Research Proposal 371l71

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Research Proposal Research Methods International Health BSc

Sally Price January 2006

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Research Proposal Summary of full proposal This research project is entitled ‘Safe pedestrian practices: the perception of children in Sri Lanka’. Road traffic accidents are one of leading causes of death amongst child pedestrians in low-income countries. Despite this, little research has been done into effective interventions to reduce child mortality in these countries. This study aims to provide original and useful data from Colombo, Sri Lanka which will help in the development of new or existing road safety interventions and education, particularly in relation to child knowledge and perception. The method of research involves recruiting school children aged 8-9 years from the Holy Family Convent and St. Peter’s College schools situated on Galle road, Colombo. These schools have been selected as they have similar location, one being a girls school, the other a boys school. The first part of the study involves a draw and write technique where the children will be asked to draw a picture of themselves crossing Galle road, the main road by their school. They will then be given a piece of paper with the instruction ‘tell me what you have drawn and why’. Six children from each class will be then purposively selected to take part in a focus group. Content analysis will be used when analysing this section of the results. Finally I will carry out a two day observation of child pedestrian behaviour on Galle road. Behaviour of the children will be compared using the UK’s Green Cross Code. It is estimated that the research will take approximately four weeks to complete. This includes, recruiting and gaining consent from the participants, carrying out the draw and write activity, completing two focus groups and carrying out the observational study. The estimated cost of this research £1163.

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020-023-678 Background Road Traffic Accidents (RTAs) are one of the leading causes of morbidity and mortality worldwide with 86% of deaths occurring in low- and middle-income countries despite ing for only 40% of motor vehicles1. RTAs are the overriding cause of child injuries killing approximately 180 000 children under 15 each year. Children are rarely the cause of road traffic accidents but suffer as pedestrians, cyclists and engers2. Lack of research in low-income countries has meant a slow introduction of effective intervention strategies to reduce the mortality rates. Many factors are able for the high RTA rates in low-income countries including impaired driving, lack of enforcement and vehicle type. However the most significant differences found in low-income countries are the wide variation in road vehicles and the high number of vulnerable road s. The mixture of road s including pedestrians, bicycles, handcarts, mopeds, rickshaws, motorcycles, vans, cars, trucks and buses means that schemes to combat this problem have not been required in the same extent in high-income countries and therefore local research is needed3. Child pedestrians for a large proportion of vulnerable road s. The high number of pedestrian and cyclist casualties in these countries reflects not only their inherent vulnerability but also insufficient attention to their needs in policymakingError: Reference source not found. A study in Pakistan observed 250 pedestrians in the top 10 risk areas for pedestrian RTAs in Karachi. They observed walking and crossing the road and walking on the pavement. Only 60% of the pedestrians looked left and right before crossing. 52% crossed the street less than 2 seconds before a vehicle ed the point they had just crossed. 35% caused the traffic to swerve to avoid the observed pedestrian. Of the 250 pedestrians observed walking on the street edge, 82% had a pavement available to them but were not using it4. Of the pedestrians using pavements 28% encountered an encroachment and 84% of these stepped on to the street to avoid it. Among those who were observed stepping on the road from the sidewalk, 66% did not look out for oncoming trafficError: Reference source not found. Possible study limitations were that only pedestrian behaviour was studied, not actual accidents and the study sites were the top ten risk sites for RTAs in Karachi so may not be transferable to other situations. The advantage of this data is that it was carried out in a low-income country which means the findings can be drawn on for other settings. Policy changes such as restricting the amount of pavement space being used by stalls or shops and publicity to highlight the danger of such behaviour along with the important of observation when crossing roads may make a large difference to fatality rates. Risk perception has been widely studied as a risk factor for injuries however literature relating to child pedestrian safety is seriously lacking. Zeedyk et al5 carried out research on children who had been taught a programme of road safety. They carried out two studies, both focussing on the skill of finding a safe place to cross the road. Firstly they tested the effect of the programme in improving knowledge and secondly whether the children transferred their knowledge to change their behaviour in a traffic environment. Initial results encouragingly showed that the interventions were

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020-023-678 effective in increasing the children’s knowledge of safe and dangerous places to cross roads and that this information was retained for six months. The second study however showed that this knowledge did not influence behaviour and that those children who had received knowledge on safety when crossing roads behaved no differently from those children who had receive no information whatsoever. That is the children were not applying the knowledge they had displayed during pretestingError: Reference source not found. The study’s main limitation is that it does not allow any further information on why the children didn’t apply their knowledge in the real situation, only that they didn’t. Research in Australia6 into the parental risk perceptions of childhood pedestrian road safety found that cultural risk factors significantly affected risk perception and safety behaviour. The results showed that Chinese and Arabic speaking parents perceived the road environment to be significantly less risky to their children than parents from the other two language groups. One significant limitation of this study is that assumptions were made that the language spoken by an individual was closely linked to their cultural make-up. Since the main finding was the differences between perceptions from different cultural groups it seems important that this factor is reliable. Despite this, this study reinforces the need for local research from which local interventions can be implemented. As described there is very little research on road safety in low-income countries, particularly regarding the safety of child pedestrians. Intervention strategies to help reduce child pedestrian mortality can only be implemented if the factors underlying the increasing rates are established. It is hoped this study will help to describe the behaviour and perceptions of children in a named area in Sri Lanka regarding safe pedestrian practice. The study will help build on existing knowledge of child pedestrian safety but provide an original and detailed description of the behaviour and perceptions of Sri Lankan children in a defined area. The data produced from this study will identify the knowledge and behaviour of child pedestrians, what they perceive to be safe practices and why they think this. This study anticipates highlighting the importance of child perception in safety behaviours. Child perceptions should be taken into when considering the design of safety education programmes and road safety interventions.

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020-023-678 Research Question The background literature shows a clear gap in research into the behaviour, knowledge and perceptions of child pedestrians in low-income countries. The research question for this study is: Child pedestrian fatalities: the ability of child perceptions in Sri Lanka The aim of this study is to discover the perceptions children in Sri Lanka have regarding road safety and specifically related to their own safety as pedestrians which may influence their risk of being involved in a RTA. The results of this study will enable a greater understanding of how a defined group of children in Colombo, Sri Lanka use the local roads, what they know about road safety, how they perceive it and therefore whether they generally behave in accordance to their knowledge and perceptions. This was discussed above by Zeedyk et alError: Reference source not found who found the knowledge of the children in their study did not affect their behaviour. The objectives of this study are to: - Observe and record the road behaviour of children in the local area - Identify what the children know about pedestrian safety - Discover whether the children know why certain practices are safe - Make comparisons between what the children know about road safety and say they are aware of and how they behave in the real situation Detailed Research Proposal pedestrian injury Children are particularly vulnerable to pedestrian death because they are exposed to traffic threats that exceed their cognitive, developmental, behavioral, physical and sensory abilities. This is exacerbated by the fact that parents overestimate their children’s pedestrian skills. Children are impulsive and have difficulty judging speed, spatial relations, and distance. Auditory and visual acuity, depth perception and proper scanning ability develop gradually and do not fully mature until at least age 10. Method RTA death rates in Sri Lanka totalled 11 per 100 000 population in 19957 with pedestrian accidents ing for 45% of the total fatal accidents, one of the highest rates in Asia8. The research will be carried out among children in Sri Lanka. The selected site is Galle Road, Colombo which is the main road from Colombo to Galle along the west coast of Sri Lanka and is the location of a number of schools. The assumption will be made that the majority of child pedestrians walking alongside and crossing that particular road are from one of the local schools. The study population will be girls and boys aged 5-15 years old attending schools in Colombo, Sri Lanka. Research shows RTAs predominantly affect those under the age of 15 9. Schools in Sri Lanka are commonly single sex which means children will be

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020-023-678 selected from 2 schools, St Peter’s College, a boys’ school and Holy Family Convent, a girls’ school. Worldwide, boys are more likely to be affected by RTAs than girls so studying boys and girls may highlight important differences which could for such a difference between them10 11. I was unable to find any research indicating which children are most at risk of RTAs only that those under 15 are an increased risk compared to the rest of the population. Research from Canada suggests children aged 6-9 years are most at risk and in a survey on children’s road safety practice several countries including the UK, New Zealand and the US identified those under 10 as most at risk12. Research such as this in low income countries is scarce. Consequently I have decided to select the age groups 7-8 and 9-10 years as my sample. The methods being used in this study have been deemed inappropriate for children under 6 to carry out. Two classes of children, aged 7-8 and 9-10 from each of the schools mentioned year group will be studied, giving a total of 4 classes. Variations in ages might allow for difference in safety knowledge due to age to be identified. For example if the younger children perceive a certain dangerous practice to be safe and the same results are found in the older children this may indicate a problem with safety education or local road dangers rather than naivety due to age. This study uses triangulation, a combination of methodologiesError: Reference source not found. Spend a day in the class with the children before holding research session? The first part of the research will involve a draw and write technique. Each child will receive a plain piece of paper on which they will be asked to draw a picture of themselves crossing Galle Road. The children will be given very little direction besides this to allow and allowed around 20 minutes to give them the freedom to depict what they wish. Each of the children will then receive a piece of paper on with the question ‘Tell me about what you have drawn and why’. It is hoped this general question will give further clarity on their drawings. Focus groups will be used for the second part of this study. They allow more discussion with the children which will hopefully provide more detail regarding their perspectives on pedestrian safety. Six children from each of the studied classes will be purposively sampled for the focus groups, so there will be 4 focus groups in total. Following the day spend in the class and the previous section of the research I will be able to select those children whom I feel are most at ease in my present and whose trust I have gained. In other words the children will be purposefully sampled which selects information-rich cases, from which you can learn a great deal about issues of central importance to the purpose of the research, for study in depth13. This should allow for productive focus groups. There is also evidence which shows that children are often better interviewed in groups for several reasons including: they know and are comfortable talking to other children, they can help keep each other on track and truthful and it allows children more room to set the level and content of the discussion which highlights what issues are important to those children at that time.14

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020-023-678 It will be important to emphasis that there are no correct answers in this session and will be a general discussion amongst the children regarding their safety as pedestrians. The session will be about discovering what knowledge the children have being safe when crossing roads and their general perceptions of road safety. The focus group will be fairly unstructured but will focus on the following areas:   

Knowledge of being safe on the roads Whether they feel safe when walking and crossing roads How they perceive other children walking and crossing roads

The research will finish with an observational study on Galle road. Over a 2 day period the behaviour of child pedestrians aged 5-11 crossing this main road will be monitored using recording tables and a video camera. Recordings will take place on 2 weekdays from 7-3 to coincide with school hours. ‘Observational studies describe the setting observed, the activities taking place, the people who participated in those activities and the meaning of what was observed from the perspective of those observed.’Error: Reference source not found This study may require an element of covert observation to reduce bias and for ethical and moral reasons. This is because people may well behave different when they know they are being observed to how they would behave if they were not aware of being observed.Error: Reference source not found The main observations made will be based on the UK Green Cross Code15: 1. Think First - find the safest place to cross 2. Stop – stand on the pavement near the curb 3. Use your eyes and ears - look all around for traffic and listen 4. Wait until it’s safe to cross - if traffic is coming let it 5. Look and Listen - when it's safe, walk straight across the road 6. Arrive Alive - keep looking and listening for traffic while you cross It will also be noted whether the child is alone or accompanied, be it by an adult or other children. Analysis The separate parts of the study will be analysed individually. The initial observation study of behaviour of the road is more for descriptive purposes. Data will be recorded into a series of groups depending on the actions of the children. The data will be presented in a mixture of tables and charts depending on the outcome of the results. The activity section of the study including the children annotating pictures according to what they feel are safe and dangerous parts of a particular road will be analysed in a similar way. The data will be grouped depending on what they identify on the pictures. Conclusions will be drawn from these pictures regarding the perceptions of the children, relating to their age, sex and any of relevant features.

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020-023-678 The focus group data will be analysed using content analysis. This involves transcription of the interview from the Dictaphone onto paper and themes from the discussion being drawn out. It is hoped that the result analysis from this research will be useful in producing effective road safety interventions specifically aimed at child pedestrians in this area of Sri Lanka. Limitations The main limitation to the study is the 4 week time restriction. This greatly affects the method and analysis of the study. Consequently only a small study sample can be used and only a small range of ages. The quantative data recorded can only be used descriptively and not generalised for use in other settings. As a government-run school is the site where the study sample is taken from the results may be biased regarding the safety knowledge of the children. For example the school may have regular road safety education classes or alternatively have never been taught any road safety. The only effect of this is that the results cannot be generalised however they can be effectively used to target intervention strategies for the local community. Interventions such as changes to the road, traffic signs, road crossings or education campaigns aimed at the local school children, depending on what the results show. Other limitations include the age of the children recorded crossing the road will not be reliable. Although a descriptive study can be done it is not possible to tell the exact age of the children without asking them which would be virtually impossible to do on a main road with only one researcher present.

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020-023-678 Potential Risks Potential risks to the success of this study include: - Identifying an appropriate place where there is a main road near to a local school. - Recruiting the participants as it requires informed consent both from the parents and teacher as well as co-operation from the children. - Communicating with the children – although English is widely spoken in Sri Lanka it cannot be assumed that all the children will have a good grasp of English and therefore a translator will be required. - Time restrictions. Although I have timetabled the research in fit within a 4 week period in reality this is not always accurate so completing the project in the allotted time may cause problems. - Analysing the results may be difficult as I have no idea what the results may or may not show - I have never been to Sri Lanka previously and therefore I may find problems I cannot anticipate. Personnel I still need to make with a school where my research can be carried out. This will require a local in Sri Lanka. English is spoken in Sri Lanka and taught in schools as a foreign language however I cannot assume that the teacher or children, particularly of young ages, will have good enough English for the research to be carried out effectively, especially not within the focus groups. This will therefore require the use of a translator who is fluent in both English and Sinhalese can communicate between myself and the children and assist in discussion of the focus group and the translation and transcription following it. Plan for dissemination of results to relevant groups The research project will be made available to those groups of people who would find a use for the results which would hopefully help improve road safety for those very children who participant in the study. This could possibly include parents, teachers, governors, local authorities and the government. The completed study can be emailed or posted to the relevant bodies. The outcomes of the research may have positive and negative effects. On one hand it may uncover details regarding the current road safety education which might not be favourably but on the other hand it may provide a good basis to produce new and original interventions, not previously trialled, which may benefit the safety of the local child pedestrians.

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Timetable for research

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020-023-678 Budget Below is an estimate of the full cost of this research project. Prices are based on averages obtained from a range of sources and previous experiences. Salaries The only salary to be paid in this research is the cost of a translator, firstly to help communications in the run up to the research but particularly during the focus groups and then translating the information into English before I transcribe it onto paper. Average cost of a translator = (still unknown) Travel Costs including allowances Approximate cost of flights from England to Colombo, Sri Lanka = £500 Approximate cost of accommodation in Sri Lanka for 4 weeks = £260 Approximate living costs (travel, food etc) for 4 weeks = £200 Capital Equipment A Dictaphone will be needed for this research. The cheapest priced including tapes was £80. I will possibly use a video camera to recorded child pedestrian behaviour on a road however I already have access to one so this will incur no direct costs. Consumables – paper/phone/fax/email I have estimated the maximum cost of paper for the activities, recording and production of a bound report including use of a computer and Internet access whilst in Sri Lanka will be around £80. Overheads There are no known overheads. Total The approximate cost of this research project, lasting 4 weeks is around £1100 (not including the use of a translator) Ethical Issues The main ethical issues in this research project s that the study participants are children. Informed consent needs to be given for participants to take part however children are unable to do this themselves. It is therefore the responsibility of the parent/guardian/teacher to do this on their behalf. The children will however have the opportunity to opt out of the study if they wish to do so. See the attached ethics committee application form.

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References

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McIlvenny S, Al Mahrouqi F, Al Busaidi T, Al Nabhani A, Al Hikmani F, Al Kharousi Z, Al Mammari S, Al Hoti A, Al Shihi A, Al Lawati A, Al Kharousi I. Rear seatbelt use as an indicator of safe road behaviour in a rapidly developing country. The Journal of the Royal Society for the Promotion of Health. 2004; 124(6):280-283. 1

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WHO. www.who.int/entity/ceh/publications/12childinjury.pdf. Accessed 05/01/06

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WHO. World Report on Road Traffic Injury Prevention. Chapter 3 Risk Factors; 2004.

Khan F.M, Jawaid M, Chotani H, Luby S. Pedestrian environment and behaviour in Karachi, Pakistan. Accident, Analysis and Prevention. 1999; 31:335-339. 4

Zeedyk M.S, Wallace L, Carcary B, Jones K, Larter K. Child and road safety: Increasing knowledge does not improve behaviour. British Journal of Education Psychology. 2001; 71:573-594. 5

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Lam L.T. Parental risk perceptions of childhood pedestrian road safety: A cross cultural comparison. Journal of Safety Research. 2005; 36:181-7 Jacobs G, Aeron-Thomas A, Astrop A. Estimating Global Road Fatalities. Transport Research Laboratory. TRL Report 445. 2000. http://www.transportlinks.org/transport_links/filearea/publications/1_329_TRL445.pdf Accessed on 10/01/06. 7

Asian Development Bank. Vulnerable Road s in the Asian and Pacific Region. http://www.adb.org/Documents/Books/Road-Safety-Guidelines/vulnerable-road-s.pdf Accessed on 5/01/06. 8

Qureshi A.F, Bose A, Anjum Q. Road Traffic Injuries: A new agenda for child health. Road Traffic Injuries. JSP. 2004; 14(12):719-721. 9

National SAFE KIDS Campaign (NSKC). Pedestrian Injury Fact Sheet. Washington (DC): NSKC, 2004. 10

WHO. World Report on Road Traffic Injury Prevention. Chapter 2 The global impact. 2004. http://www.who.int/world-health-day/2004/infomaterials/world_report/en/index.html Accessed on 01/02/06. 11

Christie N, Towner E, Cairns S, Ward H. Children’s road traffic safety: An international survey of policy and practice. Department for Transport. Road Safety research report no 47. 2004. 12

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Patton M.Q. Qualitative Evaluation and Research Methods. Second Edition. Sage Publications. 1990.

Hatch J.A. Qualitative research in early childhood settings. Praeger. 1995. Department for Transport. Arrive Alive. The Green Cross Code. http://www.thinkroadsafety.gov.uk/arrivealive/greencross.htm Accessed on 3/02/06. 14 15