Role of Health Sector in Road Traffic Injuries Prevention: A Public Health Approach

Saber Azami‑Aghdash, Hassan Abolghasem Gorji, Hojatolah Gharaee, Ahmad Moosavi, Homayoun Sadeghi‑Bazargani


Background: Although the main burden of the Road Traffic Injuries (RTIs) is on the health sector, compared with other sectors, no clear definition is available about its role in the prevention of the RTIs. So this study has been performed to define the role of the health sector in the prevention of RTIs –before the incidence. Methods: In this qualitative study with a grounded theory approach, the possible roles of the health sector in the prevention of the RTIs were identified in three phases. At the first stage of the study, the roles of the health system in the prevention of the RTIs identified from the literature. In the next step, semi‑structured interviews (ranged from 45 to 90 minutes) with 42 experts were done for identifyingroles. Finally, Consensus attained on the identified roles by using the Delphi technique and with the participation of 30 experts. Results: Literature review and interviews resulted in 42 and 86 roles for the health sector in the prevention of the RTIs, respectively. After removing the duplicates and merging the similar, 46 roles were entered into Delphi. Five roles excluded in the Delphi leaving 41 roles in 7 dimensions of communications (6 roles), intra‑sector cooperation (9 roles), inter‑sector leadership (6 roles), evaluation (6 roles), research (5 roles), education (3 roles), and health‑specific issues (6 roles). Conclusions: It seems that the health sector can help an impressing reduction of the RTIs by playing the roles identified in this study, which the most important of them is Communication/Informing role. So first the general public and then the health sector itself would benefit from it.


Health sector; injuries; preventive medicine; public health; traffic accident

Full Text:



Huang Y, Tian D, Gao L, Li L, Deng X, Mamady K, et al.

Neglected increases in rural road traffic mortality in China:

Findings based on health data from 2005 to 2010. BMC Public

Health 2013;13:1111.

Bakhtiyari M, Delpisheh A, Monfared AB, Kazemi-Galougahi MH,

Mehmandar MR, Riahi M, et al. The road traffic crashes as a

neglected public health concern; An observational study from

Iranian population. Traffic Inj Prev 2015;16:36-41.

Zimmerman K, Jinadasa D, Maegga B, Guerrero A. Road traffic

injury on rural roads in Tanzania: Measuring the effectiveness of

a road safety program. Traffic Inj Prev 2015;16:456-60.

WHO. Global Status Report on Road Safety 2013: Supporting A

Decade Of Action, World Health Organization. Geneva: World

Health Organization; 2013.

WHO. World Report on Road Traffic Injury Prevention. Geneva:

World Health Organization; 2004.

Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM,

Abd-Allah F, et al. Global, regional, and national incidence,

prevalence, and years lived with disability for 328 diseases

and injuries for 195 countries, 1990–2016: A systematic

analysis for the Global Burden of Disease Study 2016. Lancet


Sachs JD. From millennium development goals to sustainable

development goals. Lancet 2012;379:2206-11.

Organization WH. Global Status Report on Road Safety 2018:

Summary. Geneva, World Health Organization; 2018.

Roy N, Murlidhar V, Chowdhury R, Patil SB, Supe PA,

Vaishnav PD, et al. Where there are no emergency medical

services—Prehospital care for the injured in Mumbai, India.

Prehosp Disaster Med 2010;25:145-51.

Bhatti JA. Prioritisation of road traffic injury prevention fund

spending in developing countries. Inj Prev 2010;16:214-5.

Yankson IK, Browne EN, Tagbor H, Donkor P, Quansah R,

Asare GE, et al. Reporting on road traffic injury: Content

analysis of injuries and prevention opportunities in Ghanaian

newspapers. Inj Prev 2010;16:194-7.

Staton C, Vissoci J, Gong E, Toomey N, Wafula R, Abdelgadir J,

et al. Road traffic injury prevention initiatives: A systematic

review and metasummary of effectiveness in low and middle

income countries. PLoS One 2016;11:e0144971.

Margie P, Richard S, David S. World Report on Road Traffic

Injury Prevention. Geneva World Health Organization;

(ISBN: 92 4 156260 9).

Waller PF. Public health’s contribution to motor vehicle injury

prevention. Am J Prev Med 2001;21(4 Suppl):3-4.

Sleet DA, Dinh-Zarr TB, Dellinger AM. Traffic safety in the

context of public health and medicine. Improving Traffic Safety

Culture in the United States. 2007:41-58.

Racioppi F, Eriksson L, Tingvall C, Villaveces A. Preventing

Road Traffic Injury: A Public Health Perspective for Europe.

Copenhagen: Copenhagen, Denmark. WHO Regional Office for

Europe; 2004.

McCallin A, Scott H, Johnston T. Which grounded theory.

Grounded Theory Online; Supporting GT Researchers; 2009.

Calman L. What is Grounded Theory. The University of

Manchester, UK; 2006.

Grbich C. Qualitative Data Analysis: An Introduction. Sage;

London, UK 2012.

Ope C, Ziebland S, Mays N. Analysing qualitative data. BMJ


Cleary M, Horsfall J, Hayter M. Data collection and sampling

in qualitative research: Does size matter? J Adv Nurs


Byrne M. Sampling for qualitative research. Aorn J


Higginbottom GM. Sampling issues in qualitative research.

Nurse Res 2004;12:7-19.

Azami-Aghdash S, Tabrizi JS, Sadeghi-Bazargani H,

Hajebrahimi S, Naghavi-Behzad M. Developing performance

indicators for clinical governance in dimensions of risk

management and clinical effectiveness. Int J Qual Health Care


Gopalakrishnan S. A public health perspective of road traffic

accidents. J Family Med Prim Care 2012;1:144-50.

Integrated Disease Surveillance Project (IDSP) 2021 [Available


&lid=1592. [Last accessed on 2012 May 23].

Razzak JA, Shamim MS, Mehmood A, Hussain SA, Ali MS,

Jooma R. A successful model of Road Traffic Injury surveillance

in a developing country: Process and lessons learnt. BMC Public

Health 2012;12:357.

Ma S, Li Q, Zhou M, Duan L, Bishai D. Road traffic injury

in China: A review of national data sources. Traffic Inj Prev

;13(Suppl 1):57-63.

Ward E, McCartney T, Arscott-Mills S, Gordon N, Grant A,

McDonald AH, et al. The Jamaica Injury Surveillance System:

A profile of the intentional and unintentional injuries in Jamaican

hospitals. West Indian Med J 2010;59:7-13.

Rojas Medina Y, Espitia-Hardeman V, Dellinger AM, Loayza M,

Leiva R, Cisneros G. A road traffic injury surveillance system

using combined data sources in Peru. Rev Panam Salud Publica


Hatamabadi HR, Vafaee R, Haddadi M, Abdalvand A,

Soori H. Necessity of an integrated road traffic injuries

surveillance system: A community-based study. Traffic Inj Prev


van Schagen I, Machata K. Best practices in road safety:

Handbook for measures at the country level. Luxembourg,

Publications Office of the European Communities Eur-OP 2010.

Boulanger A, Divjak M, Orozova-Bekkevold I, Zabukovec V.

Typology of Evaluation Methods: Current Practices and

Campaign Evaluation; Deliverable 2.1 of Campaigns and

Awareness Raising Strategies in Traffic Safety (CAST),

Directorate-General for Transport and Energy, European

Commission, Brussels (2007). 2007.

Zampetti R, Messina G, Quercioli C, Vencia F, Genco L, Di

Bartolomeo L, et al. Nonfatal road traffic injuries: Can road

safety campaigns prevent hazardous behavior? An Italian

experience. Traffic Inj Prev 2013;14:261-6.

Phillips RO, Ulleberg P, Vaa T. Do road safety campaigns work.

A metaanalysis of road safety campaign effects. A theoretical

approach to assess road safety campaigns, Evidence from seven

European countries. Belgian Road Safety Institute; 2009.

Hoekstra T, Wegman F. Improving the effectiveness of road

safety campaigns: Current and new practices. IATSS Res


Menon GR, Gururaj G, Tambe M, Shah B. A Multi-sectoral

approach to capture information on road traffic injuries: Indian J Community Med 2010;35:305-10.

Azami-Aghdash S, Sadeghi-Bazargani H, Saadati M,

Mohseni M, Gharaee H. Experts’ perspectives on the application

of public-private partnership policy in prevention of road traffic

injuries. Chinese J Traumatol 2020;23:152-8.

Derakhshani N, Darghahi G, Gharaee H, Vahedi S, Pour-Golam N.

Barriers and facilitators of road traffic injuries prevention in Iran:

A qualitative study. J Inj Violence Res 2019;11(4 Suppl 2):179.

Stevenson M, Thompson J. On the road to prevention: Road

injury and health promotion. Health Promot J Austr 2014;25:4-7.

Al Turki YA. How can Saudi Arabia use the decade of action for

road safety to catalyse road traffic injury prevention policy and

interventions? Int J Inj Contr Saf Promot 2014;21:397-402.

Road safety: The critical transportation issue in Canada.

Overview. Annual report on road safety vision 2010. 2002.

Duperrex O, Bunn F, Roberts I. Safety education of pedestrians

for injury prevention: A systematic review of randomised

controlled trials. BMJ 2002;324:1129.

Ker K, Roberts I, Collier T, Beyer F, Bunn F, Frost C.

Post-licence driver education for the prevention of road traffic

crashes: A systematic review of randomised controlled trials.

Accid Anal Prev 2005;37:305-13.

Elvik R, Vaa T. Handbook of Road Safety Measures. Amsterdam:

Elsevier; 2004.

Sadeghi-Bazargani H, Abedi L, Mahini M, Amiri S,

Khorasani-Zavareh D. Adult attention-deficit hyperactivity

disorder, risky behaviors, and motorcycle injuries: A case-control

study. Neuropsychiatr Dis Treat 2015;11:2049-54.

Vaa T. ADHD and relative risk of accidents in road traffic:

A meta-analysis. Accid Anal Prev 2014;62:415-25.

Jerome L, Habinski L, Segal A. Attention-deficit/hyperactivity

disorder (ADHD) and driving risk: A review of the literature and

a methodological critique. Curr Psychiatry Rep 2006;8:416-26.

El Farouki K, Lagarde E, Orriols L, Bouvard MP, Contrand B,

Galera C. The increased risk of road crashes in attention

deficit hyperactivity disorder (ADHD) adult drivers: Driven by

distraction? Results from a responsibility case-control study.

PLoS One 2014;9:e115002.

Safiri S, Sadeghi-Bazargani H, Amiri S, Khanjani N,

Safarpour H, Karamzad N, et al. Association between adult

attention deficit-hyperactivity disorder and motorcycle traffic

injuries in Kerman, Iran: A case-control study. J Clin Res Gov


Ebrahimi MH, Sadeghi M, Dehghani M, Niiat KS. Sleep habits

and road traffic accident risk for Iranian occupational drivers. Int

J Occup Med Environ Health 2015;28:305-12.

Valent F, Di Bartolomeo S, Marchetti R, Sbrojavacca R,

Barbone F. A case-crossover study of sleep and work hours and

the risk of road traffic accidents. Sleep 2010;33:349-54.

Aguiar M, Valenca J, Felizardo M, Caeiro F, Moreira S, Staats R,

et al. Obstructive sleep apnoea syndrome as a cause of road

traffic accidents. Rev Port Pneumol 2009;15:419-31.

Petkovic S, Palic K, Samojlik I. Blood alcohol concentration in

fatally injured drivers and the efficacy of alcohol policies of the

new law on road traffic safety: A retrospective 10-year study in

autonomous province of Vojvodina, Republic of Serbia. Traffic

Inj Prev 2016;17:553-7.

Esser MB, Wadhwaniya S, Gupta S, Tetali S, Gururaj G,

Stevens KA, et al. Characteristics associated with alcohol

consumption among emergency department patients presenting

with road traffic injuries in Hyderabad, India. Injury


O’Connor LR, Ruiz RA. Alcohol and hospitalized road traffic

injuries in the Philippines. Yale J Biol Med 2014;87:307-19.

Sebego M, Naumann RB, Rudd RA, Voetsch K, Dellinger AM,

Ndlovu C. The impact of alcohol and road traffic policies on

crash rates in Botswana, 2004-2011: A time-series analysis.

Accid Anal Prev 2014;70:33-9.

Hu G, Mamady K. Alcohol-related road traffic injury and Global

Burden of Disease 2010. Lancet 2013;382:1092‑3.