A practical approach for applying best practices in behavioural interventions to injury prevention

The contribution of driving with friends to young drivers' intention to take risks: An expansion of the theory of planned behavior

Young drivers' reckless driving, especially among males, is a global phenomenon and a major cause of injury and death. The behavior of young people, including their driving norms, is influenced by the dominant social discourse in their age group. Thus, the nature of the interaction between young drivers and their peers may contribute to increased or decreased risk exposure not only for everyone in the car, but also for other road users, and therefore warrants deeper examination. This study aims to shed light on driving with friends as a particular case of driving with peers. It was designed to examine the role of the four dimensions of the Safe Driving Climate among Friends (SDCaF) scale, in predicting young drivers' intention to take risks behind the wheel, beyond the contribution of the Theory of Planned Behavior (TPB). The sample consisted of 166 participants (70 men, 96 women), ranging in age from 17 to 24 years, who completed a set of self-report questionnaires. The findings demonstrate that the SDCaF dimensions, and especially perceived friends' pressure while driving, add to the explained variance in intention to engage in risky driving, beyond the variance explained by gender and the three components of the TPB. In addition to its theoretical expansion of the TPB model to include specific components relating to perceived driving with friends, the study's practical significance lies in directing efforts towards revealing pathways to reduce reckless driving among young people, through engaging their friends in the process.

Safe Driving Climate among Friends (SDCaF): A new scale

Reckless driving among young people, especially young men, is a major cause of injury and fatalities the world over. Like other aspects of this age group, young drivers' driving behaviors and norms are influenced by the accepted social discourse of their peers. Yet despite extensive existing knowledge on young drivers, very few studies have dealt specifically with their characteristic friendship relations. This lacuna in the literature may reflect the absence of specific research tools for examining driving with friends. To fill this gap, we conducted a series of studies with 706 young drivers (aged 17-24) of both sexes aimed at developing and validating a multidimensional scale designed to examine the effect of the social relations of adolescents and young adults on their driving. Entitled Safe Driving Climate among Friends (SDCaF), the final scale consists of 19 items, which tap four dimensions of driving with friends: friends' pressure; social costs of driving with friends; communication with friends about driving; and shared commitment to safe driving. The validity of the scale was established by examining associations between its four dimensions and various variables of personality, friendship, and driving. The findings indicate good reliability and validity, with the three variables of resistance to peer influence, self-disclosure, and personal responsibility for safe driving yielding positive associations with the SDCaF dimensions communication and shared commitment to safe driving, and negative associations with the dimensions friends' pressure and social costs. General tendency to respond to social pressure was positively associated with the dimensions of friends' pressure and social costs, and negatively associated with shared commitment to safe driving. Gender differences were also found, with men scoring higher than women on friends' pressure, and lower than women on shared commitment to safe driving. The SDCaF can serve as a research tool, as well as a diagnostic instrument for detecting susceptibility to reckless driving among young drivers, thereby aiding in the design of targeted educational and intervention programs.

Contributors to young drivers' driving styles - A comparison between Israel and Queensland

Among the numerous factors that contribute to young novice drivers' driving styles, personality characteristics, sociodemographic variables, family atmosphere, and friends' norms are known to have an important impact. However, cross-cultural comparisons are relatively rare in the safety literature concerning young drivers. This study aimed at comparing young drivers from Israel and Queensland (Australia) and examining the contribution of personality, sociodemographic, family and friends' aspects to their driving styles (reckless and careless; hostile and angry; anxious; patient and careful). More specifically, this study examined the associations between young drivers' driving style and their perceptions of separation-individuation, the family climate for road safety, and the safe driving climate among friends. We also examined sociodemographic and driving history variables such as gender, the marital status of parents, and personal exposure to traffic crashes. The study consisted of two samples of male and female young drivers (age 17-22) from Israel (n=160) and Queensland (n=160), who completed a set of valid and reliable self-report questionnaires. Findings indicate that in general, maladaptive driving styles are associated with lower family tendency to engage in promoting road safety, higher pressure and costs of driving with peers, and unhealthier separation-individuation aspects. The opposite is observed for the patient and careful driving style that relates to higher engagement of the family in road safety, lower pressure from friends, and healthier separation-individuation. Some differences were found regarding specific styles between the two samples. In addition, women scored lower than men in the reckless and careless style, and higher (in the Israeli sample) in the anxious as well as the patient and careful styles. Overall, similarities in the associations between the study variables in the samples exceed the differences, and the importance of examining variables on multi-levels when referring to young drivers' driving styles, is confirmed. The findings attest to the universal utility of the MDSI, together with the understanding that only a wider examination of personal and environmental contributors enables true insights into the complex behavior of driving among young drivers.

This Much Water: a qualitative study using behavioural theory to develop a community service video to prevent child drowning in Western Australia

OBJECTIVES

Drowning in children under the age of 5 is a frequently occurring, yet preventable event. This research used behavioural theory to test the suitability and appropriateness of a drowning prevention message in a community service video.

DESIGN

This qualitative study used content analysis of focus groups. Constructs from the Health Belief Model guided the data analysis.

SETTING

Community organisations and playgrounds in Perth, Western Australia.

PARTICIPANTS

Participants were parents or carers of at least one child under 5 years residing in Western Australia. Seven focus groups (n=57) were conducted with eight participants in each group. Most participants were parents (96%), female (95%), aged between 25 and 34 years (63%) and were born in Australia (68%).

RESULTS

Participants indicated the community service video was credible in communicating the message that young children were susceptible to drowning in shallow water and that various water hazards existed in and around the home. However, a range of external factors, such as the child's age, type of water hazard, presence of siblings and other environmental factors, influenced risk perceptions. Child drowning was seen as a serious issue. Controlling access to water and the role of supervision were understood to be important factors in preventing drowning.

CONCLUSIONS

The lack of published drowning prevention interventions shaped by behavioural theory limits the understanding of best practice. Using constructs from the Health Belief Model, this research confirmed the perceived seriousness, devastating and unforgettable consequence of drowning; however, findings were mixed regarding cues to action. Future development of drowning prevention media messages should test strategies to increase susceptibility and self-efficacy among the target group and explore the impact of different message senders. The findings provide a valuable understanding of possible messages and their execution for use in media campaigns, as one component of an effective public health intervention to prevent child drowning underpinned by behavioural theory.

Surviving or thriving: quality assurance mechanisms to promote innovation in the development of evidence-based parenting interventions

Parenting interventions have the potential to make a significant impact to the prevention and treatment of major social and mental health problems of children. However, parenting interventions fail to do so because program developers pay insufficient attention to the broader ecological context that influences the adoption and implementation of evidence-based interventions. This context includes the professional and scientific community, end users, consumers, and broader sociopolitical environment within which parenting services are delivered. This paper presents an iterative stage model of quality assurance steps to guide ongoing research and development particularly those related to program innovations including theory building, intervention development, pilot testing, efficacy and effectiveness trials, program refinement, dissemination, and planning for implementation and political advocacy. The key challenges associated with each phase of the research and development process are identified. Stronger consumer participation throughout the entire process from initial program design to wider community dissemination is an important, but an often ignored part of the process. Specific quality assurance mechanisms are discussed that increase accountability, professional, and consumer confidence in an intervention and the evidence supporting its efficacy.

Norms, athletic identity, and concussion symptom under-reporting among male collegiate ice hockey players: a prospective cohort study

BACKGROUND

Many athletes fail to report concussion symptoms to coaches or medical personnel, putting them at risk for potentially catastrophic neurologic consequences if additional brain trauma is sustained prior to full recovery.

PURPOSE

The purpose of this study was to determine whether concussion reporting norms prior to the start of the athletic season predicted reporting symptoms of a possible concussion during the season, and whether this association was moderated by athletic identity.

METHODS

Members of six National Collegiate Athletic Association Division 1 men's ice hockey teams (n = 116) completed written surveys before and after the 2012-2013 collegiate ice hockey season.

RESULTS

Participants who at pre-season perceived that "most athletes" were likely to report symptoms of a concussion were themselves more likely to report symptoms during the season. Athletic identity weakly moderated this association.

CONCLUSIONS

Perceived reporting norms may be an important target of interventions aimed at reducing symptom under-reporting among athletes.

A new method for assessing content validity in model-based creation and iteration of eHealth interventions

Background

The advent of eHealth interventions to address psychological concerns and health behaviors has created new opportunities, including the ability to optimize the effectiveness of intervention activities and then deliver these activities consistently to a large number of individuals in need. Given that eHealth interventions grounded in a well-delineated theoretical model for change are more likely to be effective and that eHealth interventions can be costly to develop, assuring the match of final intervention content and activities to the underlying model is a key step. We propose to apply the concept of “content validity” as a crucial checkpoint to evaluate the extent to which proposed intervention activities in an eHealth intervention program are valid (eg, relevant and likely to be effective) for the specific mechanism of change that each is intended to target and the intended target population for the intervention.

Objective

The aims of this paper are to define content validity as it applies to model-based eHealth intervention development, to present a feasible method for assessing content validity in this context, and to describe the implementation of this new method during the development of a Web-based intervention for children.

Methods

We designed a practical 5-step method for assessing content validity in eHealth interventions that includes defining key intervention targets, delineating intervention activity-target pairings, identifying experts and using a survey tool to gather expert ratings of the relevance of each activity to its intended target, its likely effectiveness in achieving the intended target, and its appropriateness with a specific intended audience, and then using quantitative and qualitative results to identify intervention activities that may need modification. We applied this method during our development of the Coping Coach Web-based intervention for school-age children.

Results

In the evaluation of Coping Coach content validity, 15 experts from five countries rated each of 15 intervention activity-target pairings. Based on quantitative indices, content validity was excellent for relevance and good for likely effectiveness and age-appropriateness. Two intervention activities had item-level indicators that suggested the need for further review and potential revision by the development team.

Conclusions

This project demonstrated that assessment of content validity can be straightforward and feasible to implement and that results of this assessment provide useful information for ongoing development and iterations of new eHealth interventions, complementing other sources of information (eg, user feedback, effectiveness evaluations). This approach can be utilized at one or more points during the development process to guide ongoing optimization of eHealth interventions.

Systematic, theoretically-grounded development and feasibility testing of an innovative, preventive web-based game for children exposed to acute trauma

BACKGROUND

Millions of children are affected by acute medical events annually, creating need for resources to promote recovery. While web-based interventions promise wide reach and low cost for users, development can be time- and cost-intensive. A systematic approach to intervention development can help to minimize costs and increase likelihood of effectiveness. Using a systematic approach, our team integrated evidence on the etiology of traumatic stress, an explicit program theory, and a user-centered design process to intervention development.

OBJECTIVE

To describe evidence and the program theory model applied to the Coping Coach intervention and present pilot data evaluating intervention feasibility and acceptability.

METHOD

Informed by empirical evidence on traumatic stress prevention, an overarching program theory model was articulated to delineate pathways from a) specific intervention content to b) program targets and proximal outcomes to c) key longer-term health outcomes. Systematic user-testing with children ages 8-12 (N = 42) exposed to an acute medical event and their parents was conducted throughout intervention development.

RESULTS

Functionality challenges in early prototypes necessitated revisions. Child engagement was positive throughout revisions to the Coping Coach intervention. Final pilot-testing demonstrated promising feasibility and high user-engagement and satisfaction.

CONCLUSION

Applying a systematic approach to the development of Coping Coach led to the creation of a functional intervention that is accepted by children and parents. Development of new e-health interventions may benefit from a similar approach. Future research should evaluate the efficacy of Coping Coach in achieving targeted outcomes of reduced trauma symptoms and improved health-related quality of life.

Young driver distraction: state of the evidence and directions for behavior change programs

Adolescent drivers are overrepresented in distraction-related motor vehicle crashes. A number of potential reasons for such an elevated risk include driving inexperience, high adoption of communication technology, increased peer involvement, and tendency to take risks, which render young drivers particularly vulnerable. Major legislative efforts in Graduated Licensing Systems that include passenger restrictions have shown positive effects. Restrictions on cell phone use are also being introduced; however, it is challenging to enforce such regulations. This article argues that such contextual, legislative interventions are an essential prevention strategy, but there is an unfilled need to introduce behavior change programs that may target adolescents, parents, and friends. A theoretical framework is applied in which risk and protective factors are identified from research within the contexts of community and jurisdiction. In the literature on distraction, social context and normative influences are key elements used to inform program design for adolescent drivers, with parental monitoring informing interventions targeting parents. Following from this assessment of the message content assessment, the design of strategies to deliver the messages is reviewed. In the current literature, school-based programs, simulations, and Web-delivered programs have been evaluated with supplementary strategies delivered by physicians and parents. Such developments are still at an early stage of development, and ultimately will need controlled implementation and evaluation studies. Of course, there is no likely single approach to prevent adolescent driver distraction. Complementary approaches such as the further development of technological interventions to manage phone use are needed.

Pedestrian injury and human behaviour: observing road-rule violations at high-incident intersections

Background

Human behaviour is an obvious, yet under-studied factor in pedestrian injury. Behavioural interventions that address rule violations by pedestrians and motorists could potentially reduce the frequency of pedestrian injury. In this study, a method was developed to examine road-rule non-compliance by pedestrians and motorists. The purpose of the study was to examine the potential association between violations made by pedestrians and motorists at signalized intersections, and collisions between pedestrians and motor-vehicles. The underlying hypothesis is that high-incident pedestrian intersections are likely to vary with respect to their aetiology, and thus are likely to require individualized interventions – based on the type and rate of pedestrian and motorist violation.

Methods

High-incident pedestrian injury intersections in Vancouver, Canada were identified using geographic information systems. Road-rule violations by pedestrians and motorists were documented at each incident hotspot by a team of observers at several different time periods during the day.

Results

Approximately 9,000 pedestrians and 18,000 vehicles were observed in total. In total for all observed intersections, over 2000 (21%) pedestrians committed one of the observed pedestrian road-crossing violations, while approximately 1000 (5.9%) drivers committed one of the observed motorist violations. Great variability in road-rule violations was observed between intersections, and also within intersections at different observation periods.

Conclusions

Both motorists and pedestrians were frequently observed committing road-rule violations at signalized intersections, suggesting a potential human behavioural contribution to pedestrian injury at the study sites. These results suggest that each intersection may have unique mechanisms that contribute to pedestrian injury, and may require targeted behavioural interventions. The method described in this study provides the basis for understanding the relationship between violations and pedestrian injury risk at urban intersections. Findings could be applied to targeted prevention campaigns designed to reduce the number of pedestrian injuries at signalized intersections.

The contribution of fatal crashes involving teens transporting teens

OBJECTIVE

We determined the proportion of all fatal crashes of 16- and 17-year-old drivers that involved the presence of teenage passengers from 2004 to 2008.

METHODS

Data on fatal crashes of 16- and 17-year-old drivers were derived from the Fatality Analysis Reporting System for the years 2004-2008.

RESULTS

For both 16- and 17-year-old drivers, in each of the 5 years examined, at least 39 percent of all their fatal crash events involved the presence of 13- to 19-year-old passengers and no one younger or older. For 16- to 17-year-olds combined, the proportion of crashes involving drivers with teen passengers changed little from 2004 (43%) to 2008 (41%), despite the growth in the number of states with passenger restrictions from 23 to 37 during this period.

CONCLUSION

A high proportion of teen crashes involve the presence of other teens as passengers at the time of the crash. There is a need to find effective ways to reduce these crashes.

Graduated driver licensing research, 2007-present: a review and commentary

The evolution of graduated licensing systems in the past 25 years has resulted in dramatic growth in research on this topic. The most recent summary reports have covered the period up to 2007. In the present article more recent and ongoing research is categorized, summarized, and discussed.