Road safety lead agency challenges of three decades of intervention for road safety in Iran: implications for policy-makers.

BACKGROUND: Road traffic crashes and associated injuries and mortalities are one of the big public health challenges, especially in low/middle-income countries. Road safety lead agency (RSLA) is a vital factor in the sustainable prevention and promotes road safety. In the recent decades, various policy interventions have been conducted for road safety in Iran. This study aimed at exploring the challenges of RSLA from the perspectives of stakeholders at various levels. METHODS: A qualitative study was conducted. In-depth interviews and document reviews were used for data collection. To conduct interviews, different stakeholders at various levels such as policy-makers, senior national authorities, researchers and faculty members were selected. Data collection was conducted between November 2019 and June 2020. Thematic content analysis approach was used for data analysis. RESULTS: The experts' perspectives were analysed and then categorised under five main themes including the role and position of the lead agency, the role and duties of the actors and players, translating policy into practice, intrasectoral and intersectoral cooperation and coordination and evidence production and application and a total of 22 subthemes were identified. The current structure of the RSLA is one of the main challenges emphasised by the research participants. CONCLUSION: To achieve significant improvements in road safety at the national level, a strong management system and leadership body is a critical issue. Organisational reform to establish an effective unique lead agency is proposed to cope with RSLA challenges.

Developing Pedestrians' Red-light Violation Behavior Questionnaire (PRVBQ); Assessment of Content Validity and Reliability.

OBJECTIVE: To develop a self-completion pedestrians' red-light violation behavior questionnaire (PRVBQ) based on the theory of planned behavior (TPB) and assess the content validity and reliability. METHODS: This study was conducted in three phases of (i) PRVBQ development study; (ii) Content validity study including face validity; and (iii) Reliability assessment. The directed content analysis method was used for the analysis of the qualitative interviews. The item impact score was used for face validity. Content validity index (CVI) in the item level and average scale level, and content validity ratio (CVR) were determined. Intra-class Correlation Coefficient (ICC), and Cronbach's alpha was assessed for test-retest reliability and internal consistency respectively. RESULTS: Draft questionnaire including 86 items was constructed. Sixteen items were eliminated due to low face and content validity, remaining 70 items in total. The PRVBQ was rated as having good content validity (individual items CVI ranged from .80 to 1, and overall PRVBQ CVI-Average=0.95, p=0.05). The direct measures (reflective indicators) showed excellent internal consistency with Cronbach's alpha=0.9. All items showed excellent agreement. CONCLUSION: This study using a comprehensive process of development and assessment of content validity and reliability developed a content valid and reliable questionnaire predicting pedestrians' red light violation behavior.

Measurement properties of self-report pedestrians' road crossing behavior questionnaires constructed based on the theory of planned behavior: protocol for a systematic review.

BACKGROUND: Pedestrians' unsafe crossing behavior exposes them at risk of trauma and death and puts a tremendous burden on the health care system. The theory of planned behavior (TPB) is one of the leading theoretical models used to develop pedestrians' road crossing behavior questionnaires, yet the quality of measurement properties of them has not been evaluated. The aim of the proposed systematic review is to evaluate the quality of measurement properties of the questionnaires constructed based on the TPB to predict pedestrians' road crossing behavior. METHODS: We will include studies validating or evaluating one or more psychometric properties of the self-reported questionnaire employing the TPB for predicting pedestrians' road crossing behavior. A comprehensive search strategy will be formulated based on the components of review aim. The databases of MEDLINE, Embase, PubMed, Cochrane Library, PsycINFO, PsycARTICLES, and ProQuest, also grey literature and the reference lists of the included studies, will be searched. A hand search for the relevant journals and Google Scholar will be conducted. COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist will be used to evaluate the measurement properties of the included questionnaires. First, we will assess standards for the methodological quality of each study. Then, each scale or subscale of a questionnaire will be rated using the updated criteria for good measurement property. We will quantitatively pool or qualitatively summarize the results and will evaluate them against the criteria for good measurement properties. Finally, we will grade the pooled or summarized evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach and provide recommendations for the most appropriate instrument. DISCUSSION: The proposed systematic review will evaluate the measurement properties of self-report pedestrians' road crossing behavior questionnaires constructed based on the TPB. The findings will help researchers in selecting the appropriate TPB-based instrument for pedestrians' road crossing behavior. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017047793.

Red light violation and pedestrians' modal salient beliefs about unsafe road crossing behavior: a qualitative study.

BACKGROUND: Pedestrians are amongst the most vulnerable road users and their unsafe behaviors have a major impact on traffic injuries. The aim of this study was to determine the underlying psychological factors behind red light violation in pedestrians' crossing behavior based on the Theory of Planned Behavior (TPB) and to provide recommendations for preventive interventions. METHODS: This qualitative study was conducted in Tabriz, one of the metropolitan cities of Iran. 30 pedestrians were individually interviewed using semi-structured, open-ended questions to elicit salient consequences, social referents, and circumstances regarding pedestrians' red light crossing behavior. The transcribed interviews were analyzed using directed content analysis followed by frequency analysis in order to detect modal salient beliefs. RESULTS: A total number of 115 sub-categories were identified which were then classified in the ten predetermined categories of the Theory of Planned Behavior: advantages, disadvantages, positive feelings, negative feelings, approving referents, disapproving referents, behaving referents, not-behaving referents, facilitators, and barriers. "Saving time" was elicited as the most important both the advantage and the positive feeling. "Getting injured" was identified as the most serious disadvantage. "Lowering the level of culture" was obtained as the main negative feeling. "Friends/Peers" comprise the most prominent group among both the approving and the behaving referents, whereas "Family members" constituted the most significant group both among the disapproving and the not-behaving referents. "Being in a hurry" was introduced as the most substantial facilitator and "The fear of accident" was identified as the most influential deterrent factor. CONCLUSIONS: Based on the major findings, reducing pedestrians' red light violations needs to focus: on the perceived negative and positive consequences and feelings of this behavior like getting injured, and saving time respectively; on the approval role of friends/peers, and the disapproval role of family; and on the fear of accident as a barrier, and rushing as a facilitating factor. More precise quantitative research is needed to determine the predictive power of these factors in such risky behavior.