By Dr Lisa Dorn, Founder, PsyDrive
Recently, PsyDrive were commissioned to design a seatbelt campaign for ambulance staff called 'Safe in the Back'. The project was funded by major fleet insurer QBE European Operations and Marsh, a global leader in insurance broking and led by the Association of Ambulance Chief Executives. The seatbelt campaign emerged further to discussions with national ambulance forums about road traffic collisions involving ambulances resulting in staff and patient casualties and fatalities. One of the safety aspects involved was the tendency for ambulance staff to not always wear seat belts and/or to secure patients in the back of ambulances.
What’s the theory?
Road safety interventions must be theoretically, and evidence based to increase the likelihood of changing behaviour. However, most road safety interventions focus on increasing awareness of the risks like not wearing a seatbelt - but typically the effects are short-lived (Box and Dorn, 2023). Some road safety interventions may be doing more harm than good. For example, theatre events in UK schools deliver testimonial accounts of a road traffic collision to young people using fear/threat appeals. However, neither increasing the perception of risk of becoming a victim of a road crash nor the risk of regret from having caused an incident makes a material change in attitudes to road safety (Box, 2023). Worst still, fear appeals may increase optimism bias or the tendency to rate yourself as more skilful and less prone to road collisions than your peers and increase the risk of engaging in more dangerous driving behaviour (White et al, 2011). However, generating positive emotions as part of an intervention has been shown to be more persuasive (Cutello, Gummerum, Hanoch, & Hellier, 2020) as it tends to encourage safety promoting behaviours and may be more effective for increasing engagement with risk information (Cutello, Hellier, Stander & Hanoch, 2020b).
Behaviour Change Techniques
The first step in the design of a campaign is to understand your target audience. A survey of frontline staff across the UK was administered to capture experiences and opinions of the current seatbelt practice in the back of ambulances. The survey included a measure of staff attitudes and beliefs about seatbelt wearing. The aim of the campaign was to identify and reframe the beliefs around belting up in the back of an ambulance using Behaviour Change Techniques (BCTs). BCTs are defined as “Observable, replicable and irreducible component[s] of an intervention designed to alter or redirect causal processes that regulate behaviour” (Michie et al, 2013) and use active ingredients to achieve positive behavioural outcomes. For example, the BCT ‘credible source’ (i.e., present verbal or visual communication from a credible source in favour of or against a behaviour) was included by inviting senior ambulance NHS Trust managers to be filmed to encourage seatbelt use in the back of ambulances. The results of the survey were also used to address specific attitudes to seatbelt using BCTs that encourage staff to protect themselves, colleagues and patients when travelling in the back of an ambulance. Other effective behavioural change principles were incorporated into the campaign such as the use of positive framing.
The campaign included a professionally developed film, posters and leaflets disseminated to all NHS Ambulance Trusts in the UK. Click below for more information.
Behaviour Change Techniques and their application to road safety interventions is covered in the final module of the 2 day online accredited Human Factors and Road Risk Management Level 2 course. To book your place, click on the link below.
References
Box, E. (2023) Empowering young drivers with road safety education: Practical guidance emerging from the Pre-driver Theatre and Workshop Education Research. RAC Foundation. https://www.racfoundation.org/wp-content/uploads/Road-Safety-Education-report-Box-November-2023-1.pdf.
Box, E., & Dorn, L. (2023). A cluster randomised controlled trial (cRCT) evaluation of a pre-driver education intervention using the Theory of Planned Behaviour. Transportation research part F: traffic psychology and behaviour, 94, 379-397.
Cutello, C. A., Gummerum, M., Hanoch, Y., & Hellier, E. (2020a). Evaluating an Intervention to Reduce Risky Driving Behaviors: Taking the Fear Out of Virtual Reality. Risk Analysis, 41 (9), 1662-1673.
Cutello, C. A., Hellier, E., Stander, J., & Hanoch, Y. (2020b). Evaluating the effectiveness of a young driver-education intervention: Learn2Live. Transportation Research Part F: Traffic Psychology and Behaviour, 69, 375–384.
Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., ... & Wood, C. E. (2013). The behaviour change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behaviour change interventions. Annals of behavioral medicine, 46(1), 81-95.
White, M. J., Cunningham, L. C., & Titchener, K. (2011). Young drivers’ optimism bias for accident risk and driving skill: Accountability and insight experience manipulations. Accident Analysis and Prevention, 43, 1309–1315.
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