A smartphone app designed to promote proper child car seat use among parents proved effective in a study led by researchers at Arkansas Children’s Hospital Research Institute and Johns Hopkins Bloomberg School of Public Health.

The researchers and their colleagues developed the interactive app, Safety in Seconds v2.0, and tested it in a randomized, controlled trial involving more than 700 participants, half of whom were seen in the Emergency Department at Arkansas Children’s.

Participants reported significant improvements in several child car seat practices such as having the correct car seat or restraint for the child’s age and weight, and having the car seat inspected by a child passenger safety technician. These results held up at three and six months after the program.

“We wanted to see how this form of communication with messages tailored to each family would help them improve compliance,” said Mary Aitken, MD, MPH, medical director of the Injury Prevention Center at Arkansas Children’s Hospital and a professor of Pediatrics in the University of Arkansas for Medical Sciences College of Medicine. “We’re excited to see families will embrace an app like this and keep their kids safer by following its instructions.”

The study is published this month in the American Journal of Preventive Medicine.

Despite major improvements in safety measures over the past few decades, motor vehicle crashes continue to be the leading cause of death for young children, and parents still frequently choose the wrong type of car seat or seat restraint for their children. The National Highway Traffic Safety Administration has estimated, for example, that only about 46 percent of children aged ages four to seven years are placed in the proper booster car seats, and 24 percent use a seat belt prematurely.

The Safety in Seconds v2.0 app works on iPhones and Android phones. It asks each participant a series of questions about his or her practices and beliefs concerning child car seats, and then, based on that information, delivers appropriate safety tips in a personalized way, using the names of the participant’s children and referring to relevant child car seat laws in the participant’s state. The app provides a link to an online “parent portal” with additional safety education, and can send reminder messages about child car seat safety as the child grows.

The researchers recruited a total of 742 parents of 4-7 year olds to the study in the emergency rooms of the Johns Hopkins Children’s Center and Arkansas Children’s Hospital. Each participant was randomly assigned to an intervention group, which received the Safety in Seconds app, or a control group, which received a similarly structured app about fire safety.

In the study, the team examined four behaviors reported by participants at enrollment and after three and six months: having the correct car seat or restraint for the child’s age and weight; having the child ride in the back seat always; buckling up the child all the time; and having the car seat inspected by a certified child passenger safety technician, often accessible via a local fire department or children’s hospital.

At three months, the group receiving the Safety in Seconds app reported large and statistically significant increases in the rates of three of these four behaviors—the exception was having the child’s seat belt buckled, for which the rates were very high at the start and thus had little room to rise. For each of the three behaviors with significant reported increases, the increase was roughly double that seen in the control group.

At six months, there remained significant improvements in the intervention group relative to the control group for two of the behaviors: having the correct car seat and having it inspected.

“These results are encouraging — the trial design with a well-matched control group gives us confidence that this is a real, positive finding that we can attribute to the content of the app,” co-author David Bishai, MD, PhD, pediatrician and professor at the Bloomberg School who led the team’s analytic approach, said. “Reaching parents with messages focused on their child’s specific needs can help them sort through the confusing array of products and information currently in the consumer market place.”

The team is now following up with a larger-scale, foundation-sponsored trial of the app in four states. They are also exploring ways to distribute the app to parents, possibly via pediatricians’ offices or even Apple’s App Store or Google’s Play Store.

“Results of an RCT in Two Pediatric Emergency Departments to Evaluate the Efficacy of an m-Health Educational App on Car Seat Use” was written by Mary E. Aitken, Andrea C. Gielen, David M. Bishai, Elise Omaki, Wendy C. Shields, Eileen M. McDonald, Nicholas C. Rizzutti, James Case, Molly W. Stevens.

Funding was provided by the National Institutes of Health.