The efficacy of an educational intervention in promoting self-regulation among high-risk older drivers

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Abstract

Visual processing impairment increases crash risk among older drivers. Many older drivers meet the legal requirements for licensing despite having vision impairments that elevate crash risk. In this study, 365 older drivers who were licensed, visually-impaired, and crash-involved in the prior year were randomly assigned to an intervention group or usual-eye-care control group to evaluate the efficacy of an educational intervention that promoted the performance of self-regulatory practices. The educational curriculum was designed to change self-perceptions about vision impairment and how it can impact driver safety and to promote the avoidance of challenging driving situations through self-regulation, leading to reductions in driving exposure. Analyses compared the intervention and control groups at pre-test and 6 months post-test with respect to self-reported perceptions about vision and driving practices. At post-test, drivers who had received the educational intervention were more likely to acknowledge that the quality of their eyesight was less than excellent, report a higher frequency of avoiding challenging driving situations (e.g. left-turns) and report performing more self-regulatory practices (e.g. three right-turns) as compared to controls. Additionally, drivers in the educational intervention group reported significantly fewer days, fewer places and fewer trips made per week as compared to those not receiving the educational intervention. These findings imply that visually-impaired older drivers at higher risk for crash involvement may benefit from educational interventions by reducing their driving exposure and increasing their avoidance of visually challenging driving situations. A critical future step in this research program will be to examine whether this educational intervention has an impact on the safety of these high-risk older drivers by reducing their crash involvement in the years following the educational intervention.

Introduction

Injuries and deaths from vehicle crashes have become a public health concern, particularly among older drivers who as a group have a higher crash rate per mile driven and who are more likely to die or become seriously disabled after a crash as compared to other age groups (National Highway Traffic Safety Administration, 1997). Like young and middle-aged adults, almost 90% of older adults rely on the private automobile for the majority of their transportation needs (Transportation Research Board, 1988, Martinez, 1995), and thus, driving cessation can hamper the personal mobility of this population. The increased crash risk among older drivers is linked to visual impairment (Owsley, 2002). Many older drivers with visual problems meet the legal requirements for licensing despite having impairments that elevate crash risk. Therefore, it is important to develop interventions for older drivers who maintain driving privileges while coping with visual limitations that hamper driving performance.

Efforts to intervene on older drivers through a primary crash prevention approach deserve consideration. Educational programs have been developed to promote driver safety among the elderly (Beno, 1981), addressing topics such as common age-related functional changes that impact driving (AAA, 1998, American Association of Retired Persons, 1997, Janke, 1994, National Safety Council, 1997). These programs are tailored for group administration or presented in a booklet or video. Two educational programs for older drivers have been evaluated (McKnight et al., 1982, Janke, 1994). Although these programs had a positive impact in terms of gains in knowledge of safety facts, it remains to be determined whether there were also changes in driver attitudes and self-perceptions. The field of health education indicates that changes in attitudes and self-perceptions play a critical role in generating intentions to change behavior and are, thus, prerequisites to changing behavior itself (Ajzen and Madden, 1986, Pender and Pender, 1986, Strain, 1991). Thus, it is interesting to consider if visually-impaired older drivers were provided with information to increase self-awareness about their risks for adverse driving outcomes, would they be more likely to exhibit safety-oriented behaviors, as compared to those who are not provided with such information?

‘Knowledge enhances your safety’ (KEYS) is a randomized intervention study to evaluate an educational program that promotes safe driving practices among visually-impaired older drivers. KEYS has two primary outcome measures assessed during the 2 years following randomization: self-reported driver behaviors (e.g. avoidance of challenging driving situations, exposure), and state-recorded crash involvement in the ensuing years. The focus is on older drivers at “high-risk” for crash involvement, where high-risk is operationally defined as older drivers with visual processing impairment, high driving exposure, and a crash on the state record in the year prior to enrollment. These are known to be characteristics that elevate the risk of crash involvement in older drivers (Owsley, 2002). KEYS has an experimental design with random assignment to either an intervention group (those who receive the educational curriculum) or a non-intervention group. Here, we report the results of the first 6 months follow-up with respect to self-reported attitudes about vision impairment and driving and self-reported driving behaviors. Analyses focus on the following questions: does an individualized, one-on-one educational curriculum presented to high-risk older drivers: (1) change their self-perceptions about the quality of vision, (2) change their general attitudes toward driver safety, and (3) increase their avoidance of challenging driving situations through self-regulation and reduced driving exposure.

Section snippets

Subjects

The source population consisted of older drivers in the Birmingham, Alabama area as provided by records of the Alabama Department of Public Safety. Potential participants were contacted by a letter describing the study, followed by a phone call to determine if they met the inclusion criteria for age, driving status, and driving exposure (see the following sections). If so, they were invited to visit the Clinical Research Unit in the Department of Ophthalmology at the University of Alabama at

Sample characteristics

Participants (N=365) had a mean age of 74 years (60–91 years; S.D.=6) with 69% male and 31% female, and 23% African–American and 77% white of non-Hispanic origin. The high percentage of males in this sample is consistent with the population of crash-involved drivers from which they were recruited where males are more likely to have a history of crash involvement than females (National Highway Traffic Safety Administration, 1997). Eighteen percent of our participants had both visual acuity

Discussion

The purpose of this paper was to evaluate the efficacy of an educational curriculum designed to increase self-awareness about driving and vision and to promote self-regulatory behaviors among older drivers at high-risk for crashing because of vision impairment, previous recent crash involvement, and high driving exposure. The first question addressed was whether an educational curriculum could improve older drivers, awareness that their vision was impaired (when in fact it was) and that these

Acknowledgements

This research was funded by General Motors Corporation pursuant to an agreement between General Motors and the United States Department of Transportation.

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