Two studies were conducted to compare the efficacy of two behavioral prompts in increasing safety-belt use. Two approaches were used in both studies. The first approach involved showing a sign with the message, "Please Buckle Up, I Care" to unbuckled drivers leaving a parking lot; the second involved displaying the nationwide slogan "Click it or Ticket" (CioT). Participants were 1,822 unbuckled drivers exiting two student parking lots of a large university. Research assistants identified an unbuckled driver, flashed one of two signs, and recorded whether the driver buckled after the prompt, as well as the driver's facial reactions and hand gestures. Of the unbuckled drivers, 34% buckled following the Flash-for-Life (FfL) prompt, and 26% with the CioT prompt (p < .05). Drivers gave significantly more positive facial expressions and hand gestures following FfL vs. CioT prompt (p < .05). The second study used a variation of the procedures in Study I and implemented the intervention at a large department store. Driver age was measured with the previous driver variables. Participants were 1,990 unbuckled drivers exiting a parking lot. Results showed no significant differences in terms of compliance to signs (20.8% for FfL and 20.4% for CioT, p's > .05). Significant differences in hand gestures, facial expressions and ages were detected as a function of compliance, regardless of sign (all p's < .001). Specifically, drivers who complied with either prompt were more likely to be younger, and present positive hand gestures and facial expressions. Implications and future directions are discussed. / Master of Science

This study represents a collaborative effort among university academics and community stakeholders. Virginia Tech's (VT) Center for Applied Behavior Systems (CABS) teamed up with student groups following the death of a fellow student to create The A.R.K. Project. This multiple-component intervention study specifically targeted students on the VT campus, in an attempt to increase driver safety-belt use. Observations on VT students' safety-belt use and other safety-related behaviors (i.e., turn-signal use and cell-phone use) were made during pre-intervention, intervention, post-intervention, and follow-up study phases and compared with observations made on drivers in two non-equivalent control groups (VT faculty/staff and Radford University (RU) students). Evaluation of the project revealed no meaningful changes in daily percentages of VT student safety-belt use, when compared to that of non-equivalent control groups. Percentages by phase did vary in the hypothesized direction for VT students. Percentages by phase varied in similar ways for VT faculty/staff, suggesting the student-targeted intervention, over-all, was not responsible for the observed changes. However, one inter-personal intervention component, the Buckle-Up Flashcards prompt was associated with a particularly successful rate of compliance. Thirty percent of un-buckled drivers complied with this inter-personal response. Because VT student safety-belt use did not change as a function of the intervention, it was irrelevant to investigate response generalization to other safety-related behaviors. Instead, the author focused on covariation between safety-belt use, turn-signal use, and cell-phone use. Buckled drivers were significantly more likely to indicate turns with a turn signal and were significantly less likely to use cell phones. Other additional findings of epidemiologic importance were that safety-belt use was significantly more likely among VT faculty/staff than VT students and safety-belt use was significantly more likely among VT faculty/staff and VT student females than among VT faculty/staff and VT student males. Interpretations of these findings and directions for future research are discussed. / Master of Science

While safety-belt use markedly reduces morbidity and mortality, many young adults in the U.S. do not buckle-up 100% of the time. Following a series of community-level interventions on a university campus, this dissertation project focused on promoting individual-level safety-belt use. More specifically, a targeted web-based assessment and brief motivational intervention for individuals with lower rates of safety-belt use was developed and tested. A Pilot Study conducted prior to the Main Study developed self-reported assessment measures for safety-belt use and motivation. Recruitment, baseline assessment, intervention, and follow-up assessment were conducted via the Internet. Student drivers who buckled-up less than 70% of the time and who met other eligibility requirements were enrolled in a within subjects, randomized, attention-controlled design. At baseline, each participant completed an assessment of: (1) demographics; (2) driving behaviors; and (3) social cognitive and motivational variables including knowledge, perceived importance, confidence (self-efficacy), and readiness to buckle-up. Participants were then randomly assigned to one of two groups: (1) an attention-control group receiving emailed general nutrition information or (2) a motivational interviewing-consistent feedback group receiving emailed personalized feedback. Dependent variables were re-assessed approximately ten days after feedback/general nutrition information were emailed via follow-up assessment. Outcomes analyses using non-parametric statistics were conducted twice. First, an analysis of “completers” was conducted using data from those who completed follow-up. Second, a more conservative intent-to-treat analysis was conducted after carrying the last observation forward for those who did not complete follow-up, assuming no change among those who did not complete follow-up. Overall, results suggest this web-based assessment and brief motivational intervention was feasible and acceptable to participants. Overall, results from both analyses found statistically significant increases in median driver and passenger belt use between baseline and follow-up among participants in both groups. Further, effect sizes suggest the magnitude of change was greater among those in the intervention group versus those in the attention-control group. Participants were then categorized according to whether or not they increased driver belt use by at least one instance between baseline and follow-up. Those who received the intervention were not significantly more likely than those who received general nutrition information (i.e., assessment only) to increase driver safety-belt use by at least one instance. No statistical differences were found in either the completer or intent-to-treat analyses. Yet, when participants were categorized according to whether or not they increased passenger belt use by at least one instance between baseline and follow-up, those who received the intervention were 1.75 times more likely than those who received general nutrition information (i.e., assessment only) to increase passenger safety-belt use by at least one instance. This difference was not found in the intent-to-treat analysis. In general, study participation was associated with increased ratings of motivation (i.e., importance, confidence, and readiness) at follow-up. Results were interpreted with caution given psychometric weaknesses including high intercorrelations found between constructs of motivation in the Pilot Study. However, median change in one construct, readiness, was investigated in post-hoc analyses. Using the intent-to-treat sample, it was found that participants who were categorized as having increased driver safety-belt use by at least one instance also reported statistically significant median changes in readiness to buckle-up as a driver. Those categorized as having increased passenger safety-belt use by at least one instance also reported statistically significant median changes in readiness to buckle-up as a passenger. Further, although there was a trend for participants in the intervention group to be more likely than those in the attention-control group to commit to buckling-up and asking others to do the same at follow-up, there were no significant differences in commitment between groups. However, regardless of group assignment, change in median readiness was associated with: (1) commitment to buckle-up as a driver; (2) commitment to buckle-up as a passenger; (3) commitment to ask others to buckle-up while acting as a driver; and (4) commitment to ask others to buckle-up while acting as a passenger. Overall, these studies found the Internet to be an acceptable and promising venue for assessment and brief motivational intervention to promote safety-belt use among university students. Further, safety-belt use and motivational constructs such as importance, confidence, and readiness may be measured via self-report methodology. Results suggest participation in the study was associated with improvement in safety-belt use and some levels of motivation. While there were trends for those in the intervention group to report greater increases, there were no statistically significant differences between the groups in the ITT analyses. In the completer analyses, it was found that those in the intervention group were significantly more likely to report increased passenger safety-belt use. Future research may elucidate more specific psychometric properties of new measures used. In particular, readiness may be a proxy motivational variable that appears to relate to change in safety-belt use among drivers and passengers as well as commitment to buckle-up and ask others to do the same. The simple process of assessment may be sufficient to produce changes in readiness related to behavior change. / Ph. D.

Bakgrund: Det prehospitala arbetet är utmanande i avseende att kombinera ett patientsäkert vårdarbete och yrkesmässig bilkörning. Vårdutrymmet i en ambulans är en riskfylld miljö både då bilen står parkerad på en olycksplats samt när den är i rullning. Trafiksäkerhet i ambulanssjukvård är därav en avgörande faktor för patientsäkerheten och ambulanssjuksköterskans arbetsmiljö. Brister denna säkerhet riskerar patienten att bli utsatt för ett vårdlidande och ambulanssjuksköterskan för en arbetsmiljöskada. Syfte: Syftet med studien är att beskriva ambulanssjuksköterskans upplevelser och uppfattningar av säkerhetsbältets användning på patienten under ambulanstransport och på så vis öka följsamheten gällande säkerhetsbältes användning. Metod: En kvalitativ intervjustudie genomfördes med enskilda intervjuer. Kvalitativ innehållsanalys med induktiv ansats användes som analysmetod. Resultat: Analysen resulterade i 5 kategorier som bildade resultatets rubriker “bältets betydelse”, “svagheter och brister”, “hinder för säkerhetsbälte”, “arbetsmiljö och säkerhet” samt “samverkan mellan förare och vårdare”. Slutsats: Av studiens resultat kunde slutsatsen dras att säkerhetsbältesanvändningen i ambulansen har stor förbättringspotential samt att upplevelse och uppfattning går i sär med hur verkligheten ser ut. Resultatet visar även vilka orsaker till en bristande bältesanvändning som är vanligast och förslag på hur man kan komma till rätta med dessa. Att säkerhetsbältesanvändningen för patienterna i ambulansen förs upp till diskussion är av stor vikt för att främja patientsäkerheten och ambulanssjuksköterskans Arbetsmiljö̈. För att öka följsamheten gällande säkerhetsbältesanvändningen är det av värde att flera studier utöver denna genomförs utifrån olika synvinklar, exempelvis patientens upplevelse / Background: The pre-hospital work is challenging in terms of combining apatient-safe care work and professional driving. The care room in an ambulance is a risky environment both when the car is parked on an accident site and when it is rolling. Traffic safety in ambulance care is therefore a crucial factor for patient safety and the ambulance nurse's work environment. If this safety fails, the patient risks being exposed to a suffering patient and the ambulance nurse for a work environment injury. Purpose: The purpose of the study is to describe the ambulance nurses experiences and perceptions of the safety belts use on the patient during ambulance transport and in this way increase compliance with seat belt use. Method: A qualitative interview study was conducted with individual interviews. Qualitative content analysis with inductive approach was used as analysis method. Result: The analysis resulted in 5 categories that formed the results headings “the importance of the belt”, “weaknesses and deficiencies”, “obstacles to safety belts”, “work environment and safety” and “collaboration between driver and carer”. Conclusion: From the results of the study, it could be concluded that the seat belt use in the ambulance has great improvement potential and that experience and perception go in particular with the reality. The result also shows the reasons for a lack of belt use that is most common and suggestions for how to deal with these. The fact that the safety belt use for the patients in the ambulance is brought up for discussion is of great importance for promoting patient safety and the ambulance nurses working environment. In order to increase adherence to seat belt use, it is of value that several studies in addition to this are carried out on the basis of different perspectives, forexample the

[pt] Esta dissertação tem como hipótese que as deficiências de projeto do cinto e do habitáculo traseiros dos automóveis de passeio, do ponto de vista ergonômico, causam desconforto e constrangimento no uso ordinário do cinto de segurança, provocando seu uso errado, sua rejeição, e sujeitando os passageiros, em caso de acidentes, a lesões e à morte. Sobre a importância do uso do cinto, especialmente o do banco traseiro, se explica o conceito e a magnitude das forças envolvidas na proteção dos ocupantes de um veículo. Se mostra que a história da legislação do cinto está muito relacionada com a evolução do produto, exceto no Brasil. Faz-se uma análise do ergodesign dos componentes do cinto, seus complementos e suplementos, em particular do ergodesign destes no habitáculo traseiro dos carros mais vendidos. As entrevistas com vítimas de acidentes no banco traseiro, com taxistas e com o bombeiro aposentado serviram de apoio para a confirmação da hipótese. O registro, em vídeo, do comportamento real dos passageiros, em conjunto com as respostas dos questionários aplicados aos mesmos, também ratificaram boa parte dos problemas ergonômicos detectados nesse estudo, cujas principais causas são: ausência de dispositivo emergencial de soltura, ausência do dispositivo retrator, ausência do dispositivo pré- tensionador, falta de mais pontos de ancoragem (fixação) do cinto, e presença do ocupante central. Conclui-se que, para reduzir lesões e mortes dos usuários de automóvel, nos corriqueiros acidentes, é urgente estender as boas soluções de alguns carros a todos os demais e reformular a respectiva legislação. / [en] This study is developed based on the hypothesis that the deficiencies of project of the package for the automobile s rear passengers, as well as of the rear seat safety-belt itself, from the ergonomic point of view, cause discomfort and constrain people to its usual use. Therefore, its rejection or misuse have been subjecting the passengers to injuries and even to death, in case of accidents. Concerning the importance of the safety-belt s use, especially at the rear seat, the concept and the magnitude of all forces involved toward the protection of the occupants of a vehicle are explained. The legislation history of safety belts is very related with the evolution of the product, except in Brazil. An analysis is done about the ergodesign of the safety-belt s components, its complements and supplements; and particularly its ergodesign in the rear passengers package of the best selling automobiles in the market. Interviews with taxi-drivers, a pensioner fireman and victims of accidents who were at rear seat, became to support the confirmation of the hypothesis. The video recording of the real behaviour of passengers, in addition to the answers of a questionnaire applied to each one of them, had also ratified part of the ergonomic problems detected in this study, which main causes are: absence of emergency release device, absence of the retrator device, absence of the pretensioner device, lacks of more points of anchorage for the belt and the presence of a central occupant in the rear seat of a vehicle. Therefore, we conclude that to reduce injuries and deaths of the automobile users, in current accidents, it is urgent to extend the good solutions for the safety belt of some cars to all of them and to remodel its respective legislation.

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