The applicability of the Precaution Adoption Process Model for understanding self-regulatory driving behaviour among older drivers Heidy Hassan 1, Mark King 1, & Kerrianne Watt 2 1 Centre for Accident Research and Road Safety – Queensland, Queensland University of Technology 2 School of Public Health, Tropical Medicine and Rehabilitation Sciences- Queensland, James Cook University Text here The Centre for Accident Research and Road Safety - Queensland 1. Introduction The success of self-regulation, in terms of enhancing older drivers’ safety and maintaining their mobility, depends largely upon older drivers’ awareness of the declines in their driving abilities. Therefore, interventions targeted at increasing older drivers’ safety should aim to enhance their awareness of their physical, sensory and cognitive limitations. Moreover, previous research suggests that driving behaviour change may occur through stages and that interventions and feedback may be perceived differently at each stage. 2. Study aims To further understand the process of driving self-regulation among older adults by exploring their perceptions and experiences of self-regulation, using the PAPM as a framework. To investigate the possible impact of feedback on their driving on their decision making process. 3. Methodology Research tool: Qualitative focus groups (n=5 sessions) Recruitment: Posters, media, newspaper advertisement and s Inclusion criteria: Aged 70 or more, English-speaking, current drivers Participants: Convenience sample of 27 men and women aged 74 to 90 in the Sunshine Coast and Brisbane city, Queensland, Australia 4. Analysis Thematic analysis was conducted following the process outlined by Braun and Clarke (2006) to identify, analyse and report themes within the data. Four main themes were identified. Overview of the four main themes and the usability of the PAPM “I don't drive at night-time if I can avoid it. If I'm down to see my family, I always try and get home before dark “If I had to give up driving, I’d be lost. I’d have to ride on taxis and I think the bus service is every hour at least” Importance of driving Driving was viewed as important by participants as it impacted on their well-being and quality of life Feedback Participants were open towards receiving feedback. For the majority of participants, feedback had to come from someone they trust and respect. The majority of participants thought that they would listen to their physician. Limitations with the current feedback they are receiving and possible solutions were identified throughout the discussion. “I find that I tend to plan my journeys ahead a little bit more ” “It is very important to me, and I think for most older people, it is part of their independence ” People pay more attention to professional people rather than...it's tough for you, you know……… It carries more weight. They've got the evidence. They'll say, well, you tick some of the boxes, but you don't tick some of the others “It’s very hard for a doctor to say if somebody has a heart attack they should not drive. There is a lot of people driving around that’s got pacemakers and they have got no trouble driving” Changes in driving pattern Participants reported reducing their driving for a variety of reasons (e.g. retirement, relocation, mere preference). Some participants also noted that they plan their trips quite often now, avoid night-time driving, and being more cautious. The planning process Stopping driving is an emotional and difficult decision. participants drew their expectations from other older drivers’ experiences. Few indicated that they are not planning to renew their licence in the near future, mainly due to medical illness. Few participants indicated that they made some major changes in their lifestyle that would facilitate their transition to a non-driving state one day. However, the majority have not thought about the future of their driving. Several barriers and facilitators towards giving up driving have been identified throughout the discussion (e.g. household composition, alternative transport options, relocation closer to common destinations, etc.). “I hope by the time I can’t drive, I will be dead or I will be making my plan to go somewhere where I don’t drive ” “I can't predict what I'm going to be doing in 10 years' time, because partly…..the technology will change. Partly, I don't know how I'm going to feel” Conceptualizing older adults’ driving behaviour within the stages of PAPM The unengaged Aware that age-related declines can have an impact on people’s driving ability and that older drivers adapt by restricting and reducing the amount of their driving. Confident about their driving and did not feel the need to change their driving or seek feedback regarding their driving ability. Do not think about the future of their driving and view alternative transport negatively The unengaged Aware that age-related declines can have an impact on people’s driving ability and that older drivers adapt by restricting and reducing the amount of their driving. Confident about their driving and did not feel the need to change their driving or seek feedback regarding their driving ability. Do not think about the future of their driving and view alternative transport negatively “As far as our own abilities are concerned, I don't think...there has been a lot of change in the last 20 years, for me” The undecided Aware of changes in their own driving ability. Start to think about the future of their driving. Driving is still key to their independence, however, some are starting to consider alternative options such as relying on their partner. The undecided Aware of changes in their own driving ability. Start to think about the future of their driving. Driving is still key to their independence, however, some are starting to consider alternative options such as relying on their partner. “I think in another three years or four I won’t be driving a lot, because I’m getting too old” “If I lose my license, I’ve lost my independence. I’ve gotta get on a bus, but I mean I’ve got “refers to his partner” anyway so she can drive and she’s a good driver” “I think in another three years or four I won’t be driving a lot, because I’m getting too old” “If I lose my license, I’ve lost my independence. I’ve gotta get on a bus, but I mean I’ve got “refers to his partner” anyway so she can drive and she’s a good driver” “I've recently moved into a retirement village, and I've been very careful to choose one where there's a very good bus service there” “I probably won't renew my license next year.. The doctor says it's up to you, but my recommendation is, when your license is due next year, forget it” “I've recently moved into a retirement village, and I've been very careful to choose one where there's a very good bus service there” “I probably won't renew my license next year.. The doctor says it's up to you, but my recommendation is, when your license is due next year, forget it” The planner Recognise the need to monitor their own abilities and regulate their driving accordingly. Have made life goal changes to facilitate giving up driving in the future. Have sought feedback, mostly from health professionals Positive attitude towards the use of alternative transport options. The planner Recognise the need to monitor their own abilities and regulate their driving accordingly. Have made life goal changes to facilitate giving up driving in the future. Have sought feedback, mostly from health professionals Positive attitude towards the use of alternative transport options. “I think I've changed my driving. Since I got these (his glasses), I don't drive anywhere near as much in the night-time….. Yeah, where it never used to worry me” The regulator Started to restrict their driving to avoid certain challenging situations in response to changes in their driving abilities. The regulator Started to restrict their driving to avoid certain challenging situations in response to changes in their driving abilities. Conclusion Building upon previous research and the findings of the current study, we have developed an initial model of driving self-regulation among older drivers. The information gathered from the focus groups will inform the development of a survey instrument to further examine the applicability of understanding older drivers’ behaviour within the proposed PAPM. (A paper reporting this research is currently under review) Stage 2 unengaged Stage 2 unengaged Stage 3 undecided Stage 3 undecided Perceived changes in driving abilities Interpersonal factor Feedback Intrapersonal factors Knowledge and attitude about older drivers' safety issues Health literacy Crash history (recency, severity, and perceived crash responsibility) Interpersonal factor Feedback Intrapersonal factors Knowledge and attitude about older drivers' safety issues Health literacy Crash history (recency, severity, and perceived crash responsibility) Capacity to drive safely Stage 5 Decided to act Self-monitoring Stage 5 Decided to act Self-monitoring Stages 6 and 7 Self-regulation/cessation of driving Stages 6 and 7 Self-regulation/cessation of driving Interpersonal factor Feedback Social norm Intrapersonal factors Perceived likelihood to crash Perceived precaution effectiveness Barriers and benefits of adopting self-regulation Importance of driving Levels of driving comfort/confidence Interpersonal factor Feedback Social norm Intrapersonal factors Perceived likelihood to crash Perceived precaution effectiveness Barriers and benefits of adopting self-regulation Importance of driving Levels of driving comfort/confidence Feedback Alternative transportation options (availability, cost, accessibility, safety, and convenience) Household composition Social support In-vehicle technology Feedback Alternative transportation options (availability, cost, accessibility, safety, and convenience) Household composition Social support In-vehicle technology Cognition Physical Sensory