Developing a national road traffic safety education program in Iran

In Iran, Road Traffic Injuries (RTIs) are the leading cause of injuries and the second leading cause of death [1, 2]. In recent years, like most of the developing countries, various interventions and programs have been designed and implemented to reduce RTIs [3‐6]. Some of these interventions and programs, including severe treatment with speeding, violations, improvements to vehicle safety, and raised fines and penalties, have a moderate impact on reducing the rate and burden of accidents and some of these interventions, such as increased police funding, security of roads, speed cameras, improved emergency medical care services, and development of transportation infrastructures, especially for the rail transportation, have a slight impact on reduction of traffic accidents [7].

Basically, in road accidents, three factors of human, road, and vehicle are identified as major components, and the quality and quantity of displacements will be affected by these three factors. Human is the most unknown and most important factor in the course of events and, with all the efforts of experts in various sciences, the human reactions in dealing with the events cannot be predicted. Many differences between human beings, including physical, mental, etc., lead to the unknown nature of humans, such that above 70% of the accidents are attributed to this factor. Although the human factor has its own characteristics in various communities, the human factor, versus other causes, is the most important and difficult part for controlling transportation systems [8]. The analysis of road traffic accidents in Iran suggests that the most common factor involving RTIs could be the human factor. In fact, in traffic crashes in Iran, the human factor alone or along with other factors is often responsible for the majority of traffic accidents [9, 10].

The behavior of pedestrians, motorcyclists, and cyclists is a human factor involved in the occurrence of traffic accidents. Due to the role of human factor in the occurrence of accidents, traffic safety education programs are needed to be implemented. The public needs to become aware that the issues of traffic and traffic accidents are vital to their health and safety. In order to reduce traffic injuries policies such as improving the behavior of road users are implemented in countries such as Australia that are pioneering the reduced RTIs and crash fatalities [11] . In Germany, through traffic education in schools, the mortality rate of 19,000 in 1970s was reduced to 9000 in 1995. In Hamburg, Germany, the deaths caused by accidents became stable around 100 people per year by education in all groups from kindergarten to university and even holding courses for the elderly [12]. Other studied showed that it is necessary to develop road safety education [13, 14].

Different studies in Iran has shown that, despite the implementation of specific laws such as the use of seat belts, the rate of deaths has had small decline without education, demonstrating the need for education and cultural development in the country [5, 15].

Therefore, the role of education in reducing traffic accidents is inevitable and the educational programs for the population must be provided and implemented based on the resources and facilities as well as the environmental, economic, political, and cultural conditions of each society.

Considering the human factors for the occurrence of accidents from 2006 to 2016 in Iran, it is concluded that most of these factors can partially be eliminated through education. The major factors, including violation of traffic laws [10, 16‐19] and inadequate information [10, 20], are the other cases, in which education can play an important role for changing behaviors. Therefore, it is essential to pay attention to education and cultural development that lead to behavioral changes [21, 22]. Therefore, given the importance of accidents as the second leading cause of death in Iran and the necessity of education with respect to the facilities, and social, cultural, and political contexts of Iranian society. The aim of the present study was to develop the National Traffic Safety Educational Program (NRTSEP) and reduce Road Traffic Injuries (RTIs).

As part of the project for developing the National Iranian Road Safety Program, this qualitative study was conducted to develop a National Traffic Safety Educational Program (NRTSEP) in 2019. Semi-structured in-depth interview and focus group discussions (FGD) were used to collect data. Participants in the needs assessment were recruited from of different setting of Tabriz and the traffic experts from Tehran, Mashhad and Shiraz were interviewed. In order to gain a different viewpoint, a purposive sampling method was applied to insure that participants with varying levels of socioeconomic status, age, educational level, job, personal or family accident records, and driving violations were present in this work. At the beginning of interviews, all of participants were informed about the aim of the study.

Overall, Six major themes emerged from the analysis forming the six dimensions of NRTSEP, including target group, program content, educational methods, instructors, resources, and evaluation. More information on themes and categories are presented in Table 1.

The purpose of the present study was to develop a national educational program on traffic safety promotion. The importance of education is to the point that one of the pivots of the Decade of Action for Road Safety 2011–2020 is education [27]. One of the important indicators that reduce deaths caused by accidents in developed countries is paying attention to education [12]. In Iran, we have above 17,000 deaths caused by traffic accidents. It is predicted that for each death, 16 cases of accidents lead to hospital admissions and 400 cases require outpatient services [28]. The highest rate of admissions in hospital emergencies is caused by traffic accidents that imposes huge direct and indirect costs on the government and the public and accounts for a major share of annual budget of countries [29].

In order to reduce accidents, hospitalizations, and problems and also to reduce its costs, an educational program is required to promote the user safety behavior given the environmental, economic, political, cultural conditions along with changes in the road network and increased vehicle safety. Based on the results of the study, the national educational program on road traffic safety promotion was designed in 6 dimensions. The main dimensions of this program included, target group, educational program content, teaching method, instructors, resources, and evaluation method.

In the present study of the target group, included 12 groups of preschooler to university students, youth, teachers, parents, elderly, motorcyclists, cyclists, pedestrians, drivers, license applicants, instructors and managers of driving schools, special groups (disabled, pregnant women, blind, etc.), managers at different levels, car manufacturers, and policymakers. In other words, based on the results of the present study, various levels of society should have traffic safety education. Similar to the present study, the PRSE (Permanent Road Safety Education) is continued for learning traffic culture from childhood to the end of life at all levels of society in the successful countries of the world on lowering traffic accidents, such as the Netherlands [12]. Similar to the present study, children’s education has been considered because high-risk behaviors are more common in adults and children [30] Childhood, on the other hand, is a very important period for developing behavior [31]. The European Commission also identifies vulnerable groups such as the elderly, pedestrians, disabled people, and all road users as target groups that must be trained [32]. A review study is focused on education of vulnerable groups, such as children, the elderly, pedestrians, bicycles and motorcyclists in the Asia [33]. In Iran, due to the high number of traffic accidents and injuries, all target groups need to be trained. The emphasis of the people and the experts was on education from childhood until the end of life. Knowledge development is one of the pillars of road safety, which can affect drivers’ awareness and behavior on the road [13].

The content of the present program consisted of 27 items (Table 1), which is consistent with the educational content used in the world. In the present study, the education of the traffic rules and regulations and safe passage behavior (type of safe passage, place of safe passage, benefits and risks of safe passage) have been mentioned in the educational content for both pedestrians and other users. In Switzerland, the educational content consisted of two main sections: traffic safety, legal traffic behavior, compliance with traffic regulations, and environment [33] and have been successful in traffic education and reduce RTIs. Visibility, reflectors in clothing, bags and shoes, day lights, proper lighting for roads, post-accident care training, public transport to reduce traffic volumes, safe cycling and its infrastructures, education of managers at different levels, car manufacturers, and policymakers to improve vehicle safety, improvement of transport system, modification of road network structure, and greater vehicle safety, overtaking and speed, pedestrian safety, and place of safe passage, were the results of the present study that WHO has also pointed out [34]. Wearing seat belts, safety helmets, observing authorized driving speed, alcohol use, and first aid were the educational content obtained in the present study, Permanent education of theirs can reduce of RTIs [35‐38].

In the present study, the educational methods included audio-visual media, practical education, role modeling, simulators, taking courses, campaigns, workshops, educational seminars, group discussions, social networks, financial and moral penalties, and brief reports, which is similar to the review study conducted by Jamaludin et al. [39]. The teaching methods in schools at Netherlands are done using traffic guides and distribution of books, pamphlets, films and CDs. In Germany, the traffic safety education is done via film and slides, websites, book distribution, simulators, games, practical street tours [12], and workshops [36]. The safety and traffic training course will be held in Iranian universities from 2018. This course was conducted as a national preliminary study in four stages. The results showed that before participating in the training courses, the level of knowledge of student traffic was low. Studies have also shown that “pedestrian safety” and “first aid” were the most useful and practical issues [40]. The educational method can varied based on target group and type of content. For example, in the driver license applicants, some behaviors such as the impact of using a mobile phone while driving can be simulated, so the person can somehow understand the reality. In the present study, educational instructors included TV programs, schools and university teachers, parents, teachers of driving schools, seminary, health workers, and police experts, and a part of which has been noted in a study conducted by Mark Lee and Al-Mansour [35]. Peden has also considered the health workers as educational authorities [36]. Mütze and Dobbeleer reported that in 81% of the states, the Ministry of Education is responsible for safety and traffic education, in collaboration with Minister of Transport, police, and government and nongovernmental agencies. In England and Wales, the local highway authorities are responsible for road safety education [37].

The participants of the present study considered IRIB and its programs as the most important educational authorities, which directly and indirectly affect the education and promotion of safe traffic behavior, and then, there are the teachers trained in schools who are responsible for education of students. In this study, the resources were human resources, appropriate technology, adequate budgeting and financial support, materials and physical space, national traffic document, strong monitoring system, and NGOs. In Turkey, Kenya and Egypt, NGOs have been involved in traffic safety promotion programs [36]. The necessary resources and training budget in the Netherlands are provided by the sustainable budget of traffic safety education. In Germany, the books and pamphlets for traffic courses are provided by the Traffic Education Association and are given to teachers for training. German educational resources are so rich that could have reduced the death rate of pedestrian children by almost 20 times. Since 1947, the legal authority of road safety has been given to local authorities in England, and by hiring road safety officers, they provide the education costs of the road safety program. The Swedish National Institute of Transport and Research, along with other transport and training institutions, develop educational programs and provide resources to the education target group [12].

Experts participating in the present study stated that the resources will be managed in case of a leader agency in the field of traffic in the country. This agency can monitor and evaluate the organizations’ function, lead the policymaking, and manage the resources, and therefore, the problem of inter sectional cooperation that wastes the resources will be resolved. In countries that have managed to reduce the number of injuries caused by traffic accidents, an agency or organization with sufficient authority is responsible for plans and activities to reduce traffic accidents and other organizations should have an interaction and collaboration with this agency [41, 42].

The results of the present study showed that the educational program should be evaluated. For evaluation of program, the items included the frequency of deaths caused by traffic accidents, number of accidents and hospitalizations before and after training program, frequency of safe and non-safe behaviors before and after training program, satisfaction with program, and air pollution. Some programs have evaluated traffic behaviors after educational programs [43]. Some of the programs have also focused on quality of program and subsequent behavior changes [37]. Some studies have investigated the mediating variables, such as knowledge, attitude, and safe behavior [44]. In the Netherlands, an annual evaluation is conducted by research institutes on the impact of traffic training on behavior of students and parents, and the headings and instructions are constantly being revised, varied, resolved, and modified. All educational products and sustainable education plans of road safety are also evaluated. In German schools, in case of traffic accidents for a student who is unfamiliar with traffic regulations, the relevant teacher is responsible. At the end of each year, the students are tested so both the student and teacher are evaluated [12].

The present designed program must be implemented, and during implementation at various levels, the level of learning, impact on society, and long-term investment must be evaluated.

According to the people and professionals, Ministry of Education plays a key role in education and institutionalization of traffic behaviors, and the curriculum on traffic safety should be included in all grades and educational levels of students based on their age and are taught in a practical manner. Due to a high interaction between parents and children, the education of children will affect parents. Moreover, the television and radio should also provide the traffic education so that this interaction can continue to reach a safe traffic behavior. After the Ministry of Education and the media, the driver license centers are particularly important in education and promotion of safe behaviors. According to both groups of people and professionals, the education of managers at different levels and policymakers in establishing and modifying infrastructure and adopting and reforming laws are critical in the national educational program on traffic safety promotion. The experts particularly emphasized the need for a leader agency to manage the traffic accidents.