Driving Research Group Road safety interventions aimed at young novice drivers – what is the missing ingredient? Dr Mark Sullman Driving Research Group Cranfield University

This talk Current situation What are BCTs? Which BCTs work? How do these compare with currently used BCTs Practical applications Conclusions

Current Situation - Statistics Young drivers (17-24 year olds) made up 1.5% of the licence holders and up to 12% of all fatal and serious crashes 1 in 6 newly qualified drivers will crash within 6 months How we try to reduce this?

Current Interventions Often school-based. Attempt to ensure school children understand the risks & potential consequences of dangerous driving. Try to educate & change attitudes to dangerous driving with the idea that this will lead to safer driving when they get their licence. Considerable investment across the world. Which BCTs are used? Do they improve young driver safety?

Scientific Evidence Surprisingly little scientific literature on the topic. Majority rely solely on self-reported attitudes or behaviours (not actual behaviours, fines or crashes). Very small number of robust studies worldwide. Scientific literature which does exist shows no changes in crash risk or even increased risk (e.g. Wynne-Jones & Hurst, 1984). Reviews of the literature conclude there is no evidence these types of interventions work (e.g. Vernick et al., 1999; Roberts & Kwan, 2008). Why and what can be done to improve? Perhaps the scientific literature on behaviour change can help?

Behavioural Science Has become increasingly well known & popular over last few years. US President Obama - Executive Order (2015) “Using Behavioral Science Insights to Better Serve the American People”. A growing body of evidence demonstrates that behavioural science insights ……. can be used to design government policies to better serve the American people.

What are Behaviour change techniques (BCTs)? Scientifically proven techniques for changing behaviour. The smallest components that on their own have the potential to change behaviour. The “active ingredients” of an intervention which are observable and replicable. Can be used alone or in combination with other BCTs.

Which BCTs are effective for behaviour change? Smoking - evidence from randomised controlled trials (RCTs): 43 BCTs useful for smoking cessation (Michie et al., 2011) 16 with good evidence of effectiveness Road safety interventions for young drivers/pre-driver WE SIMPLY DO NOT KNOW WHICH BCTs WORK!

Where too now? To design more effective interventions, need to know what the components of a successful intervention are Many other types of health behaviours have many scientifically robust evaluations of interventions. Road safety interventions for young drivers/pre-driver WE SIMPLY DO NOT KNOW WHICH BCTs WORK! Can we learn from other fields? Idea - review evidence regarding which BCTs can change other types of health behaviours.

Literature Review Interventions which used BCTs to improve behaviour in: Obesity Physical exercise Diet & nutrition Four databases searched Taxonomy used to classify BCTs

BCT Taxonomies Physical activity/healthy eating/mixed - 26 BCTs (Abraham & Michie, 2008) Physical activity & healthy eating - 40 BCTs (Michie et al., 2011) Behaviour Change Taxonomy V1 - 93 BCTs (Michie et al., 2015)

Method Literature search to identify interventions which used BCTs to improve behaviour (diet & nutrition, physical exercise, obesity prevention, drug use, road safety, smoking and sex). Identified articles – downloaded & read (+ any supplementary info.) Adolescents, children, adults. Whether the intervention was successful (statistically significant) at changing behaviour or not. Identify which BCTs were more common in successful interventions

Results Over 200+ articles read. BCTs were identified for 90 interventions. All interventions included more than 1 BCT. Results were summed across all health behaviours (obesity, physical exercise, diet & nutrition). Children, adolescents, adults and over the three age groups.

Six most successful BCTs (all ages combined) 12 (Prompt self-monitoring behaviour); 10 (Prompt specific goal setting); 2 (Provide information on consequences); 20 (Plan social support/social change); 8 (Provide instructions); and 13 (Provide feedback on performance).

Most successful BCTs in adolescents 12 (Prompt self-monitoring behaviour); 13 (Provide feedback on performance); 8 (Provide instructions); 10 (Prompt specific goal setting); 1 (Provide information on behaviour health link); 2 (Provide information on consequences); 11 (Prompt review of behavioural goals); and 20 (Plan social support/social change).

Most successful BCTs in adolescents 12 (Prompt self-monitoring behaviour); 13 (Provide feedback on performance); 8 (Provide instructions); 10 (Prompt specific goal setting); 1 (Provide information on behaviour health link); 2 (Provide information on consequences); 11 (Prompt review of behavioural goals); and 20 (Plan social support/social change).

Most successful vs. Fylan & Stradling 12 (Prompt self-monitoring behaviour); 13 (Provide feedback on performance); 8 (Provide instructions); 10 (Prompt specific goal setting); 1 (Provide information on behaviour health link); 2 (Provide information on consequences); 11 (Prompt review of behavioural goals); and 20 (Plan social support/social change).

Most successful vs Fylan & Stradling 12 (Prompt self-monitoring behaviour); 13 (Provide feedback on performance); 8 (Provide instructions); 10 (Prompt specific goal setting); 1 (Provide information on behaviour health link); 2 (Provide information on consequences); 11 (Prompt review of behavioural goals); and 20 (Plan social support/social change). All included 1 & 2, four included b 5 of the 7 most effective BCTs not included in any of the UK-based interventions F & S appraised.

Practical Applications

BCT 10 – Prompt specific goal setting Ask the young driver to develop specific goals regarding safety-related behaviours. This should include detailed planning on how often they will do the behaviour (or not do), for how long, in what context and with whom. Example - they could develop a goal of never using a mobile phone while driving (handheld or hands-free) for the first two years and they will achieve this by ALWAYS turning their mobile phone off before they open the drivers’ door.

BCT 13 – Provide feedback on performance Providing information on their recorded driving behaviour. This can be their self-recorded driving behaviour, what was observed by another person (e.g., a parent), or as recorded by an In-Vehicle Data Recorder (IVDR). Often paired with goal setting (BCT 10) and used to inform the driver how they are going regarding meeting their goals.   For example, the young driver may have developed the goal of staying within the speed limit 100% of the time they are driving the car. They could use the IVDR to provide feedback on how they are going with meeting this goal. The feedback helps the driver to understand their progress and allows them to adjust the strategy, direction or effort and/or intensity of their efforts, if necessary.

BCT 20 – Plan social support or social change Prompting consideration of how important others (e.g., friends and family) could change their behaviour to offer the person help or social support. For example, the young driver could ask their parents and friends not to phone them while they are driving and to be understanding when they don’t answer their phone or text while driving.  Young drivers could also pledge to support each other in avoiding the temptation to drive dangerously due to peer pressure.

Conclusions Knowledge of which BCTs work in road safety is lacking The active ingredients which work with other health behaviours have been reviewed here. These BCTs should be trialled in road safety interventions. Vital that adequate evaluations - to start building an evidence base regarding which BCTs are effective in this setting. (possible that other BCTs may be more effective for changing road safety behaviour).

Elizabeth Box and Steve Gooding RAC Foundation for funding this work. ACKNOWLEDGEMENTS Elizabeth Box and Steve Gooding RAC Foundation for funding this work.