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Published in: BMC Public Health 1/2009

Open Access 01-12-2009 | Research article

The requirements and challenges in preventing of road traffic injury in Iran. A qualitative study

Authors: Davoud Khorasani-Zavareh, Reza Mohammadi, Hamid Reza Khankeh, Lucie Laflamme, Ali Bikmoradi, Bo JA Haglund

Published in: BMC Public Health | Issue 1/2009

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Abstract

Background

Road traffic injuries (RTIs) are a major public health problem, especially in low- and middle-income countries. Among middle-income countries, Iran has one of the highest mortality rates from RTIs. Action is critical to combat this major public health problem. Stakeholders involved in RTI control are of key importance and their perceptions of barriers and facilitators are a vital source of knowledge. The aim of this study was to explore barriers to the prevention of RTIs and provide appropriate suggestions for prevention, based on the perceptions of stakeholders, victims and road-users as regards RTIs.

Methods

Thirty-eight semi-structured interviews were conducted with informants in the field of RTI prevention including: police officers; public health professionals; experts from the road administrators; representatives from the General Governor, the car industry, firefighters; experts from Emergency Medical Service and the Red Crescent; and some motorcyclists and car drivers as well as victims of RTIs. A qualitative approach using grounded theory method was employed to analyze the material gathered.

Results

The core variable was identified as "The lack of a system approach to road-user safety". The following barriers in relation to RTI prevention were identified as: human factors; transportation system; and organizational coordination. Suggestions for improvement included education (for the general public and targeted group training), more effective legislation, more rigorous law enforcement, improved engineering in road infrastructure, and an integrated organization to supervise and coordinate preventive activities.

Conclusion

The major barriers identified in this study were human factors and efforts to change human behaviour were suggested by means of public education campaigns and stricter law enforcement. However, the lack of a system approach to RTI prevention was also an important concern. There is an urgent need for both an integrated system to coordinate RTI activities and prevention and a major change in stakeholders' attitudes towards RTI prevention. The focus of all activities should take place on road users' safety.
Literature
1.
go back to reference Peden M, Scurfield R, Sleet D, Mohan D, Hyder A, Jarawan E, Mathers C, edi: World Report on Road Traffic Injury Prevention. 2004, Geneva: World Health Organization Peden M, Scurfield R, Sleet D, Mohan D, Hyder A, Jarawan E, Mathers C, edi: World Report on Road Traffic Injury Prevention. 2004, Geneva: World Health Organization
2.
go back to reference Murray CJL, Lopez AD: The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. 1996, Boston: Harvard School of Public Health Murray CJL, Lopez AD: The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. 1996, Boston: Harvard School of Public Health
3.
go back to reference Kopits E, Cropper M: Traffic fatalities and economic growth. 2003, Washington DC: The World Bank (Policy Research Working Paper No.3035), 10.1016/j.aap.2004.04.006.CrossRef Kopits E, Cropper M: Traffic fatalities and economic growth. 2003, Washington DC: The World Bank (Policy Research Working Paper No.3035), 10.1016/j.aap.2004.04.006.CrossRef
4.
go back to reference Razzak J: The Potential of Ambulance Records for a Road Traffic Safety Agenda in Low-Income Cities. Studies from Karachi, Pakistan. 2005, Karolinska Institutet, Department of Public Health Sciences Razzak J: The Potential of Ambulance Records for a Road Traffic Safety Agenda in Low-Income Cities. Studies from Karachi, Pakistan. 2005, Karolinska Institutet, Department of Public Health Sciences
5.
go back to reference Soderlund N, Zwi AB: Traffic-related mortality in industrialized and less developed countries. Bull World Health Organ. 1995, 73 (2): 175-182.PubMedPubMedCentral Soderlund N, Zwi AB: Traffic-related mortality in industrialized and less developed countries. Bull World Health Organ. 1995, 73 (2): 175-182.PubMedPubMedCentral
6.
go back to reference Sintuvanich A: The impact of industrialization on road traffic accidents in Thailand. J Med Assoc Thai. 1997, 80 (10): 631-635.PubMed Sintuvanich A: The impact of industrialization on road traffic accidents in Thailand. J Med Assoc Thai. 1997, 80 (10): 631-635.PubMed
7.
go back to reference Mohan D: Traffic safety and city structure: lessons for the future. Salud Publica Mex. 2008, 50 (Suppl 1): S93-100.PubMed Mohan D: Traffic safety and city structure: lessons for the future. Salud Publica Mex. 2008, 50 (Suppl 1): S93-100.PubMed
9.
go back to reference Mohan D, Tiwari G, Meleckidzedeck K, Fredrick MN: Road traffic injury prevention training manual. 2006, Geneva: World Health Organization and Indian Institute of Technlogy Delhi Mohan D, Tiwari G, Meleckidzedeck K, Fredrick MN: Road traffic injury prevention training manual. 2006, Geneva: World Health Organization and Indian Institute of Technlogy Delhi
10.
go back to reference Global Road Safety Partnership: Speed management: a road safety manual for decision-makers and practitioners. 2008, Geneva: Global Road Safety Partnership Global Road Safety Partnership: Speed management: a road safety manual for decision-makers and practitioners. 2008, Geneva: Global Road Safety Partnership
12.
go back to reference Bhalla K, Shahraz S, Naghavi M, Bartels D, Murray C: Road Traffic Injuries in Iran. 2008, Harvard University Initiative for Global Health Road Traffic Injury Metrics Group Bhalla K, Shahraz S, Naghavi M, Bartels D, Murray C: Road Traffic Injuries in Iran. 2008, Harvard University Initiative for Global Health Road Traffic Injury Metrics Group
13.
go back to reference Forjuoh SN: Traffic-related injury prevention interventions for low-income countries. Inj Control Saf Promot. 2003, 10 (1-2): 109-118. 10.1076/icsp.10.1.109.14115.CrossRefPubMed Forjuoh SN: Traffic-related injury prevention interventions for low-income countries. Inj Control Saf Promot. 2003, 10 (1-2): 109-118. 10.1076/icsp.10.1.109.14115.CrossRefPubMed
14.
go back to reference Sanaei-Zadeh H, Vahabi R, Nazparvar B, Amoei M: An epidemiological study and determination of causes of traffic accident-related deaths in Tehran, Iran (during 2000-2001). J Clin Forensic Med. 2002, 9 (2): 74-77. 10.1054/jcfm.2002.0547.CrossRefPubMed Sanaei-Zadeh H, Vahabi R, Nazparvar B, Amoei M: An epidemiological study and determination of causes of traffic accident-related deaths in Tehran, Iran (during 2000-2001). J Clin Forensic Med. 2002, 9 (2): 74-77. 10.1054/jcfm.2002.0547.CrossRefPubMed
15.
go back to reference Rasouli MR, Nouri M, Rahimi-Movaghar V: Spinal cord injuries from road traffic crashes in southeastern Iran. Chin J Traumatol. 2007, 10 (6): 323-326.PubMed Rasouli MR, Nouri M, Rahimi-Movaghar V: Spinal cord injuries from road traffic crashes in southeastern Iran. Chin J Traumatol. 2007, 10 (6): 323-326.PubMed
16.
go back to reference Zavareh DK, Mohammadi R, Laflamme L, Naghavi M, Zarei A, Haglund BJ: Estimating road traffic mortality more accurately: use of the capture-recapture method in the West Azarbaijan province of Iran. Int J Inj Contr Saf Promot. 2008, 15 (1): 9-17. 10.1080/17457300701794105.CrossRef Zavareh DK, Mohammadi R, Laflamme L, Naghavi M, Zarei A, Haglund BJ: Estimating road traffic mortality more accurately: use of the capture-recapture method in the West Azarbaijan province of Iran. Int J Inj Contr Saf Promot. 2008, 15 (1): 9-17. 10.1080/17457300701794105.CrossRef
17.
go back to reference Khorasani-Zavareh D, Haglund BJA, Mohammadi R, Naghavi M, Laflamme L: Traffic injury deaths in West Azarbaijan province of Iran: a cross-sectional interview-based study on victims' characteristics and pre-hospital care. International Journal of Injury Control and Safety Promotion. 2009, 16 (3): 119-126. 10.1080/17457300903023980.CrossRefPubMed Khorasani-Zavareh D, Haglund BJA, Mohammadi R, Naghavi M, Laflamme L: Traffic injury deaths in West Azarbaijan province of Iran: a cross-sectional interview-based study on victims' characteristics and pre-hospital care. International Journal of Injury Control and Safety Promotion. 2009, 16 (3): 119-126. 10.1080/17457300903023980.CrossRefPubMed
18.
go back to reference Classen S, Lopez ED, Winter S, Awadzi KD, Ferree N, Garvan CW: Population-based health promotion perspective for older driver safety: conceptual framework to intervention plan. Clin Interv Aging. 2007, 2 (4): 677-693.PubMedPubMedCentral Classen S, Lopez ED, Winter S, Awadzi KD, Ferree N, Garvan CW: Population-based health promotion perspective for older driver safety: conceptual framework to intervention plan. Clin Interv Aging. 2007, 2 (4): 677-693.PubMedPubMedCentral
19.
go back to reference Franzen C, Bjornstig U, Jansson L: Injured in traffic: experiences of care and rehabilitation. Accid Emerg Nurs. 2006, 14 (2): 104-110. 10.1016/j.aaen.2006.01.003.CrossRefPubMed Franzen C, Bjornstig U, Jansson L: Injured in traffic: experiences of care and rehabilitation. Accid Emerg Nurs. 2006, 14 (2): 104-110. 10.1016/j.aaen.2006.01.003.CrossRefPubMed
20.
go back to reference Hijar M, Vazquez-Vela E, Arreola-Risa C: Pedestrian traffic injuries in Mexico: a country update. Inj Control Saf Promot. 2003, 10 (1-2): 37-43. 10.1076/icsp.10.1.37.14108.CrossRefPubMed Hijar M, Vazquez-Vela E, Arreola-Risa C: Pedestrian traffic injuries in Mexico: a country update. Inj Control Saf Promot. 2003, 10 (1-2): 37-43. 10.1076/icsp.10.1.37.14108.CrossRefPubMed
21.
go back to reference Lambert JH, Peterson KD, Joshi NN: Synthesis of quantitative and qualitative evidence for accident analysis in risk-based highway planning. Accid Anal Prev. 2006, 38 (5): 925-935. 10.1016/j.aap.2006.03.003.CrossRefPubMed Lambert JH, Peterson KD, Joshi NN: Synthesis of quantitative and qualitative evidence for accident analysis in risk-based highway planning. Accid Anal Prev. 2006, 38 (5): 925-935. 10.1016/j.aap.2006.03.003.CrossRefPubMed
22.
go back to reference Lewis IM, Watson B, White KM, Tay R: Promoting public health messages: Should we move beyond fear-evoking appeals in road safety?. Qual Health Res. 2007, 17 (1): 61-74. 10.1177/1049732306296395.CrossRefPubMed Lewis IM, Watson B, White KM, Tay R: Promoting public health messages: Should we move beyond fear-evoking appeals in road safety?. Qual Health Res. 2007, 17 (1): 61-74. 10.1177/1049732306296395.CrossRefPubMed
23.
go back to reference Khorasani-Zavareh D, Khankeh HR, Mohammadi R, Laflamme L, Bikmoradi A, Haglund BJ: Post-crash management of road traffic injury victims in Iran. Stakeholders' views on current barriers and potential facilitators. BMC Emerg Med. 2009, 9 (1): 8-10.1186/1471-227X-9-8.CrossRefPubMedPubMedCentral Khorasani-Zavareh D, Khankeh HR, Mohammadi R, Laflamme L, Bikmoradi A, Haglund BJ: Post-crash management of road traffic injury victims in Iran. Stakeholders' views on current barriers and potential facilitators. BMC Emerg Med. 2009, 9 (1): 8-10.1186/1471-227X-9-8.CrossRefPubMedPubMedCentral
24.
go back to reference Bikmoradi A, Brommels M, Shoghli A, Khorasani Zavareh D, Masiello I: Organizational culture, values, and routines in Iranian medical universities. Higher Education. 2009, 57: 417-427. 10.1007/s10734-008-9152-2.CrossRef Bikmoradi A, Brommels M, Shoghli A, Khorasani Zavareh D, Masiello I: Organizational culture, values, and routines in Iranian medical universities. Higher Education. 2009, 57: 417-427. 10.1007/s10734-008-9152-2.CrossRef
25.
go back to reference Emami A, Mazaheri M: Difficulties in Recruiting Participants for Research Study on Immigrant Dementia Caregiver: Challenges in Conducting Research with a Culturally Diverse Population. Journal of Immigrant & Refugee Studies. 2007, 5 (4): 103-108. 10.1300/J500v05n04_06.CrossRef Emami A, Mazaheri M: Difficulties in Recruiting Participants for Research Study on Immigrant Dementia Caregiver: Challenges in Conducting Research with a Culturally Diverse Population. Journal of Immigrant & Refugee Studies. 2007, 5 (4): 103-108. 10.1300/J500v05n04_06.CrossRef
26.
go back to reference Rezapur-Shahkolai F, Naghavi M, Shokouhi M, Laflamme L: Unintentional injuries in the rural population of Twiserkan, Iran. A cross-sectional study on their incidence, characteristics and preventability. BMC Public Health. 2008, 8 (1): 269-10.1186/1471-2458-8-269.CrossRefPubMedPubMedCentral Rezapur-Shahkolai F, Naghavi M, Shokouhi M, Laflamme L: Unintentional injuries in the rural population of Twiserkan, Iran. A cross-sectional study on their incidence, characteristics and preventability. BMC Public Health. 2008, 8 (1): 269-10.1186/1471-2458-8-269.CrossRefPubMedPubMedCentral
27.
go back to reference Strauss A, Corbin J: Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 1998, Thousand Oaks, USA: Sage Publications, 2 Strauss A, Corbin J: Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 1998, Thousand Oaks, USA: Sage Publications, 2
28.
go back to reference Corbin A, Strauss J: Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 2008, USA: Sage Publications, 3CrossRef Corbin A, Strauss J: Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 2008, USA: Sage Publications, 3CrossRef
29.
go back to reference Pettersson KO, Johansson E, Pelembe Mde F, Dgedge C, Christensson K: Mozambican midwives' views on barriers to quality perinatal care. Health Care Women Int. 2006, 27 (2): 145-168. 10.1080/07399330500457994.CrossRefPubMed Pettersson KO, Johansson E, Pelembe Mde F, Dgedge C, Christensson K: Mozambican midwives' views on barriers to quality perinatal care. Health Care Women Int. 2006, 27 (2): 145-168. 10.1080/07399330500457994.CrossRefPubMed
30.
go back to reference Ministry of Health and Medical Education: Official letter. 2005, Tehran, Iran: Undersecretary for Research and Technology, 391- Ministry of Health and Medical Education: Official letter. 2005, Tehran, Iran: Undersecretary for Research and Technology, 391-
31.
go back to reference Mock C, Quansah R, Krishnan R, Arreola-Risa C, Rivara F: Strengthening the prevention and care of injuries worldwide. Lancet. 2004, 363 (9427): 2172-2179. 10.1016/S0140-6736(04)16510-0.CrossRefPubMed Mock C, Quansah R, Krishnan R, Arreola-Risa C, Rivara F: Strengthening the prevention and care of injuries worldwide. Lancet. 2004, 363 (9427): 2172-2179. 10.1016/S0140-6736(04)16510-0.CrossRefPubMed
32.
go back to reference Duperrex O, Bunn F, Roberts I: Safety education of pedestrians for injury prevention: a systematic review of randomised controlled trials. BMJ. 2002, 324 (7346): 1129-10.1136/bmj.324.7346.1129.CrossRefPubMedPubMedCentral Duperrex O, Bunn F, Roberts I: Safety education of pedestrians for injury prevention: a systematic review of randomised controlled trials. BMJ. 2002, 324 (7346): 1129-10.1136/bmj.324.7346.1129.CrossRefPubMedPubMedCentral
33.
go back to reference Elvik R, Vaa T: Handbook of road safety measures. 2004, Amsterdam: Elsevier Elvik R, Vaa T: Handbook of road safety measures. 2004, Amsterdam: Elsevier
34.
go back to reference Younesian M, Moradi A, Khalaji A, Mesdaghi Nia AR, Zargr M: Evaluation of the effect of offender motorcyclists' penalty enforcement project on the incidence of road traffic accident injuries in Tehran (In Persian). Payesh. 2007, 6 (1): 19-26. Younesian M, Moradi A, Khalaji A, Mesdaghi Nia AR, Zargr M: Evaluation of the effect of offender motorcyclists' penalty enforcement project on the incidence of road traffic accident injuries in Tehran (In Persian). Payesh. 2007, 6 (1): 19-26.
35.
go back to reference Lie A, Krafft M, Kullgren A, Tingvall C: Intelligent seat belt reminders-do they change driver seat belt use in Europe?. Traffic Inj Prev. 2008, 9 (5): 446-449. 10.1080/15389580802149690.CrossRefPubMed Lie A, Krafft M, Kullgren A, Tingvall C: Intelligent seat belt reminders-do they change driver seat belt use in Europe?. Traffic Inj Prev. 2008, 9 (5): 446-449. 10.1080/15389580802149690.CrossRefPubMed
36.
go back to reference Krafft M, Kullgren A, Lie A, Tingvall C: The use of seat belts in cars with smart seat belt reminders--results of an observational study. Traffic Inj Prev. 2006, 7 (2): 125-129. 10.1080/15389580500509278.CrossRefPubMed Krafft M, Kullgren A, Lie A, Tingvall C: The use of seat belts in cars with smart seat belt reminders--results of an observational study. Traffic Inj Prev. 2006, 7 (2): 125-129. 10.1080/15389580500509278.CrossRefPubMed
38.
39.
go back to reference Stigson H, Krafft M, Tingvall C: Use of fatal real-life crashes to analyze a safe road transport system model, including the road user, the vehicle, and the road. Traffic Inj Prev. 2008, 9 (5): 463-471. 10.1080/15389580802335240.CrossRefPubMed Stigson H, Krafft M, Tingvall C: Use of fatal real-life crashes to analyze a safe road transport system model, including the road user, the vehicle, and the road. Traffic Inj Prev. 2008, 9 (5): 463-471. 10.1080/15389580802335240.CrossRefPubMed
40.
go back to reference Bedard M, Guyatt GH, Stones MJ, Hirdes JP: The independent contribution of driver, crash, and vehicle characteristics to driver fatalities. Accid Anal Prev. 2002, 34 (6): 717-727. 10.1016/S0001-4575(01)00072-0.CrossRefPubMed Bedard M, Guyatt GH, Stones MJ, Hirdes JP: The independent contribution of driver, crash, and vehicle characteristics to driver fatalities. Accid Anal Prev. 2002, 34 (6): 717-727. 10.1016/S0001-4575(01)00072-0.CrossRefPubMed
41.
go back to reference Tercero F, Andersson R: Measuring transport injuries in a developing country: an application of the capture-recapture method. Accid Anal Prev. 2004, 36 (1): 13-20. 10.1016/S0001-4575(02)00109-4.CrossRefPubMed Tercero F, Andersson R: Measuring transport injuries in a developing country: an application of the capture-recapture method. Accid Anal Prev. 2004, 36 (1): 13-20. 10.1016/S0001-4575(02)00109-4.CrossRefPubMed
42.
go back to reference Zargar M, Khaji A, Karbakhsh M, Zarei MR: Epidemiology study of facial injuries during a 13 month of trauma registry in Tehran. Indian J Med Sci. 2004, 58 (3): 109-114.PubMed Zargar M, Khaji A, Karbakhsh M, Zarei MR: Epidemiology study of facial injuries during a 13 month of trauma registry in Tehran. Indian J Med Sci. 2004, 58 (3): 109-114.PubMed
43.
go back to reference Taher AA: Ocular injuries in 367 patients with middle and upper third facial trauma: experience in Tehran. J Craniofac Surg. 1996, 7 (2): 117-121. 10.1097/00001665-199603000-00007.CrossRefPubMed Taher AA: Ocular injuries in 367 patients with middle and upper third facial trauma: experience in Tehran. J Craniofac Surg. 1996, 7 (2): 117-121. 10.1097/00001665-199603000-00007.CrossRefPubMed
44.
go back to reference Akbari ME, Naghavi M, Soori H: Epidemiology of deaths from injuries in the Islamic Republic of Iran. East Mediterr Health J. 2006, 12 (3-4): 382-390.PubMed Akbari ME, Naghavi M, Soori H: Epidemiology of deaths from injuries in the Islamic Republic of Iran. East Mediterr Health J. 2006, 12 (3-4): 382-390.PubMed
45.
go back to reference Zargar M, Modaghegh MH, Rezaishiraz H: Urban injuries in Tehran: demography of trauma patients and evaluation of trauma care. Injury. 2001, 32 (8): 613-617. 10.1016/S0020-1383(01)00029-8.CrossRefPubMed Zargar M, Modaghegh MH, Rezaishiraz H: Urban injuries in Tehran: demography of trauma patients and evaluation of trauma care. Injury. 2001, 32 (8): 613-617. 10.1016/S0020-1383(01)00029-8.CrossRefPubMed
46.
go back to reference Soroush AR, Ghahri-Saremi S, Rambod M, Malek-Hosseini SA, Nick-Eghbal S, Khaji A: Pattern of injury in Shiraz. Chin J Traumatol. 2008, 11 (1): 8-12. 10.1016/S1008-1275(08)60002-4.CrossRefPubMed Soroush AR, Ghahri-Saremi S, Rambod M, Malek-Hosseini SA, Nick-Eghbal S, Khaji A: Pattern of injury in Shiraz. Chin J Traumatol. 2008, 11 (1): 8-12. 10.1016/S1008-1275(08)60002-4.CrossRefPubMed
47.
go back to reference Roudsari BS, Sharzei K, Zargar M: Sex and age distribution in transport-related injuries in Tehran. Accid Anal Prev. 2004, 36 (3): 391-398. 10.1016/S0001-4575(03)00032-0.CrossRefPubMed Roudsari BS, Sharzei K, Zargar M: Sex and age distribution in transport-related injuries in Tehran. Accid Anal Prev. 2004, 36 (3): 391-398. 10.1016/S0001-4575(03)00032-0.CrossRefPubMed
48.
go back to reference Razzak JA, Luby SP, Laflamme L, Chotani H: Injuries among children in Karachi, Pakistan--what, where and how. Public Health. 2004, 118 (2): 114-120. 10.1016/S0033-3506(03)00147-1.CrossRefPubMed Razzak JA, Luby SP, Laflamme L, Chotani H: Injuries among children in Karachi, Pakistan--what, where and how. Public Health. 2004, 118 (2): 114-120. 10.1016/S0033-3506(03)00147-1.CrossRefPubMed
49.
go back to reference Haddon W, Suchman E, Kline D: Accident Research: Methods and Approaches. 1964, New York: Harper and Row Haddon W, Suchman E, Kline D: Accident Research: Methods and Approaches. 1964, New York: Harper and Row
51.
go back to reference Glasser B: The Constant Comparative Method of Qualitative Analysis' in Social Problems. 1965, California: University of California Press, 12: Glasser B: The Constant Comparative Method of Qualitative Analysis' in Social Problems. 1965, California: University of California Press, 12:
Metadata
Title
The requirements and challenges in preventing of road traffic injury in Iran. A qualitative study
Authors
Davoud Khorasani-Zavareh
Reza Mohammadi
Hamid Reza Khankeh
Lucie Laflamme
Ali Bikmoradi
Bo JA Haglund
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2009
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-9-486

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