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

From: Meta-synthesis of qualitative evidence in road traffic injury prevention: a scoping review of qualitative studies (2000 to 2019)

Author, year Country Aim of study Participants (number) Approach Data collection Results
Main Categories Subcategories
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 unreal experiences
emotional responses
need to inform and need for information
need for assistance
perception toward the maxillofacial injury
experience on treatment
staff-patient interaction
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 Hazards caused by drivers and riders
Insufficient parental responsibility
Risk taking by children
Lack of activities and facilities
Parents’ views on solutions
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 Problems related to environment
Social respect to elderly
physical health
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 conformity with the masses/crowds
bypassing the law/ law evasion
lack of social cohesion and sense of belonging in social relations’
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 Lack of clear and sustained political and budgetary support
Ineffective coordination between the different sectors involved
Insufficient community participation
Lack a reliable and fully functional information system
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
Driving while under the influence of psychoactive substances
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 1. Massive educational campaign
2. Vital education programmes in schools
3. Increase and improve streets and avenues
4. Urban planning policies to locate schools and parking lots
5. Obligatory programmes for bars
6. Special paths for pedestrian crossings in risk zones
7. Clear signalization for pedestrians and bus stops
8. Obligatory exam to obtain drivers license and increase minimum age for drivers
9. Implementation of punitive law system
10. Permanent program for selection and training of policemen and salaries improvement
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
  1. IDIs In-depth Interviewees, FGDs Focus Group Discussion, CA Content-Analyze, GT Grounded Theory, NGs Nominal Groups
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