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Int J Env Health Eng 2015,  4:38

Pedestrian safety in traffic environment: An E-mail-based intervention to promote crossing behaviors among medical college students

1 Department of Public Health, School of Health, Ilam University of Medical Sciences, Ilam; Student Research Center, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
3 Statistic and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
4 Statistic and Epidemiology, School of Health, Ilam University of Medical Sciences, Ilam, Iran
5 Department of Health Education and Promotion, School of Health, Qom University of Medical Sciences, Qom, Iran

Date of Web Publication30-Nov-2015

Correspondence Address:
Dr. Firoozeh Mostafavi Darani
Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Science, Hezar Jerib Ave., Isfahan
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Source of Support: Isfahan University of Medical Sciences, Conflict of Interest: None

DOI: 10.4103/2277-9183.170705

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Aims: The aim of this study was to evaluate the effectiveness of E-mail-based intervention on safe crossing behaviors among Isfahan University of Medical Science students, in year 2014 in Iran.
Materials and Methods: In over all, 78 boy-students with 22.33 ± 1.65 years were participated in an E-mail-based intervening study. They divided into intervention group (n = 38) and control group (n = 40) by use of random allocation. The instrument of data collection included questionnaire of theory of planned behavior constructs and traffic behaviors. Questionnaires were filled out by both groups at the baseline and 6 months after the educational intervention. The safe crossing educational intervention was conducted within 1-month through E-mail service for the intervention group. The control group received no education.
Results: Results showed no significant differences between groups in mean of attitude toward safe crossing, subjective norms (SNs), perceived behavioral control (PBC), intention and safe crossing behaviors at baseline (P > 0.05). MANCOVA test demonstrated that there is a significant difference between groups after the educational intervention with adjusting the effect of age (P = 0.001, F = 31.144, Wilks lambda = 0.313). According to the ANCOVA test, after educational intervention, mean of positive attitude toward safe crossing, PBC, intention and behaviors related to safe crossing were increased in intervention group in comparing control group (P < 0.005).
Conclusion: E-mail-based intervention can promote safe crossing behaviors among college students. Conducting further studies with focusing on SNs related to safe crossing is suggested.

Keywords: E-mail-based intervention, pedestrian safety, theory of planned behavior, traffic environment

How to cite this article:
Jalilian M, Darani FM, Mahaki B, Delpisheh A, Rad GS. Pedestrian safety in traffic environment: An E-mail-based intervention to promote crossing behaviors among medical college students. Int J Env Health Eng 2015;4:38

How to cite this URL:
Jalilian M, Darani FM, Mahaki B, Delpisheh A, Rad GS. Pedestrian safety in traffic environment: An E-mail-based intervention to promote crossing behaviors among medical college students. Int J Env Health Eng [serial online] 2015 [cited 2023 Sep 24];4:38. Available from:

  Introduction Top

Traffic injuries were known as the tenth leading factors of death in 2002, and it is estimated that it will be an increase to eight leading factor of death in the worldwide in 2030. Ninety percent of death related to traffic accidents is occurred in countries with low or moderate income. These countries have 80% of the world population and only 48% of vehicles.[1] In Iran, as a developing country, traffic accidents have the highest burden of disease, and it is also known as the second leading cause of death after cardiovascular disease. They are the cause of 14.9% of death, 26.9% of standard expected years of lost life and also 58/100,000 deaths every year. Prevalence of traffic death in men is more than women.[2] The most vulnerable people in traffic environments are pedestrian, bicyclists and cyclists, respectively, which they have the highest rate of death and disability. Traffic injuries are mostly happened due to unsafe and careless behaviors of pedestrians and drivers.[3] The most prevalent kinds of these unsafe behaviors are not compliance with traffic legislations, unsafe crossing in dangerous situations, running while crossing, cross diagonally, slow walking while crossing, disregarding to traffic signals, crossing at unmarked zones, not looking at the left or right, distracted crossing, using cell phone and media devices and so.[4],[5],[6],[7],[8],[9],[10],[11] There are several factors that affect pedestrian behaviors while crossing the street. Demographic factors such as age, and gender are associated with the adoption safe or unsafe behaviors. Females wait more than males to red light in signalized intersections. This time is longer in old pedestrians rather than younger people. Male pedestrians are more intended to violate traffic law and perform unsafe behaviors in comparison to females.[11],[12] Previous studies emphasis on the impact of attitude on pedestrian's safety in traffic environments. Attitude is a factor which can predict human behavior. Attitude has a role in happening of traffic accidents indirectly. This impact is occurred by affecting the perception of danger and unsafe behavior.[13] Pedestrians' tendency to conformity with important people in their life and subjective norms (SNs) is another factor which influence pedestrians' behavior in traffic environments.[14] According to conducted studies in this field, waiting time for crossing the street is decreased in the presence of other people. In other words, pedestrian tendency to following the mass is increase in dangerous situations.[12] Khan (1999) found that pedestrian as a group performed unsafe crossing 1.8 times more than those who cross lonely.[14] Perceived behavioral control (PBC) is a predictor of pedestrian intention to safe crossing. This factor is related to people perception of difficulty or simplicity of specific behavior and also understanding of external and internal factors that facilitate or inhibit it.[15] Several studies report the effectiveness of educational interventions on PBC.[16],[17],[18] Furthermore, behavioral intention can determine pedestrians' behaviors in traffic environments.[15] Díaz reported that violation of traffic law is associated with behavioral intention which is affected by attitude, SN and perceived PBC.[19] Today, the significant challenge is how to combine these variables in a predicting framework of intention and behavior and also design effective intervention in this field.[20] Theory of planned behavior (TPB) is a theory of behavior change that could be useful to undertaking in improving pedestrian safe crossing.[15] In the other hand, selecting proper communication channel is very necessary to deliver successful intervention. An effective and inexpensive communication channel is internet and its related instruments and services.[21],[22],[23],[24] Internet-based interventions can be available asynchronously for the learners and provide strong sources of consultation and support to behavior change.[25] E-mail service is an internet-based channel and can play important role in delivering effective intervention.[18] Available documents on E-mail-based interventions demonstrated the advantage of application of this service in behavior change interventions.[18],[26],[27] Parrott et al. was reported the effectiveness of sending message through E-mail in changing individual attitude and intention.[18] In the other study, Plotnikoff et al. showed the positive effect of receiving weekly E-mail in changing human behavior.[28] Therefore, the aim of this study was to evaluate the effectiveness of E-mail-based intervention on safe crossing behaviors among Isfahan University of Medical Science students, in year 2014 in Iran.

  Materials and Methods Top

A total of 103 medical college students registered to participate in the study. Seventy-eight students had inclusion criteria and complete consent form. Inclusion criteria were access to internet at least 1-h/day, having E-mail account, checking E-mail every 2 days routinely and not suffering from any physical disability. After registration, participants were divided into intervention group (n = 38) and control group (n = 40) by use of randomized allocation. Baseline data were collected by use of TPB constructs and safe crossing behaviors questionnaire. Educational intervention was conducted to the intervention group. This group received an E-mail every 2 days within 1-month. The messages provide information on change attitude toward safe crossing; improve persuasive SNs, PBC and intention to safe crossing by sending pictures, videos, texts. The participants were asked to reply to messages and send their opinion about specific topics. [Table 1] shows how to apply the TPB constructs in promoting the safe crossing. Control group received no educational intervention during the study. Both groups participants refilled out study questionnaire after 6 months follow-up. Follow-up data were collected during 1-week and when the students were in their classes. Crossing behaviors were measured by use of Granié et al. questionnaire.[29] This questionnaire is consisting of 32 items. The reliability and validity of this questionnaire measured to cultural adaptation by calculation of the content validity ratio (CVR), content validity index (CVI) by use of Lawshe table.[30] After the calculation of CVR and CVI, 9 items were deleted, and 23 items were remained which Cronbach alpha 0.87 was calculated by conduct a pilot study on 182 medical college students' measuring. Items were scored by five-point Likert scale (always to never). We developed a questionnaire, including 15 items to measuring of TPB constructs related to safe crossing. Reliability and validity of the questionnaire were calculated by conduct a pilot study on 182 students (α = 0.70). This questionnaire was designed to evaluate attitude toward safe crossing (6 items), SN (4 items), PBC (2 items) and behavioral intention (3 items). All items scored using five-point Likert scale. Attitude, SN and were scored from strongly agree to strongly disagree. PBC items were scored very easy to very difficult. Behavioral intention items were scored from very likely to very unlikely. Minimum and maximum score for attitude was 5-30 while it was 4-20 for SN, 2-10 for PBC and 3-15 for behavioral intention. In all of the TPB Constructs, high score was considered good. This is a randomized group and pretest-posttest design study. Baseline and follow-up data were analyzed by independents sample t-test, MANCOVA, and ANCOVA. Covariance analysis was used to find a significant difference between groups after 6 months follow-up. Independent sample t-test was conduct to detect the differences between groups at baseline. In all calculations P< 0.05 was considered as significant.
Table 1: Theory, strategies and educational activities related to pedestrian safety

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  Results Top

A total of 78 medical college students were participated in the study and filled out questionnaires at the baseline and after 6 months follow-up. Samples of questionnaire variables based on the TPB constructs including results of Cronbach's alpha are shown in [Table 2]. The mean age of the participants in intervention and control groups was 22.82 ± 2.18 and 21.89 ± 1.13, respectively. 87.2% (n = 68) of them reported the life-time accident history as pedestrian and 12.8% (n = 10) reported no history. No significant differences were found between group in accident history (P = 0.931). According to the results, at baseline, the mean score of persuasive SNs related to safe crossing, PBC, behavioral intention and safe crossing behaviors were relatively low in both study groups. However the mean score of attitude toward safe crossing was high. In other words, participants in two groups reported they crossed in unsafe manner and likelihood of adopting safe behavior while crossing is low. Comparing of TPB constructs at baseline showed that there are no significant differences between groups (P > 0.005). More details were provided in [Table 3]. Multivariate analysis of covariance after adjusting the effect of age revealed a significant difference between groups in TPB constructs after 6 months follow-up (P = 0.001, F = 31.144, Wilks lambda = 0.313). According to the univariate test in comparing mean differences of TPB constructs between groups after 6 months, an significant increase in mean of positive attitude toward safe crossing, PBC, behavioral intention was found (P< 0.05). However, a significant difference was not found in persuasive SNs for safe crossing (P > 0.005). Findings in safe crossing behaviors after 6 months demonstrate a significant increase in adopting safe crossing behaviors in the intervention group in comparing a control group (P < 0.005) [Table 4].
Table 2: Summary and samples of questionnaire variables based on the TPB construct including results of Cronbach's alpha

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Table 3: Baseline characteristics and theory of planned behavior measures for pedestrian safety intervention in a college student population

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Table 4: Mean changes in TPB measures for pedestrian safety intervention in a college student population

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  Discussion Top

The study examined the effectiveness of E-mail-based persuasive messaging on safe crossing and TPB constructs among medical college students. It is hypothesized that design and implementation of E-mail-based intervention with applying TPB constructs can improve safe crossing among students. Results provide encouragement for future research in the realm of E-mail-based persuasive messaging in behavior change. Our hypothesis of effectiveness of the intervention based on E-mail was confirmed by findings the significant differences between two groups after 6 months follow. Before the intervention, at baseline, a significant difference was not found in two groups in attitude toward safe crossing. However, after intervention (6 months follow-up) attitude toward safe crossing increased significantly in the intervention group in comparison with the control group. This finding is consisted with results of other conducted study in the field of pedestrian safety.[17] There are several studies that reported change in attitude after implementing interventional programs.[18],[31],[32],[33] Parker et al. reported the improvement in attitude toward speed limit restriction among drivers.[31] In present study, the hypothesis of improvement in SNs after E-mail-based intervention was not proved. Designed intervention could not significantly altered one's feelings of whether those in their social network would support safe crossing behaviors. Further, SN would likely be an extremely difficult construct to positively change with any type of mediated intervention approach. Although the mean of SNs was increased in the intervention group in comparison with the control group, However, this improvement was not significant. However, this improvement highlighted this point that people need to be persuade and support from important persons in their social interactions for taking safe crossing behaviors. Our findings are consist with the results of Parrott et al. study which was conducted to evaluation of the impact of E-mail-based intervention on persuasive SNs related to physical activity among students.[18] Zhou et al. were reported the influence of others presence on people crossing behaviors. According to mentioned study, the tendency to following others can affect crossing behaviors in high-risk situations.[15] More studies are needed to investigation the effect of SNs on pedestrian's safe crossing behaviors. Our findings revealed that PBC was improved significantly in the intervention group after 6 months follow-up in comparison with the control group. These results showed the effectiveness of E-mail-based intervention in decreasing the barriers to safe crossing. Increasing of people perception of simplicity of performing safe crossing behaviors in different situations can develop this believe that they have more control over behaviors. Our findings are compatible with results of previous studies in the investigation of the impact of E-mail-based interventions on improving PBC among several population.[16],[17],[18] Intervention group participants reported significantly high score of safe crossing behaviors after 6 months follow-up in comparison with the control group. After 6 months follow-up, Intervention group participants were reported compliance with traffic laws, cross in signalized intersections, no crossing in dangerous situations, looking for traffic follow and red traffic signal significantly more than the control group. Furthermore, distracted walking and crossing in the intervention group was significantly decreased in comparison with the control group. Several studies reported the efficacy of E-mail-based intervention in changing the behaviors.[18],[26],[34] Bendtsen et al. showed the impact of sending persuasive messages on behavioral change, saving time and resources among a wide population of college students.[34] According to Parrott et al. study findings, prepare and sending messages based on TPB constructs have high effect on individual behavior change.[18] Our findings are congruence with mentioned study.

  Conclusion Top

E-mail-based interventions have shown high effectiveness to improve cognitive factors related to safe crossing among medical college students. SNs were not significantly change, and more studies are needed to investigate and recognition of appropriate interventional strategies to change it among road users specifically pedestrians. Given the lack of available literature on the topic of E-mail-based safe crossing interventions, this investigation was conducted with the expectation that many follow-up studies would be performed in the future. These data provide valuable information concerning the use of E-mail as an affordable, high-impact intervention tool for promoting safe crossing behaviors among pedestrians.

  Acknowledgments Top

This study was part of M. Jalilian Ph.D. dissertation in health education and health promotion, year 2013-2014. We appreciate the support of this work from the Isfahan University of Medical Science, Iran (Project Number: 392541). Authors are grateful to of Isfahan University students participation in the study.

  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4]


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