Direct observations of child restraint use to evaluate a pre-school based education and restraint distribution program

Background and aims: Education based programs to increase the use of child restraints have shown promise, however reliable tools are required to evaluate these programs. Here we describe the methodology for assessing use of child restraints as an outcome measure in a cluster randomised controlled trial evaluating the Buckle-Up Safely Program, an education and restraint subsidy program. Methods: We interviewed a parent or carer and observed children aged 2-5 years upon arrival at 27 early childhood education services during September-December 2010. The interview related to their journey and child restraint use. The child was also observed in the car. Self-report was compared to observed restraint use. Results: 736 children aged 2-5 years were evaluated and 725 completed both the interview and observations (98.5%). While 36 children were observed seated in the front seat, 20 children were reported to have travelled in the front seat (5.3% vs 2.9%, p