The Advocacy in Action Study: A cluster randomized controlled trial to reduce pedestrian injuries in deprived communities

Abstract

Background: Road traffic-related injury is a major global public health problem. In most countries, pedestrian injuries occur predominantly to the poorest in society. A number of evaluated interventions are effective in reducing these injuries. Very little research has been carried out into the distribution and determinants of the uptake of these interventions. Previous research has shown an association between local political influence and the distribution of traffic calming after adjustment for historical crash patterns. This led to the hypothesis that advocacy could be used to increase local politicians' knowledge of pedestrian injury risk and effective interventions, ultimately resulting in improved pedestrian safety. Objective: To design an intervention to improve the uptake of pedestrian safety measures in deprived communities. Setting: Electoral wards in deprived areas of England and Wales with a poor record of pedestrian safety for children and older adults. Methods: Design: mixed-methods study, incorporating a cluster randomized controlled trial. Data: mixture of Geographical Information Systems data (collision locations, road safety interventions), telephone interviews, and questionnaires. Randomization: 239 electoral wards clustered within 57 local authorities. Participants: 615 politicians representing intervention and control wards. Intervention: a package of tailored information including maps of pedestrian injuries was designed for intervention politicians, and a general information pack for controls. Outcome measures: Primary outcome: number of road safety interventions 25 months after randomization. Secondary outcomes: politicians' interest and involvement in injury prevention; cost of interventions. Process evaluation: use of advocacy pack, facilitators and barriers to involvement, and success.