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?