Reducing
accidents and promoting safety behaviours
Adapted
from Harari and Legge, Psychology and Health, Heinemann, 2001 (ISBN
0-435-80659-9),
Sarafino,
Health Psychology (2nd Ed), Wiley & Sons, 1994 and
Philip
Banyard (2002) Psychology in Practice – Health, Hodder & Stoughton (ISBN
0-340-84496-5)
Road Safety
Where young children are concerned, it is usually adults who have to take responsibility for promoting safe behaviours and preventing accidents. It is therefore adults who are targeted in health promotion and accident prevention campaigns rather than children. There are some messages that can be conveyed to children such as road safety - for example, the Green Cross Code in the 1970s. More messages are being taught in schools through Personal, Social and Health Education (PSE).
Provides basic information about children's behavior in realistic traffic situations. 56 children (aged 5-6 yrs) took part in a 'treasure trail' activity in which they were confronted with 2 road crossings, 1 at a T-junction with a moving car and the other between parked cars. Ss' performance was videotaped and coded for relevant behaviors such as stopping at the curb, looking for traffic, direction of gaze, and style of crossing (i.e., walking or running). Results reveal that performance was extremely poor. 60% of the Ss failed to stop before proceeding from the curb onto the road. Looking for oncoming traffic was exhibited by no more than 41% of the sample, dropping to as low as 7% in some instances. When looking did occur, it was initially as likely to be in the inappropriate direction (i.e. to the left) as in the appropriate direction (i.e. to the right). Consideration of individual performance revealed the existence of individual differences within the sample; such differences were relatively stable across the 2 road crossings. These findings, based on controlled naturalistic tasks and detailed observational methods, build on earlier studies that are generally able to provide only estimated rates of children's behavior. Zeedyk,-M-Suzanne; Wallace,-Linda; Spry,-Linsay Accident-Analysis-and-Prevention. 2002 Jan; Vol 34(1): 43-50
Wortel et al (1994) describe four safety behaviours that parents can engage in that prevent accidents among pre-school children:
1. · Educating the child about risks
2. · Supervision of the child
3. · Making sure that the child's environment is safe
4. · Giving first aid when an accident has happened.
Commentary
It is difficult to make a child understand the nature of risk. It is almost impossible to ensure constant supervision, and also does not allow the child to explore the environment and learn from its mistakes. Making the environment safe is the best choice.
Langley and Silva (1982) found that only 39% of parents whose child had had an accident in the pre-school period changed their behaviour to prevent further accidents. Most of the parents who did not change their behaviour did not feel that it was possible to prevent the accident.
Commentary
The problem with an approach that focuses on the role of the parent is that it lays blame on these parents, instead of recognizing the need for a safe environment to be provided for everyone. For example, if we recognize that children who grow up in deprived homes are more likely to have accidents than those who do not, then we often lay the blame for that statistic on negligent parents, rather than looking at the environment in which these parents are forced to bring up their children - in high-rise flats or on housing estates near main roads, for example.
The promotion of safe behaviours can be more effective if laws are passed.
Oborne (1982) (cited in Pitts, 1996) uses a learning theory approach to understanding safety. He argues that often safety routines and practices take a lot of time, and that these behaviours are less likely to be reinforced than behaviours that are often quicker and easier, although more risky.
Pitts (1996) lists the following accident prevention actions as the most important:
· · To eliminate the hazards from the workplace
· · To remove the individual from exposure
· · To isolate the hazard
· · Workers can be issued with personal protection - such as protective clothing.
The emphasis in this model is that the management, rather than the individual should take the action.
The use of cycle helmets
In Maryland (USA), the use of cycle helmets was compared in three counties:
- one in which a law had been passed in 1990 making it mandatory for everyone under the age of 16 to wear an approved helmet;
- one in which publicity about proposed legislation was widespread,
- and one in which there were no laws or publicity.
Using self-report measures, the increase in helmet use rose from 11.4% to
37.5%, 8.4% to 12.6% and 6.7% to 11.1% respectively. 
Observations of the use of cycle helmets in the three counties found slightly different increases: from 4% to 47%, 8% to 19%, and in the county with no laws or publicity, there was a decrease during the period of survey.
In
one state in Australia, after the wearing of cycle helmets was made compulsory
there was an immediate increase in helmet use from 31% in March 1990 to 75% a
year later. The number of cyclists killed from head injuries decreased by 48%
in the first year, and by 70% in the second year.
Adapted from The
Psychology of Preventive Health, 1996.
The death rates for motor vehicle accidents increase dramatically during adolescence, as depicted in the graph, and males between 15 and 9 years of age are about 2˝ times more likely to die in traffic mishaps than females in the same age range (Matarazzo, 1984).
Safe-driving programs
Because of the high rates of traffic fatalities in adolescence, special safe-driving programs have been directed toward teenagers. One approach has involved providing driver training in high schools, and early quasi-experimental research showed that students who take driver education courses subsequently have fewer accidents than those who do not. But later studies revealed that the course itself was not the cause of this relationship; for some reason, students who elect to take driver education simply drive less than those who do not (Robertson, 1986). Similarly, driver education for adults-for example, as a condition for employment or in response to traffic violations---also seems to have little effect on accidents.
Perception
and reaction
Other ways to reduce traffic accidents have been more effective than driver training. One approach capitalizes on research findings regarding drivers' perceptual and reaction abilities, with the goal of reducing their errors and enhancing their reaction time. Public health researcher Leon Robertson has described two examples:
(1) An extra brake light mounted in the centre of the vehicle above the trunk resulted in a 50% reduction in rear-end collisions when the front vehicle was braking, compared to randomly assigned control cars in the same fleets.
(2) Stripes across a road at an exponentially decreasing distance creates the illusion of acceleration when crossing at a constant speed . . . Installation of such stripes at high-speed approaches to roundabouts in England resulted in an average 66% reduction in crashes at such sites. (1986, pp. 22-23)
Another approach that is quite effective involves raising the legal driving age (Robertson, 1986).
SLEEPY DRIVERS
As mentioned above, there is a problem in the UK with sleep-related vehicle accidents (SRVAs). There has been extensive research into this issue (Reyner and Horn, 1998) which shows that the methods suggested to prevent this by motoring organisations, such as opening the window or turning up the radio, only have small and short-term benefits (about 15 minutes). The best advice is to take a break and maybe have a nap. It has been found that naps of between 4 and 20 minutes can have a positive effect on performance and reduce sleepiness. In fact, 15-minute naps taken every 6 hours during a period of 35 hours of no sleep have been found to be effective in maintaining a good level of performance. The common technique of having some coffee is also a good one, and laboratory tests have shown that low doses of caffeine (100—200 mg, or about two cups of coffee) improve alertness in sleepy people. The answer is fairly clear. To reduce road SRVAs we need to encourage drivers to stop driving when sleepy, and to take a nap or drink some coffee (for a review see Horn and Reyner, 1999).
MOBILE PHONES
There is concern about the use of mobile phones by drivers. A review of research by RoSPA (R0SPA, 2001 b) about the effects of using mobile phones on driving found that when the driver is using a hand-held or hands-free phone they (a) vary their road speed and (b) wander in their lane. The driver appears to lose touch with driving conditions and become distracted. They concluded that using a mobile phone when driving increases the risk of having an accident. Interestingly, not all research paints such a negative picture of the phone user. For example Alm (1998) tested the idea that the more demanding the driving task, the greater would be the effect on using a mobile phone. The study did not support the hypothesis and showed, in fact, that drivers under pressure of a demanding road will reduce the level of difficulty by, for example slowing down, when they are using a mobile phone. This suggests that we are able to successfully multi-task and adjust our behaviour to match the actions we are required to do.
The health promotion strategy to reduce accidents in drivers who are using mobile phones is carried out though driver education, through legislation (drivers must be in proper control of their vehicles at all times and holding a mobile phone whilst driving is now banned in the UK), and through employer education (so that they do not require their drivers to be available on the phone at all times).
Protective
equipment
Injuries and deaths can also he prevented if drivers and passengers will use protective equipment, such as seat belts in cars and helmets when riding motorcycles (Latimer & Lave, 1987; Robertson. 1986; Waller, 1987). But after seat belts were installed as standard equipment in cars, few people opted to use then. As a result, researchers began to try a wide variety of methods to promote the use of protective equipment in cars. Some of these studies were conducted to improve car safety for children by providing instruction and information to parents through hospitals and paediatricians. These programs have had mixed success (Cataldo et al, 1986; Christophersen, 1984, 1989). A successful hospital-based program provided computer-assisted video instruction on using an infant safety seat to mothers before leaving the hospital after giving birth (Hletko, Robin, Hletko, & Stone, 1987). A parking lot attendant at the hospital subsequently assessed the use of a safety seat when the mother brought the baby back for a check-up nine months later. Many more of these mothers than untrained mothers had their infants correctly restrained.
Some programs to increase seat belt use have been directed at the child, rather than the parent. One study presented a 2-week passenger safety curriculum to children in several preschools, using a theme character called ‘Bucklebear’' (Chang, Dillman, Leonard, & English, 1985). Two of the curriculum's main messages were that buckling up for every ride is a good thing for everyone to do and that the best seat in the car is the back seat. Some of the parents also took part in activities to promote seat belt, use. The children in several other preschools served as a control group who were matched to the experimental subjects for their prior seat belt use. Follow-up observations in the preschool parking lots 3 weeks after the program was completed revealed that over 44% of the "Bucklebear' children and only about 22% of the control children were using seat belts.
Another program used rewards to encourage seat belt use by children (Roberts & Fanurik, 1986). Before the rewards were introduced, about 5% of the children used the belts; after the rewards were introduced, about 70% used the belts. As you might expect, follow-up observations, 2˝ months after the program and rewards ended, revealed that seat belt use declined -~ but between 10% and 20% of the children were still using the belts.
Less than 5% of Americans were using seat belts by the early 1980’s, despite public health announcements and other programs to promote this behaviour (Latimer & Lave, 1987). As a result, many states began to pass laws requiring adults and children to use protective equipment in cars. Seat belt and safety seat use has generally increased sharply and traffic fatalities have decreased after these laws went into effect (Latimer & Lave, 1987; Robertson, 1986; Wagenaar & Webster, 1986; WaIler, 1987). But many people begin to revert to not using the equipment after a while, and probably less than half of the people comply with the law by the time a year has passed.
ACCIDENT REDUCTION AT WORK
Health promotion can be used at work to reduce accidents. The most frequently cited methods for reducing accidents at work are stress reduction programmes. For example, Kunz (1987) describes how a stress intervention programme reduced medical costs and accident claims in a hospital. The programme more than paid for itself with the savings from reduction in accidents. Stress reduction programmes have also been shown to reduce absenteeism (Murphy and Sorenson, 1988).
Another way of reducing accidents is through incentive programmes. Fox et al. (1987) looked at the effects of a token economy programme at open cast pits. Employees earned stamps for working without time lost for injuries, for being in work groups in which none of the workers had lost time through injury, for not being involved in equipment damaging accidents, for making safety suggestions, and for behaviour that prevented injury or accident. They lost stamps for equipment damage, injuries to their work group and failure to report accidents and injuries. The token economy produced a dramatic reduction in days lost through injury and reduced the costs of accidents and injuries. These improvements were maintained over a number of years.
A relatively simple intervention to reduce fatigue and accidents in logging workers involved encouraging them to take regular fluids. Sports science has shown that the use of regular fluid intake is one way to reduce the sense of strain in a task and delay the onset of physical and mental fatigue. A study of loggers in New Zealand (Paterson et al., 1998) looked at the normal performance of the loggers and compared it with performance when they were taking a sports drink every 15 minutes. In the normal condition, the loggers lost on average about 1 per cent of their body weight during the working day, but in the fluid condition they maintained or increased their body weight. Also in the fluid condition, the heart rate was lower, and the loggers reported feeling fresher, stronger, more alert and more vigorous. Reducing fatigue and strain can reduce errors so it is a useful intervention to keep a worker properly hydrated.
Other
methods of reducing accidents at work include poster campaigns to raise awareness of hazards and encourage a
realistic assessment of risk, staff training
and organisational review.
MEDIA CAMPAIGNS
Public information films on television often tell us to do very sensible things like dip our headlights or fit smoke alarms. They might well affect our attitudes to these procedures and products but do they affect our behaviour? In the field of accidents it is possible to estimate changes in behaviour by comparing accident rates before and after an advertising campaign. This discrepancy between attitude (what we think) and behaviour (what we do) is illustrated in a report by Cowpe (1989). This report looked at the effectiveness of a series of advertisements about the dangers of chip pan fires. Before the advertisements, people were asked about this hazard and most of them claimed that they always adopted safe practices. However, the statistics from fire brigades about the frequency of chip pan fires and the descriptions by people of what they should do suggested that their behaviour was not as safe as they thought. A television advertising campaign was developed and broadcast showing dramatic images of exactly how these fires develop, and how people should deal with them. The adverts ended with a simple statement, such as ‘Of course, if you don’t overfill your chip pan in the first place, you won’t have to do any of this’.
By comparing fire brigade statistics for the areas which received the advertisements, and those for the areas which did not, the advertisers found that the advertisements had produced a 25 per cent reduction in the number of chip pan fires in some areas, with a 12 per cent reduction overall. Surveys taken after the series of advertisements showed that people had more accurate knowledge about what they should do in the event of a chip pan fire than before. The implication from this report is very clear. Public information films and health promotion advertisements are most effective if they contain information about what to do rather than what to think or what to be scared of.
PREVENTING SLIPS, TRIPS AND FALLS
Slips, trips and falls make up around a third of injuries leading to absence from work (HSE, 1999). Older people are especially susceptible to health-damaging falls, with approximately 30 per cent of people over 65 who live in the community falling each year and about 50 per cent of the over 80s (D0H, 2000). The consequences of falling can be:
• physical injury such as fractures
• psychological impacts such as increased fear of falling
• reduced mobility
• needing to be cared for in an institution
• death.
There have been many programmes aimed at reducing damaging falls in older people. Studies that have targeted high-risk groups and offered programmes of exercise aimed at increasing mobility and strength have been relatively ineffective in reducing the number of falls. Programmes which have the greatest success combine a number of interventions such as a review of the medication the older person is taking, a safety review of their house and taking moderate exercise (for a review see D0H, 2000). For people at particular risk, there have been some interventions using hip protection so that falls are cushioned and less damaging. The problem with such interventions is that the compliance rate for wearing the devices is relatively low.
UNDERSTANDING MEDICAL INSTRUCTIONS
We live in a world full of icons and signs. Diagrams of stick people with crosses through them appear all over our everyday environment. What is the stick figure doing? Does everybody understand the same message from these signs? Research into signs can help us adjust them so that more people can understand what is required and make fewer errors in medication. For example, a study by Dowse and Ehlers (1998) on the different perceptions of signs by black and white people in South Africa, was able to devise signs that could be better recognised by the black community. Literacy in the black community is still very low in South Africa (estimated 45 per cent illiterate and 25 per cent semi-literate), so the use of icons and pictures is important in medical instructions. A set of international symbols was published in 1991 in the United States Pharmacopoeia, but the researchers believed that many of these symbols would be poorly understood by black South Africans. Following interviews with black students they devised some Africanised versions of the symbols. When they tested them with members of their target group (black South Africans with low levels of literacy), they found that the Africanised symbols were either equally well or better recognised than the US symbols.