keys knowledge enhances your safety clinical research unit department of ophthalmology university of...

KEYSKnowledge Enhances

Your SafetyClinical Research Unit

Department of OphthalmologyUniversity of Alabama at Birmingham

Beth Stalvey, MPH, PhD, CHES

Target: High-Risk Older Drivers

Crash Involved

Visually Impaired

Legally Licensed

High Driving Exposure

Curriculum

Delivery

One-on-One

Eye Care Clinic

Tailored to Individual

– Visual Function

– Driving Habits

Theory Based

1) Informational Component: Visual Function and Impact on Driving

Visual Acuity Contrast Sensitivity Depth Perception Peripheral Vision Visual Processing

Objective Assessment (Exam; Screening)

2) Skill-Building: Hazard Avoidance and Self-Regulation

NightRain

InterstateLeft-Turn

High-TrafficRush-Hour

Driving Alone

DayNo RainAccess Road3 Right-Turns; ArrowLess Traveled RoutesOff-Peak HoursDriving Companion

Driving Hazard Alternative Strategy

3) Confidence Building and Behavior Change

Vicarious Learning (Driving Scenes) Goal Setting (Signed Contract) Vicarious Experience (Testimonial) Self-Efficacy (Homework)

– Self-Assessment; Driving Diary

Booster– Skill Review; Verbal Reinforcement

Evaluation

Study Design

Baseline Assessment

RANDOM I ZED

Usual Eye Care Control

Comprehensive Eye

Exam

Post-Test Assessment 6, 12, 18, 24

months

EducationalIntervention

+ Usual Eye

Care

2 Sessions2 Sessions

Outcomes At six-month post-test, those who

participated in education session reported

significantly

– Greater level of perceived vision impairment and understanding of impact on driving

– Higher number of perceived benefits to self-regulation and hazard avoidance

– Greater readiness to make driving behavior change

Driving Exposure

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

Aver

age

Plac

es D

riven

per

Wee

k0.0

50.0

100.0

150.0

200.0

250.0

300.0

Ave

rage

Mile

age

per W

eek

Intervention

Usual Care

p=0.02 p=0.01

Intervention

Usual Care

300

250

200

150

100

50

0

7

6

5

4

3

2

1

0

Miles Per Week Places Per Week

Driving Exposure

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

Driv

ing

Avoi

danc

e Sc

ore

0.0

5.0

10.0

15.0

20.0

25.0

Self

Regu

latio

n Sc

ore

p<0.0001Intervention

Usual Care

p<0.0001

Intervention

Usual Care

Hazard Avoidance Self-Regulation

Crash Involvement

N

#

Crash

Rate per 100 Person-Years

Rate per 1,000,000 Person-Miles

Intervention 227 53

11.8448.4 py

RR 1.08 (0.71-1.64)

15.33,459,032 pm

RR 1.40 (0.92-2.12)

Usual Care

Only 176 38

11.1341.7 py

Reference

10.83,529,777 pm

Reference

Summary

Education Changes in knowledge and perceptions

Driver PerformanceReduction in driving exposureIncreased self-regulation

SafetySimilar crash rates

Crash Rate as Safety Outcome

Sufficient Power to evaluate Length of evaluation period Fault of driver

Knowledge

Self-Awareness

Motivation

Skill

Self-Regulation

Confidence

Safety?