphia; Mark Zonfrillo, MD, MSCE, Children’s Hospital of Philadelphia


Marisol Norris, MA, Drexel University; Jacqueline Omorogbe, Temple University; Niti Vora, Drexel University; Chris Sullivan, MPH, Temple University

IAB Mentors

Ken Wittenaur, Britax Child Safety, Inc.; Michelle Tsai, Consumer Reports; John Bachner, Graco Children’s Products Inc.; Lorrie Walker, Safe Kids Worldwide