https://doi.org/10.33698/NRF0201 Suresh K. Sharma, Raj Kumar, Parul Saini, Rajnish Arora
Abstract : Road safety is a major concern in young individuals in India as well as other developed and developing countries. Implementations of new road safety regulations and laws would not be able to reduce the number of deaths. Using stratified random sampling, 150 students (Medical: 100; Nursing: 50) of AIIMS, Rishikesh were recruited to determine the knowledge, attitudes and practices regarding road traffic safety regulations. Data were collected by using a structured knowledge questionnaire, attitude and practice scale. Data reveals that majority of them drive two wheelers (84%) and only 3.3% of them had learned driving training from driving school. Furthermore, only 38.7% owe the driving license and 20% of them had history of road traffic accident. Moreover, only 18.7% had adequate level of knowledge about road traffic safety and regulations. In terms of attitude, 62.0% students were strongly agree for the fact that driving license should made mandatory to drive a motor vehicle and use of alcohol should be strictly prohibited while driving (57.3%). Fortunately, 78.7 % students use indicators while taking a turn, 77.3% blow horn while overtaking, 85.3% do not prefer alcohol and 66.7% always obey all traffic signals. Furthermore, almost one third of them endanger their lives by not using helmets (36%), not wears seatbelt (34%) while driving/seating in car and sometimes using mobile while driving (32.7%). Study recommended a sensitization program to improve the knowledge, attitude and practice of Road Traffic Safety Regulations to reduce the incidence of road traffic accidents and make driving safe and pleasant.
Keywords
Road safety, knowledge, attitude, road traffic accident, practices
Correspondence at
Prof. Suresh K. Sharma Principal, College of Nursing, AIIMS, Rishikesh, Uttarakhand
Introduction
Every year the lives of almost 1.24 million people are cut short globally as a result of a road traffic accident. Around 20- 50 million more people suffer from non fatal injuries. According to World Health Organization (WHO), road traffic accidents kill more people around the world than malaria, and are the leading cause of death for young people aged between 15-29 years old, especially in developing countries 1. The primary reason for the road accidents is increasing motorization, along with this contributing factors are over speed, poor following of traffic rules, driving while drinking, not wearing seat belts and helmets, using mobile phones while driving and poor road designs. In 2010, there were close to 5 lakh road accidents in India, resulting in more than 1.3 lakh deaths and inflicted injuries on 5.2 lakh persons. These translate into one road accident per minute and one road death every 4 minutes. Unfortunately, more than half the victims were in economically active age group. The loss of main bread winner can be catastrophic.2,3
According to a report on accidental deaths in India ‘Road Accidents’ cases in the country have marginally increased by 0.7% during 2013 compared to 2012 while casualties in road accidents in the country decreased by 1.2% during 2013 as compared to 2012. It has also been observed that the rate of deaths per thousand vehicles has decreased marginally from 1.4 in 2009 to 0.9 in 2013, as the number of vehicles in the country has increased by 78.0% and the quantum of ‘Road Accidents’ has increased by 5.1% during the same period4.
In the state of Uttrakhand, 10.8 persons are killed per 10000 motor vehicles which is the very close to national average of 10.9 and during the year 2010, there were 773 fatal accidents causing 931 deaths and injured 1656 persons. The state’s capital Dehradun tops the list of persons injured in accidents followed by Haridwar, Udham Singh Nagar, Tehri and Chamoli. Hence we realized the need to assess the knowledge, attitude and practices of health sciences students regarding road traffic safety regulations in Uttarakhand.
Materials and methods
A descriptive cross sectional study was conducted among the Medical and Nursing students of All India Institute of Medical Sciences, Rishikesh, Uttarakhand. A sample of 150 i.e. medical (100) and nursing (50) students was drawn using stratified random sampling technique. Data was collected through a structured questionnaire, which was distributed randomly among the students of medical and nursing programs. The questionnaire was having the following four parts Socio-demographic profile sheet- It consisted of personal information of students i.e. age, gender, course of study, parents’ monthly income and place of residence etc.
Structured knowledge questionnaire: – The structured knowledge questionnaire consisted of driving and road traffic safety related information followed by items related to knowledge about road safety regulations. It consisted of 15 items and all items were scored dichotomous (Yes/No), indicative of the right and wrong answer to particular item. Furthermore, the total scores of the knowledge questionnaire was averaged and categorized using interquartile range into three categories: Inadequate (<50%), Moderate (50-75%) and adequate knowledge (>75%) score. The validity of the questionnaire was established with the help of experts in the field of nursing, and medical.
Attitude scale: – Attitude scale consists of 8 statements regarding attitude towards road safety and regulations. It is four point scale ranging from strongly agree (4), followed by agree (3), disagree (2) and least was given to strongly disagree (1). Reverse scoring concept was followed for negative attitude items.
Practice scale:- The expressed practice scale consists of 12 statements related to driving rules, driving speed limits and others driving related norms. Items were rated on a 3 point Liket scale ranging from always (2), sometimes (1) to never (0). The practice scale was found adequate to use in terms of validity for the study.
The study was approved by Institutional Ethical Committee and confidentiality of information and anonymity of subjects was assured during and after the data collection. The data was collected after obtaining the verbal consent of the subjects. Data was analyzed using SPSS version 16 and analyzed by using descriptive statistics.
Results
Table 1 depicts socio-demographic profile of the students. Findings revealed that around 61.1% of the students were in the age group of 19 years and older (Mean±SD=18.84±1.004) and nearly equal number of them were males (52.7%) and females (47.3%).In addition, majority (75.3%) of them were either rural or suburban dwellers. Two third (61.3%) of them verbalized that their parents’ monthly income is in between 10,001 – 50,000 per month (Table 1).
Data in table 2 depicts that 61.3% of students did not owe a driving license, but still they drive two wheelers (84%) and four wheelers (16%). Moreover, only 3.3% of them learned driving from a formal driving school, rest of them (96.7%) learned it from family members/ friends. Furthermore, 20% of students verbalized the history of road traffic accident and in addition, 62% of them also mentioned the history of road traffic accident among their family members/ friends.
Table 1: Socio-demographic characteristics of the students
N=150
| Socio-demographic characteristics | f (%) |
| Age in years | |
| <18 | 58 (38.9) |
| ³19 | 91 (61.1) |
| Gender | |
| Male | 79 (52.7) |
| Female | 71 (47.3) |
| Course of Study | |
| Medical | 100 (66.7) |
| Nursing | 50 (33.3) |
| Parent’s monthly income in Rupees | |
| Don’t Know | 14 (09.3) |
| £10,000 | 16 (10.7) |
| 10,001 – 50,000 | 92 (61.3) |
| ³50,000 | 28 (18.7) |
| Place of residence | |
| Urban | 36 (24.0) |
| Rural | 72 (48.0) |
| Semi-urban | 41 (27.3) |
Note- Age =Mean± SD=18.84±1.004
Table 2: Driving and road traffic safety related information among students
|
N=150
Data in Table 3 shows that nearly one fourth of the students (23.3%) had inadequate, about half of them (58%) had moderate level and only few of them (18.7%) had adequate level knowledge about road traffic safety and regulations.
Table 3: Level of knowledge regarding road traffic safety
N=150
Table 4 depicts the knowledge of health sciences students regarding various road symbols and basic rules regulations to be followed for road safety. Findings revealed that around 64% students had knowledge regarding age of getting minor driving license and 94% students know the age of getting major driving license. Around 96.7% students know the significance of red light at signal and know about the symbols of ‘U’ turn prohibited (86.0%) in between the road. Similarly, around half of students (53.3%) had knowledge regarding sign of
|
no entry and 72.7% students know the Knowledge Mean ± SD=9.58±2.25 (range=4 – 14). Max Score =15.
main reason of road traffic accidents. Around equal number of students were aware about the sign of overtaking prohibited and no parking. However,
Table 4. Knowledge regarding road traffic safety
N=150
| Knowledge Items | No. of subject gave correct answers f (%) |
| Age to acquire minor driving license | 96 (64.0) |
| Age to acquire major driving license | 141(94.0) |
| Imprisonment period for motor vehicle accidents without license and ownership document | 39(26.0) |
| Fine for motor vehicle accident without license and ownership document | 56(37.3) |
| Highway speed limit in Uttarakhand | 20 (13.3) |
| Average city speed limit in Uttarakhand | 92 (61.3) |
| Most important reason for road traffic accident | 109 (72.7) |
| Number of person can ride on a two wheeler | 134 (89.3) |
| Symbol of ‘U’ turn prohibited | 129 (86.0) |
| Significance of red light | 145 (96.7) |
| Road sign of give way to other vehicles | 59 (39.3) |
| Road sign of no entry | 80 (53.3) |
| Road sign of overtaking prohibited | 107 (71.3) |
| Road sign of one way only | 117 (78.0) |
| Road sign of No parking | 112 (74.7) |
majority of (86.7%) students were not aware about the highway driving speed limit in Uttarakhand and duration of imprisonment period (74.0%) in case of driving without driving licence and ownership documents.
Table 5 depicts that a good number of students were strongly agree for the fact that driving license should made mandatory to drive a motor vehicle (62.0%) and use of alcohol should be strictly prohibited while driving (57.3%). 36.7% of students felt that
helmet wearing should be made forcibly mandatory to drive a two wheeler. In the same manner, 33.3% students found disagree for the fact that a driving license is not compulsory to drive a motor vehicle and 41.3% said that traffic rules are followed ideally for safety issues not due to fear of police and ‘challan’. In terms of road safety, 54.7% students got agreed that having road signs and symbols will help to reduce the accidents.
Table 5: Attitude towards road traffic safety among students
N=150
| Road Traffic Safety | Strongly agree f (%) | Agree f (%) | Disagree f (%) | Strongly Disagree f (%) |
| Owing a driving licence for driving a motor vehicle should be mandatory | 93(62.0) | 46(30.7) | 07(4.7) | 04(2.7) |
| Wearing a seat belt while driving a car is more disturbance than the benefit of safety | 61(40.7) | 67(44.7) | 13(8.7) | 09(6.0) |
| One should not drive a motor vehicle
after consuming alcoholic, even if person feels he/she can drive comfortably |
86(57.3) | 47(31.3) | 06(4.0) | 11(7.3) |
| Helmet wearing should not be made forcibly mandatory for driving two wheeler vehicles in the city | 55(36.7) | 52(34.7) | 25(16.7) | 18(12.0) |
| Various displayed road signs and symbols help to reduce accidents | 52(34.7) | 82(54.7) | 12(8.0) | 04(2.7) |
| It is not essential to carry valid driving licence and vehicle ownership and insurance while driving
the motor vehicle |
62(41.3) | 61(40.7) | 13(8.7) | 14(9.3) |
| Motor vehicle can be driven on road before acquiring the driving licence | 27(18.0) | 62(41.3) | 50(33.3) | 11(7.3) |
| Traffic rules are followed due to fear of penalties (challan) and traffic police | 09(6.0) | 34(22.7) | 62(41.3) | 45(30.0) |
Note-Attitude Mean ±SD =24.12±3.5; Range 8-32
Table 6 depict that a good number of students always practiced healthy road traffic safety regulation such as use indicators while taking turns (78.7%), blow horn before overtaking (77.3%), obey traffic signals, lights, signs (66.7%). However,
many of them endanger their life by never practicing very crucial road traffic safety regulations such as never wearing helmet (36%), seat belts (34%), stopping at zebra crossing (24.7%) and not following specified speed limits (10.7%).
Table 6 : Practices related to road traffic safety among students
N=150
| Road Traffic Safety Practices | Always f (%) | Sometimes f (%) | Never f (%) |
| Wear a seat belt when you are driving/ seating in a four wheeler. | 54 (36.0) | 45 (30.0) | 51 (34.0) |
| Keep specified speed limit in mind while driving. | 68 (43.0) | 66 (44.0) | 16 (10.7) |
| Use helmet when driving a two wheeler. | 41 (27.0) | 55 (36.7) | 54 (36.0) |
| Obey all traffic signals, lights and signs. | 100 (66.7) | 38 (25.3) | 12 (8.0) |
| Driving a vehicle when alcoholic. | — | 22 (14.7) | 128 (85.3) |
| Use mobile phone while driving a vehicle. | — | 49 (32.7) | 101 (67.3) |
| Stopping at zebra crossing while crossing a road. | 31 (20.7) | 82 (54.7) | 37 (24.7) |
| Use indicators while taking turns and look both sides before turning. | 118 (78.7) | 18 (12.0) | 14 (9.3) |
| Use right side of road while driving. | — | 44 (29.3) | 106 (77.7) |
| Overtake from left side. | 19 (12.7) | 75 (50.0) | 56 (37.3) |
| Blow horn before over take. | 116 (77.3) | 24 (16.0) | 10 (06.7) |
Discussion
Road traffic fatalities remain a major public health problem, with the highest fatality rates per 100000 populations in low and middle income countries in Asia. These countries have higher road traffic fatality rates (21.5 and 19.5 per 100000 population, respectively) than high-income countries (10.3 per 100000)1. WHO predicts that road traffic injuries will rise to become the fifth leading cause of death by 2030.1 Indian data shows that road traffic injuries account for
20-50% emergency admissions, 10-30% of hospital admissions, and 60-70% of people hospitalized with traumatic brain injuries5.
We had nearly equal number of male and female participants. The majority (73.9%) students were in the age group of 18-19 years, which is the most vulnerable group for road traffic accidents. Majority of our students were from middle class families, while few were having a monthly parental income less than 10000 rupees. This must be highlighted that persons from poor economic settings are disproportionately affected by road traffic injuries, even in high income countries. For instance a study in New South Wales, Australia6, found that children of relatively lower socioeconomic status were at highest risk of a road traffic injury. Another study to reductions of between 4-24% in the crashes involving young people18. 14.7% of our participants were indulging in drunken driving at times. Moreover, majority of our study participant were from age group between 18-19 years. This finding has been observed by others8,9. A study from Haryana from Bangalore7 had found that mortality reported that 18% Road traffic accident from road traffic injuries was 13.1 and 48.1 per 100000 in poorer socioeconomic groups of urban and rural populations respectively, compared to 7.8 & 26.1 among their more affluent urban and rural counterparts.
More than half (54.7%) of students in study admitted crossing the specified speed limits. Similar practices have been observed by another study from south India8, where 68% of students admitted about it. Many other Indian as well as International studies have shown similar observations9,10,11 An increase in average speed is directly related both to the likelihood of a crash occurring and to the severity of crash consequences12,13. A 5% increase in average speed leads to an approximately 10% increase in crashes that cause injuries, and a 20% increase in fatal crashes14. Pedestrians have a 90% chance of surviving a car crash at 30 km/h or below, but less than a 50% chance of surviving impacts of 45 km/h or above 14,15. The risk of involvement in a crash increases significantly above a blood alcohol concentration (BAC) of 0.04 g/dl16,17. Young or novice drivers are at a much increased risk of having a road traffic crash when under the influence of alcohol. Laws which establish lower BAC between zero and 0.02 g/dl for young/novice drivers can lead victims gave history of having consumed alcohol within 6 hours before RTA19. However the percentage of accident victims under influence of alcohol was reportedly lower in older studies from India (4.6- 8%)20,21 showing that incidence of drunken driving is increasing in India.
Only 27% of students in our study always wore a helmet while driving. Wearing a motorcycle helmet correctly can reduce the risk of death by almost 40% and the risk of severe injury by over 70%22. When motorcycle helmet laws are enforced effectively, helmet wearing rates can increase to over 90%23,24. 66% of participants in our study use a seat belt (36 % always use it, another 30% consented that they use it off and on), while 34% told that they never use. A study from another medical college from India has shown 74% participants wearing the seat belts2. Wearing a seat belt reduces the risk of a fatality among front seat passengers by 40-50%24-26 and fatalities of rear seat occupants by 25-75%25-28. Mandatory seat belt laws, their enforcement and appropriate public awareness campaigning have been shown to be very effective in increasing rate of wearing seat belts 25,29,30. 67% of study participants never use mobile phone while driving. Similar findings have been reported by Jogand S et al31.
A recent study on adolescent medical students from Maharashtra9 has found that knowledge about road traffic rules was good in 42.6%, average in 42.53%, and only 14% of students had poor knowledge. These findings are similar to our observations depicting that young student population is having an overall satisfactory knowledge but when it comes to actual use of this knowledge, many falter. In the above mentioned study, 80% do not use helmets, 68% do not have driving license and nearly two third do not always follow the traffic rules. Thus, it is clear that developing a positive attitude among adolescents students towards use of road safety regulations can play a major role in changing the behavior and practice of individual. This must be accompanied by strict implementation of traffic laws. We also recommend that the knowledge about traffic rules may be included in basic school curriculum, so that children have an idea about road safety from a very early age.
The present study assessed the knowledge, attitude and practice of health sciences students regarding road traffic safety regulations and found that students were having moderate level of knowledge. However, they had significant affirmative attitude towards obeying certain road safety regulations. Therefore, a safe road traffic system is a need of today’s adolescent generation to make them more responsible to understand the meaning of life. Every country has their own rules regulations for road safety, driving and its related offences. Significant progress in national road safety requires close collaboration between different countries, relevant leaders and agencies. Developing countries still have to work upon this issues and India is one of them. The young gun of India still require frequent sensitization programs and implementation of traffic rules to develop practices which are actually safe on the road. Road safety measures through signboards, posters and mass media need to be strengthened to reduce the incidence of road traffic accidents. We also recommend addition of road safety related rule regulations as a part of curriculum at school level.
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