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Trial registered on ANZCTR

Registration number
Ethics application status
Date submitted
Date registered
Date last updated
Date data sharing statement initially provided
Type of registration
Prospectively registered

Titles & IDs
Public title
A randomized comparison of restraint fitting education and assistance delivery methods to identify an optimum delivery method for rural and remote areas of Australia (Reach Study)
Scientific title
A randomized comparison of child car restraint fitting education and assistance delivery methods to identify an optimum delivery method for parents in rural and remote areas of Australia.
Secondary ID [1] 302444 0
GO3958 – 62
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Errors in child car restraint use. 319264 0
Condition category
Condition code
Injuries and Accidents 317231 317231 0 0
Other injuries and accidents

Study type
Description of intervention(s) / exposure
3-arm RCT:
1) instructional online video - generic information video (how to install a child seat, how to secure the child, items to check) provided by emailed link, 10 minutes
2) in-person fitting service - delivered by qualified restraint fitter at Neighbourhood Houses in rural/remote Victoria, 20 minutes
3) fitting service delivered over remote assistance technology - delivered by qualified restraint fitter using Help Lightning interactive app (at Neighbourhood Houses to enable subsequent fitter check of installation), 20 minutes

A comprehension assessment is conducted by phone immediately following delivery of each intervention type. All three groups will receive a follow-up check at 3 months at a Neighbourhood House. The final survey will include questions on education material accessed over the 3 months. Adherence will be determined through answers to the comprehension assessment and final questionnaire.
Fidelity of the delivery of the interventions and dose delivered is relatively fixed with the number of people delivering each intervention limited and following defined procedures.
Intervention code [1] 318731 0
Comparator / control treatment
Arm 2 is the current standard delivery method provided for child car restraint fitting.
Control group

Primary outcome [1] 325292 0
Correct use of child car restraint, as per checklist completed by a qualified restraint fitter at Neighbourhood Houses.
Timepoint [1] 325292 0
3 months after child car restraint fitting education delivered.
Secondary outcome [1] 387431 0
Comprehension (10 item questionnaire).
The comprehension assessment is designed for this study to assess the impact of each intervention on the participants’ level of understanding of key information for ensuring correct use of child restraints. The questions are based on assessments we have used in previous work (Hall et al, 2020, 'User-driven design of child restraint information to reduce errors in use', Injury Prevention) and is based on the method described by Pander et al (2010, 'Improving the usability of patient information leaflets. Patient Educ Couns).
Timepoint [1] 387431 0
Immediately after intervention delivery.
Secondary outcome [2] 387432 0
Acceptability - qualitative semi-structured questionnaire.
Part of the follow-up survey developed for this study, the questions for acceptability were developed using a theoretical framework published by Sekhon et al (2017, ‘Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC health services research). The questions are designed to measure the seven component constructs of that theoretical framework – affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness and self-efficacy.
Timepoint [2] 387432 0
3 months after child car restraint fitting education delivered.
Secondary outcome [3] 387433 0
Feasibility - quantitative survey.
Part of the follow-up survey developed for this study, the questions were developed to collect detail about the practical logistics/potential barriers to accessing child restraint fitting services and potential for the technology being trialled in Arm 3.
Timepoint [3] 387433 0
3 months after child car restraint fitting education delivered.

Key inclusion criteria
- have a child and want to use a child car seat fitting service.
- live in a rural or remote part of Victoria, and able to visit a Neighbourhood Houses location that is taking part in the study.
- own a child seat.
- speak English well enough to understand consent documents and instructions given by the fitting service.
- have a mobile phone or tablet with a camera and able to access a web browser (eg, Google Chrome, Safari).
Minimum age
18 Years
Maximum age
No limit
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
Previously use of child seat fitting service or instructional online video.

Study design
Purpose of the study
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
The REDCap randomisation module will be used to assign each participant from an uploaded sequence generated by an independent statistician, the sequence will not be visible to the staff using the module.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Permuted block randomisation, generated by an independent statistician.
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?

The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Other design features
Not Applicable
Type of endpoint(s)
Statistical methods / analysis
Sample size of 112/arm to detect 20% difference between the hands-on delivery methods (2 and 3) and the online video, assuming the online video group demonstrates a similar level of correct use as the general population (50%). Calculated at 90% power at 5% significance level assuming a chi-squared test from analysis with 2 degrees of freedom, and allowing for 10% loss to follow up, we will recruit 125/arm for a total sample of 375.

Sample characteristics will be described as percentages for categorical variables, or range, mean, 95% CI and SD for continuous variables.
For primary analyses, we will use the chi-square test to compare proportions of serious misuse between the three groups. For secondary analysis, differences in mean percent comprehension scores between groups will be assessed using one-way ANOVA.
Qualitative methods will be used to examine acceptability in line with the theoretical framework for acceptability and emerging themes related to feasibility. Qualitative analyses will be within-group analyses, with a mixed method approach to between group analyses. We will also explore the relationship between % correct use and % comprehension using appropriate regression models.

A participant follow-up survey designed for this study will collect additional information on potential confounders of the outcome measure. Questions were drawn from previous studies where we have used a similar outcome measure (e.g. Brown et al, 2020 'A process evaluation protocol for examining the impact of instruction for correct use of child car seats designed through a consumer-driven process and evaluation in a field-based randomised controlled trial', Int J Env Res & Public Health, & Brown et al, 2019 'Can child restraint product information developed using consumer testing sustain correct use 6 months after child restraint purchase? Study protocol for a cluster randomised controlled trial', Injury Prevention).

Recruitment status
Not yet recruiting
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment in Australia
Recruitment state(s)

Funding & Sponsors
Funding source category [1] 306870 0
Government body
Name [1] 306870 0
Dept. of Infrastructure, Transport, Regional Development and Communications
Address [1] 306870 0
GPO Box 594, Canberra ACT 2601
Country [1] 306870 0
Primary sponsor type
The George Institute for Global Health
PO Box M201, Missenden Road NSW 2050
Secondary sponsor category [1] 307427 0
Name [1] 307427 0
Address [1] 307427 0
Country [1] 307427 0
Other collaborator category [1] 281498 0
Name [1] 281498 0
Kidsafe Victoria
Address [1] 281498 0
Monash Children’s Hospital
Dixon Street, Clayton VIC 3168
Country [1] 281498 0

Ethics approval
Ethics application status
Ethics committee name [1] 307025 0
University of New South Wales Human Research Ethics Committee
Ethics committee address [1] 307025 0
The University of New South Wales, Sydney NSW 2052
Ethics committee country [1] 307025 0
Date submitted for ethics approval [1] 307025 0
Approval date [1] 307025 0
Ethics approval number [1] 307025 0

Brief summary
Children under 7 years must use an age-appropriate child restraint when travelling in motor vehicles. However, incorrect use increases risk of injury 3-fold in a crash, and our previous work has shown high rates (53-74%) of incorrect use. Restraint fitting services are shown to reduce rates of incorrect use almost 2-fold, however reach of these services is limited in rural and remote areas. There is a need to find cost-effective mechanisms for delivering assistance and education on correct use of child car restraints to families in rural and remote Australia as these children are at greatest risk of death and serious injury in crashes. Three information delivery methods have demonstrated promise as countermeasures to incorrect use of restraints. These are: hands-on instruction, like that which occurs in face-to-face delivery of restraint fitting services; instruction via online video; and restraint fitting services delivered via remote virtual assistance technology. To date, there has been no comparison of these different mechanisms as cost-effective countermeasures to incorrect use of child car restraints in rural and remote Australia. To ensure the best use of limited resources it is necessary to identify the most cost-effective mechanism for delivering this type of service.
The aim of this project is to identify a cost-efficient delivery method for providing assistance and education to increase correct use of child restraints in rural and remote Australia. This study seeks to address the hypotheses:
1. Hands-on-instruction delivered face-to face and via remote virtual assistance technology will be more effective than instruction via online video in promoting correct use of child restraints.
2. Remote virtual assistance technology will be the most cost-effective method for delivering assistance and education to increase correct use of child restraint in rural and remote Australia
3. Remote virtual assistance technology delivery will be equally acceptable and feasible as face-to-face delivery, and more acceptable than online video.
We will trial each delivery method among parents interested in receiving child car restraint fitting services to test these hypotheses.
Trial website
Trial related presentations / publications
Public notes

Principal investigator
Name 105782 0
A/Prof Julie Brown
Address 105782 0
The George Institute for Global Health
PO Box M201, Missenden Road, NSW 2050
Country 105782 0
Phone 105782 0
+61 2 8052 4420
Fax 105782 0
Email 105782 0
Contact person for public queries
Name 105783 0
Ms Kirsten Jakobsen
Address 105783 0
The George Institute for Global Health
PO Box M201, Missenden Road, NSW 2050
Country 105783 0
Phone 105783 0
+61 2 8052 4379
Fax 105783 0
Email 105783 0
Contact person for scientific queries
Name 105784 0
A/Prof Julie Brown
Address 105784 0
The George Institute for Global Health
PO Box M201, Missenden Road, NSW 2050
Country 105784 0
Phone 105784 0
+61 2 8052 4420
Fax 105784 0
Email 105784 0

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No/undecided IPD sharing reason/comment
Not intended at this stage.
What supporting documents are/will be available?
No other documents available
Summary results
No Results