Abstract
OBJECTIVES: Motor vehicle crashes (MVCs) are a leading cause of death for Canadian Aboriginal peoples; developing effective interventions should be a public health priority. While intervention research has been conducted outside of Canada, few formal program evaluations have been conducted in Canada. We reviewed Canadian and non-Canadian Indigenous road safety initiatives to inform future program development in Canada.
METHODS: A systematic review of the published and grey literature examining MVC intervention programs in Indigenous communities was performed. Studies published after 1980 reporting pre-post comparisons of MVC interventions in Indigenous communities were included in the review. These studies were assessed using a modified Participatory Action Research quality assessment tool. Haddon’s Matrix of injury epidemiology and prevention was used to categorize crash-related risk factors targeted in the MVC interventions.
SYNTHESIS: A total of 11 studies met inclusion criteria, including 1 Canadian study and 10 non-Canadian studies. Successful intervention components included focus groups, training community members, educational activities, distribution of safety devices, collaboration with local law officials to enhance enforcement, driver-licensing courses, and incentive programs. Potential barriers to successful implementation and evaluation involved lack of incorporation of cultural and contextual factors, enforcement factors, and methodological limitations.
CONCLUSION: Several effective strategies to reduce MVCs can be adapted and implemented at the community and national levels. Future directions might include using multiple intervention components and incorporating a collaborative, culturally and contextually appropriate approach, while promoting evaluation initiatives and widespread dissemination of findings.
Key Words: Review, indigenous population, traffic accidents, accident prevention, Canada
Résumé
OBJECTIFS : Les accidents d’automobile sont l’une des principales causes de mortalité pour les Autochtones du Canada; élaborer des interventions efficaces devrait donc être une priorité pour la santé publique. On effectue de la recherche d’intervention hors du Canada, mais on mène peu d’évaluations formelles des programmes canadiens. Nous avons examiné des initiatives canadiennes et non canadiennes de sécurité routière indigène afin d’éclairer l’élaboration future de programmes au Canada.
MÉTHODE: Nous avons mené une revue systématique de la littérature publiée et de la littérature grise portant sur les programmes de prévention des accidents d’automobile dans les communautés indigènes. Nous avons inclus dans cette revue les études publiées après 1980 établissant des comparaisons pré/post des interventions portant sur les accidents d’automobile dans les communautés indigènes. Ces études ont été évaluées à l’aide d’un outil modifié d’évaluation de la qualité de la recherche-action. La matrice de Haddon appliquée à l’épidémiologie et à la prévention des blessures a servi à catégoriser les facteurs de risque d’accident ciblés par les interventions portant sur les accidents d’automobile.
SYNTHÈSE: En tout, 11 études ont répondu à nos critères d’inclusion, dont une étude canadienne et 10 études non canadiennes. Les éléments des interventions fructueuses étaient les groupes de discussion, la formation des membres de la communauté, les activités éducatives, la distribution de dispositifs de sécurité, la collaboration avec les agents locaux de la force publique pour améliorer l’application de la loi, les cours d’obtention du permis de conduire et les programmes d’incitation. Les obstacles possibles à la mise en oeuvre fructueuse et à l’évaluation étaient le manque d’intégration des facteurs culturels et contextuels, les facteurs d’application de la loi et les contraintes méthodologiques.
CONCLUSION: Plusieurs stratégies de réduction des accidents d’automobile efficaces peuvent être adaptées et mises en oeuvre à l’échelle communautaire et nationale. Les orientations futures peuvent inclure l’utilisation d’outils d’intervention multiples et l’intégration d’une approche concertée, appropriée sur les plans culturel et contextuel, tout en favorisant les initiatives d’évaluation et la diffusion généralisée des constatations.
Mots Clés: revue de la littérature, population d’origine amérindienne, accidents de la circulation, prévention des accidents, Canada
Footnotes
Acknowledgements: This project was funded through a Summer Internship Grant in Injury Prevention from the Ontario Neurotrauma Foundation.
Conflict of Interest: None to declare.
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