Table 1 Characteristic and results of qualitative studies on Road Traffic Injuries (RTIs) published between2000 to 2019 (N = 30)

Doohan and Saveman, 2014 [19]

Sweden

nonphysical consequences of a multifatality bus crash and the subsequent effect on the surviving passengers’ lives

survivors of a major bus crash (56)

NM

IDIs

Reacting to the crash

Feeling, thinking and helping others

Reacting to the emergency care

Encountering the Media

Receiving formal support

Processing the crash

Healing with social Support

Difficulties when sleeping

Everyday travelling

Seeking closure

Pashaei Sabet et al., 2016 [20]

Iran

experiences of encountering with physical trauma resulting from traffic accidents

participants had a record of upper and or lower extremity injuries caused by traffic accidents (NM)

CA

IDIs

experiencing some limitations

1. Limitations in daily activities

2. Dependency

disturbances in performing professional duties

–

family problems caused by trauma

–

Yadav and Shrestha, 2017 [21]

Nepal

experience of oral and maxillofacial trauma patients due to road traffic accident right from immediate after the accident till the end of definitive treatment

oral and maxillofacial trauma patients due to road traffic accident (20)

Phenomenology

IDIs

Franzen et al., 2006 [22]

Sweden

experiences of pre-hospital and hospital care and subsequent rehabilitation

people injured in a traffic environment (9)

NM

IDIs

Facing commotion

Feeling uncomfortable due to memory loss

Feeling embarrassed

Experiencing trust and security

Being the centre of attention

Having confidence in caregivers and relatives

Lacking security and support

Feeling worried and uncertain

Feeling neglected and disrespected

Feeling hindered

Struggling to return to everyday life

1. Longing for daily routines

2. Doubting the will to become healthy

3. Finding ways to cope with pain

Pashaei Sabet et al., 2014 [23]

Iran

understand the rehabilitation needs of patients with physical disabilities from road traffic accidents to return to the community

both genders and age ranged between 18 and 45 years old with at least 3 months physical disability in upper and lower limbs or spinal cord injury (12)

CA

IDIs

the need to be under the umbrella of support

Need for support by the care team

The need for social support

Tendency to spirituality

the need for continuity of care

Liberation in society

Caring knowledge search

achieving independence

–

Ghorashi et al., 2012 [24]

Iran

reasons of motorcycle accidents

motorcycle drivers in streets, injured motorcycle drivers in hospital and their families, old car drivers, traffic wardens and nurses (17)

CA

IDIs

motorcycle as entertainment tool

alcohol and drug abuse

racing

showing

environmental and technical factors

1. not adhere to laws

2. challenge with police

3. escaping of helmet

4. purchasing power

economic and cultural factors

ill-favored climate

Impaired motorcycle

neglecting motorcycles

Batool et al., 2012 [25]

Pakistan

road safety issues

government officials, academics and the general driving population (31)

NM

IDIs

Institutional Issues

Low valuation of road safety

Institutional Weaknesses

Execution Issues

Lack of human resources

Lack of timely implementation

Physical &Operational Issues

Increasing motorization and urbanization

Traffic mix on roads

Non-standardized driving practices

Poor public transport system

On-road encroachments and capacity issues

Out-dated traffic management

poor licensing and penalties system

Social injustice

Poor roads and vehicle maintenance standards

Attitudinal and behavioural issues

Characteristics of unsafe drivers

attitudinal and behavioural problems

Societal and cultural issues

Road safety research and accident data bank

Poor accident reporting and recording system

Absence of comprehensive data bank

Inaccessible and inadequate dissemination of research work

Reliance on old research work

Christie et al., 2007 [26]

UK

children’s exposure to road traffic injury risk in low socioeconomic areas

Parents of children aged 9–14 years living in low socioeconomic areas (86)

NM

FGDs

Sanusi and Emmelin, 2015 [27]

Nigeria

risk and road safety as well as of protective measures

commercial motorcycle driver’s (10)

NM

IDIs

Risk-taking as generally acceptable

Inadequate training and licensing

Poor law enforcement

Risk-saturated environment

Risk-taking as an intrinsic part of the occupation

Profit based on overriding rules

Assumptions of safety

Unavoidable accidents

Constant exposure

Risk-taking as a way to make ends meet

A fight to feed and survive

Family responsibilities

Unaffordable safety measures

Tetali et al., 2013 [28]

India

perceptions of stakeholders on road safety

government officials, subject experts, and road traffic injury victims, trauma surgeons, medical interns, nurses, and taxi drivers (37)

NM

IDIs and FGDs

Status of road safety

1. Unsafe roads

Law and enforcement

1. Ineffective enforcement

2. Unequal enforcement

3. Lack of political-will

4. Fines are not a deterrent

5. Corruption

6. Low compliance

7. Disregard of rules

Road engineering

1. Poor roads

2. Poor infrastructure

3. Poor road-use

High-risk road users

1. Passenger-seeking attitude

2. Media influence

3. Lack of parental control

4. Thrill seeking

Responsibility for road safety

1. Individual responsibility

2. Government’s responsibility

3. Collective responsibility

Strategies to improve road safety in Hyderabad

1. Awareness generation

2. Enforcement

3. Non-economic penalties

4. Stricter penalties

Hashemiparast et al., 2017a [29]

Iran

Explore the reasons for risky road crossing behaviors among young people.

males and females who had a car-accident (12)

CA

IDIs

Conformity with the masses

1. conformity with peers

2. conformity with the public space of society

anomie

–

Shams et al., 2010 [30]

Iran

views of taxi drivers about risky driving behaviors

taxi drivers (42)

NM

FGDs

the role of taxi drivers in current driving situation

–

drivers’ reasons for committing risky driving behaviors

Behavioral reasons

Non-Behavioral reasons

actions for modifying risky driving behaviors

Suitable education

Monitoring for roles

Correcting the streets

Providing suitable facilities for driving

Resolving Community Structural Problems

Carry out hazardous driving behaviors modification interventions

suitable places for implementing the recommended interventions

Drivers’ gathering places

Interior Space and Taxi Body

Taxi Drivers’ Routes

best channels for communicating and persuading taxi drivers

Mass media

Writing media

Effective people on the behavior of taxi drivers

Zamani-Alavijeh et al., 2010 [31]

Iran

explore risk behaviors among Iranian motorcyclists

Motorcyclists (32)

GT

IDIs and FGDs

personal characteristics

Individual features

Physical and mental health and balance

Knowledge and skill

Motivation to use motorcycleThe reaction of the individual to previous experiences and behaviors

Social factors

Police performance

low cost and easy availability of motorcycles

motorcycle defects and land ownership laws

traffic laws

traffic culture

vehicle related factors

Type of motorcycle

Motorcycle breakdown

abuse of safe equipment’s

1. Motorcycle Safety Equipment

2. Motorcyclist Safety Equipment

environmental factors

Type and structure of roads

lack of special motorcycle route

road safetyair condition

Khorasani-Zavareh et al., 2009 [32]

Iran

barriers effective post-crash management

medical services personnel, police officers, members of Red Crescent, firefighters, public-health professionals, road administrators; some road users and traffic injury victims (36)

GT

IDIs

involvement of laypeople

1. Cultural background

2. limitations in knowledge

3. late arrival of the emergency services

lack of coordination

lack of a systematic approach

different ambulance dispatch site locations

existence of parallel organizations with the same activity

substandard telecommunication equipment

undeveloped satellite navigation

inadequate pre-hospital services

low number of ambulance dispatch sites

inadequate human resources

insufficient physical resources

lack of police officers

lack of crash scene management skills

shortcomings in infrastructure

1. poor urban infrastructure

2. no satellite navigation

Haghparast-Bidgoli et al., 2013 [33]

Iran

influencing an effective trauma care delivery at emergency departments (EDs)

health professionals (15) and injured patients (20)

GT

IDIs

Inappropriate structure of hospitals

Teaching hospitals

Inappropriate layout and planning of ED premises

Unsupportive environment

Absence of established ways and inappropriate facilities for communication

An environment of mistrust

Low economic incentives

Shortage of staff

–

Unclear national policies

Absence of an established trauma system

Lack of continuity between pre-hospital and hospital trauma care processes

Poor organization of care at the ED

1. Absence of established trauma teams

2. Lack of protocols and guidelines for trauma care

3. Inappropriate human resource planning

Haghparast-Bidgoli et al., 2010 [34]

Iran

explore prehospital trauma care process for RTI victims

pre-hospital trauma care professionals (15)

GT

IDIs

administration and organization

Inappropriate management

inefficient structure

inefficient rules and regulation

staff qualifications and competences

Inappropriate training plans

out of date, unpractical and inadequate training courses

availability and distribution of resources

Deficiency of resources

misdistribution of resources

communication and transportation

inappropriate communication system

ineffective medical direction and referral system

involved organizations

poor coordination and cooperation between organizations

insufficient knowledge and skills regarding the rescue of victims

insufficient knowledge and skills regarding managing the crash

laypeople

Providing incomplete or wrong information

emotional reactions

conflicts with the EMS personnel

infrastructure

lack of GPS system

sub-standard road infrastructures

lack of infrastructures for helicopter ambulances in the big cities

an inadequate telecommunication system

Alinia et al., 2015 [35]

Iran

explore the barriers of pre-hospital care in traffic injuries

Peoples with at least 2 years’ experience in the field of pre-hospital services (18)

CA

IDIs

people

Inadequate knowledge about first aids

Laypeople -Involvement

Mistake calls

Metropolitan infrastructure

Traffic

Accessibility to streets and alleys

Naming of alleys

profession

Professional Autonomy

Workload

Work-related injuries

managerial issues

1. Inadequate telecommunication technology

2. Inadequate human resources

3. Inappropriate workload related privilege

4. Lack of organizational coordination

Razzaghi et al., 2017 [36]

Iran

explore the obstacles relating to the elderly pedestrians

elderly pedestrians age equal or more than 60 years old (23)

CA

IDIs

Hashemiparast et al., 2017b [37]

Iran

explore the young pedestrians risky road crossing behaviors reasons

young individuals who had the experience of vehicle-collision accident (12)

CA

IDIs

Perez-Nunez et al., 2012 [38]

Mexico

consequences of fatal and non-fatal road traffic injuries

injured and relatives of people who died (24)

Phenomenology

IDIs

Health Consequences

depend on others to perform the activities of daily life

Changes in family members health during the care of injured people

mental health

feelings of sadness and pain

Consequences on family life

change of roles

change of family composition

Household effects associated to the monetary cost

Expenditures associated to RTI

Leave households without money to bury

Families change even their eating habits

Households lose services

Injured people and some of their relatives stop working

Role change

Loss of capital

Loss of a provider

Loss of personal and household’s patrimony

Noori Hekmat et al., 2015 [39]

Iran

explore the challenges and complexities related to health care financing for traffic victims

managers at the Ministry of Health, Medical Sciences Universities, trauma specialized hospitals and basic insurances (36)

Phenomenology

IDIs

financial integration

Lack of timely payment of contributions to the Ministry of Health

Injustice in aggregating financial resources

The complex process of aggregating financial resources

accumulation

Lack of legal authority for economic activity

Financial instability

Lack of fair distribution of financial resources

The complex and timely process of allocating and distributing financial resources

Challenge and tension over deductions

distribution of financial resources and service purchasing

Non-transparency of the criteria for identifying the injured

Lack of Comprehensive Coverage for Service Article 92

Defective service coverage

Therapeutic Services Package

Lack of number of trauma services providers

General challenges Buy service

Bazeli et al., 2017 [40]

Iran

explore the challenges and facilitators in management of mass casualty traffic incidents

experienced managers, paramedics and staff of aid organizations (14)

GT

IDIs

Multiplicity of relief agencies

Several organizations are involved in managing these events.

The accident scene is managed by several organizations.

In most accidents involve at least three or four of emergency agencies

Lack of clear roles

Limit set of organizational tasks is not defined.

There is no clear description of personnel’s job

Lake of centralized and integrated commanding

There is no a certain Commander

Currently we do not have a unified command

Cultural factors

Citizens do not adhere traffic rules

traditional management culture

Huicho et al., 2012 [41]

Peru

assess current interventions implemented to reduce RTIs

policymakers and technical officers involved (19)

NM

IDIs

Ramos et al., 2008 [42]

Spain

Young people’s perceptions of traffic injury risks, prevention and enforcement measures:

Informants (43) and Young people (98)

NM

IDIs & FGDs

Determinants of traffic injuries

personal

drug use

false sense of security which comes from well equipped cars

enjoyment of the sensation of speed

distractions (using cell-phones, reading the newspaper or arguing while driving)

fatigue

night driving

being male

low educational level

social

1. rebelliousness of youth against norms

2. permissiveness of Mediterranean culture about drug use

3. having parents who break rules as a model

4. the social value attributed to vehicles as symbols of freedom

5. the early age at which moped driving is allowed

6. job-pressure on professional drivers

7. the lack of public transport

structural

unsuitable design of roads

siting of clubs far away from towns

rising traffic densities

Relevance and trends in traffic injuries

important problem

leading cause of death

complex problem to tackle

RTIs injuries and deaths are avoidable

Traffic injuries are declining

Assessment of interventions which are carried out

quite ineffective

applied too late

Intervention proposals

improve public transport

sanctions and incentives

measures to reduce adverse effects of drugs on driving

design cities more suited for pedestrians

generate social debate

Soori et al., 2015 [43]

Iran

Opportunities and barriers to enacting mandatory child car restraint laws in Iran

road safety stakeholders (28)

Phenomenology

FGDs

Barriers and threats

Lack of propaganda by mass media

Lack of related laws

Lack of parents’ awareness

Lack of a positive attitude among households

It is not a priority for the children’s needs

Lack of accessibility

It is too expensive to purchase for everyone

It is hard to find it in the market

Policy-makers do not know about its benefits

Children dislike to use it

Opportunities and facilities

Family sensitivity to their children’s health

Officials’ supports

National facilities

Executive facilities of traffic police

support of relevant organisations

Possibility to mass production by domestic industries

Trevino-Siller et al., 2011 [44]

Mexico

prioritise road traffic injury (RTI) interventions

road users and social groups (48)

NM

FGDs, NGs

Ainy et al., 2011 [45]

Iran

Presenting a practical model for governmental political mapping on road traffic injuries

experts from governmental and non-governmental organizations (26)

Phenomenology

FGDs

suggested organization to be the leading agency in prevention of RTIs

Traffic police

Presidential institution

Ministry of interior

Parliament

Cabinet

Ministry of roads and transport

Judiciary

suggestions proposed to resolve the inadequacies of planning and prevention of RTIs

Correction related laws and determine the duties

Credit allocation necessary

Careful planning and coherent

Sensitive authorities

Unique management

Doing Research to achieve accurate statistics

Determine organization responsible for

Salari et al., 2017 [46]

Iran

explore strategies to control RTIs

Mainly representatives from the police, Ministry of Road, Municipal, emergency services and Minis-try of Health (30)

NM

IDIs

Accident scene management

Integration

The use of a single Relay phone Number

Scientific examination of causes of accident

Governance and Leadership

Establishing a leading agency responsible for RTIs

Improving Accident database

Integrated Database

Education

public education, and creation of awareness

Ensuring safe driving by Enforcement

random testing of the use of alcohol and drugs

Increasing fines for traffic violations

Increasing the number of speed cameras

Ensuring safe driving by restriction

Instituting Psychological examination as part of the tests to acquire driver’s license

Restricting teens from driving at night

Ensuring the safety of Pedestrians

Construction of pedestrian bridges/overpass

Patel et al.:2017 [47]

Brazil

causes of delays in pre-hospital transport of RTIs patients

health care providers employed at prehospital or hospital settings (11)

Phenomenology

IDIs

Traffic related issues

High traffic volume

Wrong navigation information

Lack of public education

1. Lack of traffic education

2. Lack of public education to respond to trauma

3. Lack of drivers awareness of ambulance right-of-way

Insufficient personnel

Lack of personnel

Poor location

Stations distance from crashes sites

Stations located far from important places of the city

Insufficient ambulances

Lack of equipment in the ambulances

Not enough ambulances

Bureaucracy

1. Long time to receive notification within the pre-hospital care system

2. Difficulty with patient admission

Teye-Kwadjo et al.:2017 [48]

Ghana

risk factors for road transport-related injury among pedestrians

Pedestrians (26)

NM

IDIs

Behavioral factors

1. Pedestrians share lanes with vehicles

2. Pedestrians’ non-use of visibility aids at night

3. Walking with face turned against traffic

4. Cell phone use while walking

5. Drivers not yielding of right-of-way

6. Speeding

7. Repeated honking

8. Distracted driving (driver chatting with front

9. seat vehicle occupants)

10. Roadside trading/trading in motorised traffic

Personal factors

Low pedestrian crash risk perception

Pedestrian and driver attitudes to right-of way laws

Inaccurate vehicle speed estimation

Inconsiderate driving attitudes

Environmental factors

1. Narrow roadways

2. No sidewalk and crosswalks

3. No footbridges

4. Unsignalised zebra crossings

5. Nearness of food joints to roadways

6. Uncovered roadside drains

7. Nonexistent speed limits on community roads