Evaluating a Web-based Child Passenger Safety Program: Safety in Seconds v 2.0

描述（由申请人提供）：本提案是对1RO1HD069221的修订。我们正在解决在紧急医疗服务背景下对预防进行创新研究的需要，特别是利用计算机技术评估行为改变干预措施。我们建议在两个儿科急诊科（PEDs）和一个为不同人群服务的1级儿科创伤服务（PTS）中测试基于网络的、理论驱动的、计算机定制的儿童乘客安全干预措施。该提案的重点是家长为8岁及以下的孩子使用儿童约束装置（CRDs）——汽车安全座椅（CSS）和安全带定位助推器座椅（BPBS）。选择这些安全行为是因为它们是已知的有效对策，有助于防止机动车乘员受伤，这是美国儿童死亡的主要原因。虽然CSS在年龄较小的儿童中使用很常见，但在人群中存在差异，大一点的儿童使用BPBS的情况很低，滥用crd的情况很普遍。我们之前的工作，包括nichd资助的安全秒（SIS）研究和其他研究，已经证明计算机定制的干预措施在临床环境中是可行和有效的，包括儿科。然而，我们的工作是我们所知的唯一一项将这项技术应用于CSS和BPBS的具体问题的研究，也是第一次将其用于讲西班牙语的家庭。最初的SIS是一个基于信息亭的计算机定制程序，在低收入、城市和主要是非裔美国人的单一PED中取得了一些成功。该提案将在马里兰州巴尔的摩和AR小石城的讲英语和西班牙语的家庭中测试一个增强的基于网络的计划，即安全在秒v2.0 （SIS v2.0）。我们还将扩展我们之前的工作，增加几个以前从未考虑过的元素：在PTS中测试该计划；测试西班牙语版本；并增加短信提醒和可多次访问的门户网站，以加强教育信息。评估项目的成本效益，确定项目采用和实施的障碍和促进因素，也是拟议工作的创新方面，将有助于未来的传播。本研究的具体目的是：1)评估一个基于网络的、量身定制的项目对英语和西班牙语家长的儿童乘客安全知识、预防信念以及对0-8岁儿童正确和一致使用CSS和BPBS的影响；2)评估家长对子女使用BPBS的成本效益比；3)确定PED和PTS环境中项目采用和实施的障碍和促进因素。这项为期五年的研究将在约翰霍普金斯大学PED （JH-PED）和约翰霍普金斯大学PTS （JH-PTS）以及阿肯色儿童医院PED （AR-PED）进行。方法包括：a)修改现有的“秒内安全”计划，将其转换为基于网络的平台，并纳入额外的视频、音频、短信提醒和重复访问功能；b)对1650名家长（600名JH-PED， 450名JH-PTS， 600名AR-PED）进行随机对照试验，包括基线和6个月随访评估和CSS观察；C)从医疗索赔的第三方付款人的角度对计划的预期经济效益进行成本效益分析；d)对所有三种研究环境中的项目采用和实施进行深入检查，使用从关键信息提供者访谈、对诊所环境的直接观察和文件审查中收集的定性数据。随着计算机的日益普及，这项工作的结果将对向广大受众传播有效的CSS和BPBS行为改变程序具有广泛的效用，我们将推动计算机裁剪理论和方法在一个新领域的应用。

DESCRIPTION (provided by applicant): This proposal is a revision of 1RO1HD069221. We are addressing the need for innovative research on prevention in the context of emergency medical services, specifically evaluation of behavior change interventions using computer technology. We propose to test a web based, theory driven, computer-tailored intervention for child passenger safety in two Pediatric Emergency Departments (PEDs) and a Level 1 Pediatric Trauma Service (PTS) that serve diverse populations. The focus of this proposal is on parents' use of child restraint devices (CRDs) -- Car Safety Seats (CSS) and Belt-Positioning Booster Seats (BPBS) -- for their children ages 8 years and younger. These safety behaviors were chosen because they are effective countermeasures known to help prevent motor vehicle occupant injuries, the leading cause of child mortality in the United States. Although CSS use with younger children is common, there are disparities across populations, BPBS use for older children is low, and misuse of CRDs is widespread. Our previous work, including the NICHD-funded study of Safety in Seconds (SIS) and that of others, has demonstrated that computer-tailored interventions can be feasible and effective in clinical settings, including PEDs. However, our work is the only research to our knowledge applying this technology to the specific issues of CSS and BPBS and the first to use it with Spanish speaking families. The original SIS was a kiosk-based, computer tailored program that demonstrated some success in a low income, urban, and predominantly African-American population in a single PED. This proposal will test an enhanced web-based program, Safety in Seconds v 2.0 (SIS v2.0), with English and Spanish speaking families from Baltimore, MD and Little Rock, AR. We will also extend our prior work by adding several elements never previously considered: testing the program in a PTS; testing a Spanish language version; and adding text messaging reminders and a web portal that can be accessed multiple times to reinforce the educational messages. Evaluating the program's cost benefit and determining barriers and facilitators to program adoption and implementation are also innovative aspects of the proposed work that will contribute to future dissemination. The specific aims of the study are to: 1) evaluate the impact of a web-based, tailored program on English and Spanish speaking parents' child passenger safety knowledge, prevention beliefs, and the proper and consistent use of CSS and BPBS for their children ages 0-8; 2) evaluate the cost benefit ratio of the program for parents' utilization of BPBS for their children; and 3) determine the barriers and facilitators to program adoption and implementation in both PED and PTS settings. This 5-year study will take place in the Johns Hopkins PED (JH-PED) and the Johns Hopkins PTS (JH-PTS) as well as in the Arkansas Children's Hospital PED (AR-PED). Methods include: a) a modification of the existing Safety in Seconds program to convert it to a web-based platform and incorporate additional video, audio, texting reminders and repeat visit capabilities; b) a randomized controlled trial with 1,650 parents (600 JH-PED, 450 JH-PTS, 600 AR-PED), including baseline and 6-month follow up assessments and CSS observations; c) a cost benefit analysis of the program's expected financial benefit from the perspective of a third party payer of medical claims; and d) an in-depth examination of program adoption and implementation in all three study settings using qualitative data collected from key informant interviews, direct observations of the clinic environments, and document review. With the ever-growing access to computers, results of this work will have widespread utility for disseminating effective CSS and BPBS behavior change programs to a broad audience, and we will advance the application of computer tailoring theories and methods in a new area. PUBLIC HEALTH RELEVANCE: This proposal will evaluate an innovative web-based program -- Safety in Seconds v 2.0 - to increase the proper and consistent use of Car Safety Seats and Belt-Positioning Booster Seats for children ages 8 years and younger. Motor vehicle crashes are the leading cause of death for children and child restraint devices are proven to reduce the risk of death and injury. The program will be evaluated in pediatric emergency departments and a pediatric trauma center with both English and Spanish speaking families. We will also complete a cost benefit analysis of the program and a study of how to implement the program in other settings.