Keywords
road traffic accidents - human behavior - public health
Introduction
Effective solutions to road traffic accidents require input from the fields of both
engineering sciences and behavioral sciences. However, behavioral scientists encounter
several methodological barriers in researching this crucial area of public health.
Factors including lack of control for driver exposure and driver experience, difficulties
in observing actual driving behavior, and the problems associated with recording and
analyzing accident and violation rates possess limitations in researching behavioral
dimensions of road safety and accidents.[1] Insights into road safety behavior are critical in preventing and mitigating the
morbidity and mortality associated with road traffic accidents.[2] In this backdrop, the purpose of this article is to describe the role of behavior
change in injury prevention and illustrate how the application of selected behavior
change theories to injury problems, within the context of a health promotion framework,
can contribute to the enhancement of injury prevention programs.[3]
Behavior Change and Road Safety
Behavior Change and Road Safety
Behavior change is often associated with complex social, political, and economic dimensions.
This is evident from smoking, diet, alcohol consumption, physical inactivity, and
other health-related behaviors. However, unlike behavior change entailed in health-related
behaviors, road safety behavior often does not entail such complex social, political,
and economic dimensions that may prevent people to change their behavior to more healthy
ways of living.[2] For example, changes in smoking, dietary changes, alcohol consumption, and physical
activity are processes and practices embedded in social life, not one-off events triggered
by information or prevented by remedying information deficits. Neither are these processes
a consequence of people applying a rational calculus to their own actions.[2] Changing road safety behaviors is therefore an attractive policy approach. Research
into the psychological aspects of driving behavior is essential to an overall approach
to road safety issues. However, the problems of conducting such research are not easily
addressed. Controlling for the effects of experience and exposure within studies of
the general population is rather difficult,[4] and the analysis of actual driving behavior and accidents is also fraught with problems.
One way of attempting to compensate for these problems is to limit the scope of research
to groups of road users that allow for a more careful study of psychological factors.
Examples of this approach that have been successful include the study of long-distance
truck drivers[5] and taxi drivers. Research into taxi drivers is not just valuable because of its
possible usefulness to general road safety research but it is also valuable in its
own right. Taxi drivers play a crucial role in the social and economic functions of
modern society. Their contribution to the day-to-day operation of the business world
and tourism is of considerable significance, as is their general social function as
a mean of transport for those who are unable to use other modes of public or private
transport. In terms of general road safety, the use of taxis is a key alternative
to drink-driving, and hence taxis provide a service of potentially great indirect
benefit to overall road safety.[1] Many studies have shown that human behavioral factors collectively represent the
main cause of road traffic crashes, and their remedial measures can go a long way
to help prevent road traffic injuries (RTIs).[6]
[7]
[8]
[9]
[10]
[11] A growing body of work is emerging that demonstrates the positive impact of using
behavioral science approaches to both understand and reduce injury risk behaviors.[12]
[13]
[14]
[15]
[16]
Epidemiology of Road Traffic Accidents
Epidemiology of Road Traffic Accidents
Numerous epidemiological studies have demonstrated that human behavior accounts for
more than 85% of road accidents.[17]
[18]
[19] The World Health Organization report attributes 71% of road accidents to human factors.[20] Application of behavior change theories can significantly reduce the rate of road
accidents and resultant injuries.[21]
Common Risks of Road Accidents
Common Risks of Road Accidents
Speed
Speed is the most common factor that leads to accidents. The literature indicates
that both human and environmental factors can affect the speed of the motor vehicle.
Among human factors, age, gender, alcohol consumption and its level, and number of
passengers in a vehicle are often found responsible. While motor vehicle condition,
its power, its speed, road layout, surface quality, traffic density, allowed speed,
time of the day, and weather conditions significantly affect speed.[22] Influence of substance: approximately 20% road accidents in high-income countries
and 33 to 69% in low-income countries take place under the influence of alcohol.[23] However, studies from Norwegian demonstrate that the professional drivers who also
drive under the influence of alcohol have a lower rate of accidents than the nonprofessional
drivers.[24]
Fatigue
Fatigue is an important risk factor that has been found to be associated with road
accidents. Young drivers in the age range of 16 to 29 years, males, shift workers,
people with sleep apnea, drivers who had less than 5 hours of sleep, and drivers who
drive between 2:00 a.m. to 5:00 a.m. were found to be more affected with fatigue.[22] Professional drivers who work on a tight schedule were found at a higher risk of
having fatigue.[22] Research suggests that drivers experience same influence on their driving with fatigue
impairment, as they would do with alcohol consumption.[25]
Handheld Mobile Telephone
Handheld Mobile Telephone
Numerous studies have shown that the use of mobile phone leads to a bigger distraction
in driving. Across the world, a high number of accidents had been attributed to this
risky behavior.[22]
Sociodemographic Factors Affecting Behavior
Sociodemographic Factors Affecting Behavior
Age and Gender
Age and male gender have been found significantly associated with risky behaviors.
Studies conducted in low- as well as high-income countries have found that younger
people compared with older age group, and males engage in high-risk driving behaviors.[26] In those studies, it was observed that male drivers compete with other drivers,
ignore signal lights, do not fasten the seat belt, and overtake at a higher rate than
their female counterparts and take longer time to return in the proper lane.[27]
[28] Males also violate rules more than females and encounter higher numbers of fatal
accidents due to poor compliance with traffic rules.[27]
[28] Association between gender, age, time of driving in the day, and road conditions
were also observed in several international studies, and it was found that female
are much safer drivers in all road conditions (wet/dry, straight/curbed, rural/urban)
and time of day (day/night). Females become much safer drivers at a much higher rate
than their male counterparts as they get older.[29]
[30] Females were also found keeping a safer distance between other vehicles on the road,
whereas male drivers are much prone to drive in close proximity to other vehicles.[31] Males between 31 and 40 years of age were found to be more traffic rules violators
than any other age and gender group.[32]
Behavior of Professional Drivers
Behavior of Professional Drivers
This section talks about the behavior of professional drivers, mainly bus and taxi
drivers. The experience of driving makes these professionals more comfortable in driving
in all situations. Once professional drivers start seeing themselves as expert drivers,
the risk-taking behavior also increases among them. They are more likely to use mobile
phone for communication and engage in other tasks such as setting the radio station
and so on, which leads to a huge distraction in their driving.[33] Mainly high workload, fatigue, sleep deprivation, stress, and dual tasking while
operating the vehicle causes road accidents in professional drivers.[34]
[35] Professional drivers have shown poor intention of wearing a seat belt and have been
found driving in fatigue and under the influence of alcohol in middle- and low-income
countries.[36]
[37] It is well understood in the existing literature that when drivers perceive a higher
level of self-control, their behavioral intentions, motivation, and priorities for
safety rules get influenced negatively.[38] Professional drivers are more exposed to traffic hazards as they spent more time
in driving than nonprofessionals and get desensitized with the hazards and undermine
risks.[36]
[39] Professional drivers who undergo a training receive a different level of driving
license, social image of an expert driver, low level of driving anxiety, and more
driving experience. All these factors put in their minds that they are more skilled
drivers. This negative confidence brings vulnerability in their behaviors, which indirectly
promotes risk-taking behaviors.[40]
[41]
[42]
Bus Drivers
In addition to experiencing the same environmental traffic conditions, bus drivers
carry additional constraints that are imposed by the vehicle characteristics, concern
for passengers and their comfort/safety, and reaching on the scheduled time. Bus driving
has been classified as a highly stressful occupation. Often, the associated physical
and psychological factors result in poor driving performance.[43] People perceive that a higher level of control and their behavioral intentions,
motivation, and priorities regarding safety could be influenced in a safety-reducing
direction.[38] Personality trait, especially attitude of the driver, has been found highly responsible
for risky driving, failure to follow traffic rules, and number of road accidents in
studies conducted in several countries.[43]
[44]
[45]
Taxi Drivers
Compared with bus driving, taxi driving has been seen to be a strenuous occupation.
However, research findings have shown that taxi drivers face a significantly higher
risk of crime that impacts their driving negatively. Taxi driving is based on an intermittent
reward system, that is, their earning is not fixed like bus drivers, and therefore
they have even greater pressure of working long hours and in unfavorably difficult
situations. Compared with bus drivers, taxi drivers develop communicable, noncommunicable,
and chronic diseases at a much faster rate and in a higher magnitude due to frequent
contact with passengers from all walks.[46] Unhealthy lifestyle is much common among taxi drivers, which makes them prone to
obesity, heart disease, type 2 diabetes, and even HIV/AIDs infection.[46]
[47]
Other Factors
Reckless and Fun Ride
Some drivers look for gratification, adventure, joy, and pride in their driving. Mainly,
these drivers are not professional; they lack adequate training and engage in high
risk-taking behavior. Alcohol consumption is also very prevalent among this group,
which, on the one side, impairs their judgment and concentration, and on the other
side, elevates their mood, making them more vulnerable to fatal accidents.[48]
[49]
Experience
Experienced drivers gain better driving skills, attitude, and behavior, whereas drivers
who lack driving experience are more susceptible to making mistakes.[24]
Personality Traits
Personality traits including risk propensity, sensation-seeking, conscientiousness,
openness to experience, emotional stability, extraversion, and agreeableness exert
influence on drivers’ driving attitude and behavior while driving.[50]
Emotions: Anger and Anxiety
Emotions, mainly anger and anxiety, have also found to be significantly associated
with a higher chance of traffic accidents. Often, drivers charged with emotions find
difficulty in concentrating on their driving and they become victims of making mistake.[51]
[52]
Need for Behavior Change
Evidences strongly suggest that road traffic accidents can be greatly minimized by
bringing about changes in human behaviors and the associated psychological and structural
factors. Multiple behavior change theories have been successfully implied in various
driving-related risky health behaviors across the world. The health belief model has
been found to be more appropriate in addressing human behaviors and educating drivers
for the risk as well as prevention.[53]
[54] In addition, environmental changes are also needed to address the high rate of road
accidents.
Conclusion
Road traffic accidents are rapidly increasing in low- and middle-income countries;
however, public health interventions and related research are very minimal in these
countries. Behavior health theories have been applied in more advanced nations, but
application of such behavior interventions is minimal in low- and middle-income nations.
This study provides a brief idea of factors that contribute to road traffic accidents,
including differences between professional and nonprofessional drivers, association
with sociodemographic factors, and vulnerable population. This information can be
used to guide appropriate behavior change theory and plan to promote safer driving
and prevent road traffic accidents.
