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MotorVehicalSafetyIntervention-Example.docxRunning head: Physician’s Ability to Address Driving Safety with Their Patients 1
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Physician’s Ability to Address Driving Safety with Their Patients The University of Toledo Juliane Johnson 11/30/2011
Scope of the Problem
Injury and death due to motor vehicle accidents are serious, but often neglected issues globally. According to the U.S. Census, there are about 312,689,471 people in the United States and about 196,165,666 of them have driver’s licenses(Bureau, 2011). With so many drivers on the road education and awareness of driving safety are key factors in decreasing the risk of accidents and deaths among those driving. The amount of accidents due to distracted driving, driving under the influence and other driving errors is overwhelming and there many things that can be done to decrease the amount of accidents, injuries, and fatalities. There have been advances in the prevention of motor vehicle crash rates and over the past few decades the volume of motor vehicle accident fatalities has decreased for every age group. In 1985, there were about 17.8 deaths per 100,000 people between the ages of 35-69 and in 2009 that number dropped to about 12.5(Safety, 2008). Over time, new education programs, safer vehicles, safer roads and many other factors have contributed to these decreases in deaths, but the problem has not vanished completely. Motor vehicle accidents still account for more deaths between the ages 5-34 than any other cause. As of 2008, unintentional motor vehicle traffic deaths were the leading cause of death for all people between the ages 5-34 and accounted for 37,985 deaths in all people("Injury Prevention & Control: Data & Statistics," 2010). One of the most crucial aspects of intervention programs is beginning to reach the individuals who are at the highest risk of accidents along with finding new venues to reach all populations(McEvoy, Stevenson, & Woodward, 2007).
Specifically, distractions while driving are a leading cause of motor vehicle accidents that can be addressed with a change of behavior. According to the Fatality Analysis Reporting System (FARS), there were a total of 51,857 fatalities caused by crashes involving distractions in 2008 (Wilson & Stimpson, 2010). Drivers are more frequently using distracting devices like cell phones, GPS units and complex stereos while in cars than ever before. These devices may even be built directly into new models as a standard package, which can sometimes give the misconception that the devices can be used safely while driving and this is not a healthy message to send drivers.(Jacobson & Gostin, 2010). The most recent statistics even suggest that up to 21% of all traffic accidents are due to distractions while driving. Finding out how to stop this critical trend is very important to decreasing the amount of fatalities reported. One clear answer is passing legislation that can prohibit or reduce these distracted behaviors. “Since 2007, 34 states have enacted distracted driving legislation, with additional states considering adoption”(Jacobson & Gostin, 2010, p. 1419). Outside of legislation, because citizens are often not educated on current laws and these laws also tend to be hard to enforce, other venues need to be recognized. Changing individual’s behaviors in order to prevent these crashes is a good way to decrease the amount of fatalities. In order to change these behaviors, new interventions need to be explored, for example, including cautions and education in a new and innovative place like a doctor’s office.
Physicians historically are people who can be trusted and their advice is often found more important than any other source for people. Some rely solely on the direction of their physicians when it comes to dealing with sickness, injury, recovery, and health in general(Omer, Salmon, Orenstein, DeHart, & Halsey, 2009). This indicates the inclusion of motor vehicle accident injury and death in this category because it so heavily affects the health of the U.S. population. Along with supplemental education provided by physicians, educational media can be beneficial to those who are spending valuable time in physician’s waiting rooms. If physicians are able to take on a new responsibility with patients that place them in the role of educator and prevention advocate there may be more opportunities to decrease these fatalities.
Research Questions
Do physicians educate, converse, or direct patients on motor vehicle safety or educational tools for safe driving?
What stage of change are most physicians in regarding incorporating education about driving safety into everyday practice with all patients?
What are the barriers physicians identify preventing safe driving counseling?
Program Objectives
The goal of this intervention is to target physicians and their clientele in a distracted driving campaign that will raise awareness of the issue. Driving distractions is one of the most critical areas of motor vehicle accidents because of the amount of distractions available. Cell phone use, stereos, GPS systems, televisions, excessive amounts of passengers, and alcohol or drug use are all highly risky behaviors when driving.
Goal: Increase physician’s conversations with patients regarding driving safety.
Objective: 20% of physicians who receive the intervention will include driver safety in their daily patient conversation by the end of 2012.
Objective: 50% of physicians who receive the intervention will display the distracted driving media in their office in some way by the end of March 2012.
Goal: Decrease distracted driving for clientele that receive educational techniques from their physician.
Objective: 50% of individuals who receive educational supplements by physician will be accident free for at least one year post.
Objective: All individuals who receive educational supplements will have a follow-up session within six months.
Goal: Decrease motor vehicle accidents due to distracted driving in all clientele who receive educational supplements.
Objective: Clientele who receive educational supplements from physicians will experience 25% less motor vehicle crashes due to distracting activity.
Explanation of the Intervention
The primary goal of the intervention is to realize the stage of change the physician is in with alliance to the Transtheoretical model. In addition, the intervention is based on aspects of the Health Belief model in areas of benefits and barriers. If the intervention is successful, the physicians should recognize the benefits of speaking with their patients along with overcoming barriers regarding safe driving counseling. Additionally, as the physicians receive different aspects of the intervention, they may move through stages of change and be more likely to change their behaviors. The intervention is a social marketing campaign based on distracted driving behaviors that will be shown in physician’s offices in various places along with a web based seminar or webinar that the physicians will participate in for continuing education credits (CEU’s). The marketing pieces will show statistics’ about DUI’s, cell phone use, and distractions involving car stereos to show the severity of the problem along with the consequences to the viewers. These marketing tools will also be used to show the benefits of counseling in this area to the physicians. Using depictions of cell phone use and using the radio while driving will show how susceptible most individuals are to these behaviors.
The primary focus of the intervention is physicians and their ability or choice to counsel their patients about driving safety along with trying to increase the conversations that physicians are having with their patients. If physicians realize the benefits and overcome barriers of these interactions they may increase their efficacy in changing their patient’s behaviors. The webinar aspect of the intervention acts as a process of change because it may be the first time a physician has seen any information on this health behavior change. If a physician uses the webinar and understands some of the benefits it is possible to say they may have moved from pre-contemplation to contemplation or even preparation in the Transtheoretical model (Glanz, Rimer, & Viswanath, 2008). As a secondary audience, the intervention will target the patients in their physician’s office to increase awareness, education, and safe behavior. Self-efficacy is another aspect of the intervention but will only be measured in the survey for the physicians. The hope is that the intervention will reach as many individuals as possible by making them public and available. The images will be available at all times when the office is open and will be targeting specific behaviors opposed to specific populations. Distracted driving affects all populations with an emphasis on those who use electronic devices and all populations need to be addressed (McEvoy, et al., 2007).
A unique twist this intervention has is the population that will be targeted. In the past researchers have tried to focus on a specific population with interventions in order to create a better result. This intervention is not focused on a specific population other than the physician’s clientele, which can vary. An important aspect of this intervention is the patient-health provider relationship and how an open-communication relationship can help to decrease health risks outside of disease and sickness. The population may vary, but being able to focus in on the ability of the physician to instill new ideas and behaviors in their patients is something that may begin to have a serious effect on the driving behaviors. In the past, physicians have played a vital role in individual’s ability to quit smoking, lose weight, and even vaccinate themselves and their children(Omer, et al., 2009).
Additionally, the intervention will include a system for participating physicians to recognize high-risk patients to focus on or include in educational time for driving safety. As a cue to action, the highest risk patients like teens, young adults, and possibly older adults will have some sort of notification in his/her chart to mark the level of risk they present and prompt the physician to act. The notification will signify a higher risk and, in turn, remind the physician to have a conversation about driving safety. These cues to action will serve as a strong reminder that these patients are more likely to experience a crash and hence, need to be educated. This section of the intervention is based on the Health belief model also.
Media-based campaigns have been used numerous times in the past in other areas to change behaviors of particular populations. Using media campaigns like billboards, posters, commercials, and slogans has worked to change behaviors like drunk driving and binge drinking in the past. In 2005, a social marketing campaign was introduced to college students in order to decrease drinking and driving that included advertisements that were printed on postcards and other various media forms that would be distributed. Along with increased law enforcement, the campaign got relatively positive effects. College students had a significant decrease in self-reported DUI in the campuses that the intervention was applied at (Clapp et al., 2005) Furthermore, additional studies are have been completed that suggests that these types of interventions wield positive benefits and are able to change behavior (Glassman, Dodd, Miller, & Braun, 2010).
These media pieces could be utilized in physician’s offices first, but transferring them into other settings is also possible. For example, because the target population is vague and the intervention can be transformed to fit high-risk populations, this campaign could be used as screen savers on university campus computers, hospital emergency rooms, and even dorms on campus. Having the ability to manipulate the intervention makes it more feasible to research in multiple venues.
Evaluation
The evaluation tool will be a survey questionnaire given to physician’s who see patients on a regular basis. The physician’s will be selected from a convenience sample of Toledo area physicians who have offices in Lucas, Fulton, Sandusky, Wood, or Ottawa County. The survey questions will be measuring the physician’s ability, likelihood and thoughts or feelings about speaking with their patients about safe driving, distracted driving, and good driving habits. In addition, the survey will be looking to measure the stage of change each physician is in regarding implementing a supplementary educational program. The data will be collected both before and after the media campaign is implemented in a pre/post-test format. Each physician chosen will receive the pre-test survey electronically on February 1, 2012 and a second round two weeks later. Additionally, as control, physician’s offices who are not receiving the interventions will also receive the pre/post-test. The pre-test survey will be prior to the media campaign in their facility. The post-test survey will be sent out electronically on November 1, 2012 along with a second round two weeks following.
The goal of the survey is to see what changes are made to the interactions with physicians and their patients with the introduction of the social marketing campaign and the educational supplements. The data will be looked at pre implementation along with post to determine if the physicians have changed their habits regarding motor vehicle safety discussions with patients.
Limitations
Some of the major limitations of this evaluation include the inability to control for self-reported data. All data is via survey and will be self-reported. Second, the intervention will likely not be as effective with individuals who are blind, illiterate, or unable to read English because they will not experience the entire effect of the social marketing campaign. Another limitation may be a bias by the physician because of personal experiences like not having any children who are of driving age or not ever experiencing the effects of serious motor vehicle accidents.
Conclusion
Overall, the intervention and evaluation tool have the possibility of increasing awareness of the global issue of motor vehicle accident resulting in injury or death . Driving with distractions is an important health behavior that needs to be addressed with several interventions in order to make a real difference. This intervention proposes a new venue to get a valid and important point to driving population.
Bureau, U. S. C. (2011). U.S. & world population clocks. Retrieved from http://www.census.gov/main/www/popclock.html
Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health Behavior and Health Education: Theory, Research, and Practice (4 ed.). San Francisco: Josey-Bass
Glassman, T. J., Dodd, V., Miller, E. M., & Braun, R. E. (2010). Preventing High-Risk Drinking Among College Students: A Social Marketing Case Study. [Article]. Social Marketing Quarterly, 16(4), 92-110. doi: 10.1080/15245004.2010.522764
Injury Prevention & Control: Data & Statistics. (2010). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/injury/wisqars/LeadingCauses.html
McEvoy, S. P., Stevenson, M. R., & Woodward, M. (2007). The prevalence of, and factors associated with, serious crashes involving distracting activity. Accident Analysis and Prevention, 475-482.
Omer, S. B., Salmon, D. A., Orenstein, W. A., DeHart, M., & Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. New England Journal of Medicine, 360(19), 1981-1988.
Safety, I. I. f. H. (2008). Fatality Facts 2008: Teenagers. Retrieved from http://www.iihs.org/research/fatality_facts_2008/teenagers.html
