The Advocacy for Pedestrian Safety Study: Cluster Randomised Trial Evaluating a Political Advocacy Approach to Reduce Pedestrian Injuries in Deprived Communities

Ronan A Lyons, Denise Kendrick, Elizabeth M L Towner, Carol Coupland, Mike Hayes, Nicola Christie, Judith Sleney, Sarah Jones, Richard Kimberlee, Sarah E Rodgers, Samantha Turner, Mariana Brussoni, Yana Vinogradova, Tinnu Sarvotham and Steven Macey

PLOS ONE, 2013, vol. 8, issue 4, 1-12

Abstract: Objective: To determine whether advocacy targeted at local politicians leads to action to reduce the risk of pedestrian injury in deprived areas. Design: Cluster randomised controlled trial. Setting: 239 electoral wards in 57 local authorities in England and Wales. Participants: 617 elected local politicians. Interventions: Intervention group politicians were provided with tailored information packs, including maps of casualty sites, numbers injured and a synopsis of effective interventions. Main outcome measures: 25–30 months post intervention, primary outcomes included: electoral ward level: percentage of road traffic calmed; proportion with new interventions; school level: percentage with 20 mph zones, Safe Routes to School, pedestrian training or road safety education; politician level: percentage lobbying for safety measures. Secondary outcomes included politicians’ interest and involvement in injury prevention, and facilitators and barriers to implementation. Results: Primary outcomes did not significantly differ: % difference in traffic calming (0.07, 95%CI: −0.07 to 0.20); proportion of schools with 20 mph zones (RR 1.47, 95%CI: 0.93 to 2.32), Safe Routes to School (RR 1.34, 95%CI: 0.83 to 2.17), pedestrian training (RR 1.23, 95%CI: 0.95 to 1.61) or other safety education (RR 1.16, 95%CI: 0.97 to 1.39). Intervention group politicians reported greater interest in child injury prevention (RR 1.09, 95%CI 1.03 to 1.16), belief in potential to help prevent injuries (RR 1.36, 95%CI 1.16 to 1.61), particularly pedestrian safety (RR 1.55, 95%CI 1.19 to 2.03). 63% of intervention politicians reported supporting new pedestrian safety schemes. The majority found the advocacy information surprising, interesting, effectively presented, and could identify suitable local interventions. Conclusions: This study demonstrates the feasibility of an innovative approach to translational public health by targeting local politicians in a randomised controlled trial. The intervention package was positively viewed and raised interest but changes in interventions were not statistically significance. Longer term supported advocacy may be needed. Trial Registration: Current Controlled Trials ISRCTN91381117

Date: 2013
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DOI: 10.1371/journal.pone.0060158

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