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The Advocacy in Action Study a cluster randomized controlled trial to reduce pedestrian injuries in deprived communities
  1. R A Lyons1,
  2. E Towner2,
  3. N Christie3,
  4. D Kendrick4,
  5. S J Jones5,
  6. M Hayes6,
  7. R Kimberlee7,
  8. T Sarvotham1,
  9. S Macey1,
  10. M Brussoni8,
  11. J Sleney3,
  12. C Coupland3,
  13. C Phillips9
  1. 1
    Center for Health Information, Research and Evaluation CHIRAL, School of Medicine, Swansea University, Swansea, Wales, UK
  2. 2
    Center for Child and Adolescent Health, University of West of England, Bristol, UK
  3. 3
    Surrey Injury Research Group, Postgraduate Medical School, University of Surrey, Guildford, Surrey, UK
  4. 4
    Division of Primary Care, Nottingham University, Nottingham, UK
  5. 5
    Department of Primary Care and Public Health, Cardiff University, Cardiff, Wales, UK
  6. 6
    Child Accident Prevention Trust, LondonEC1R 3AJ, UK
  7. 7
    Faculty of Health and Social Care, University of the West of England, Health and Training Research Center, Frenchay Campus, Bristol, UK
  8. 8
    British Columbia Injury Research Prevention Unit, Vancouver, BC, Canada
  9. 9
    Institute for Health Research, School of Health Science, Swansea University, Swansea, Wales, UK
  1. Professor R Lyons, Center for Health Information, Research and Evaluation CHIRAL, School of Medicine, Swansea University, Singleton Park, Swansea SA2 8PP, Wales, UK


Background Road trafficrelated injury is a major global public health problem. In most countries, pedestrian injuries occur predominantly to the poorest in society. A number of evaluated interventions are effective in reducing these injuries. Very little research has been carried out into the distribution and determinants of the uptake of these interventions. Previous research has shown an association between local political influence and the distribution of traffic calming after adjustment for historical crash patterns. This led to the hypothesis that advocacy could be used to increase local politicians knowledge of pedestrian injury risk and effective interventions, ultimately resulting in improved pedestrian safety.

Objective To design an intervention to improve the uptake of pedestrian safety measures in deprived communities.

Setting Electoral wards in deprived areas of England and Wales with a poor record of pedestrian safety for children and older adults.

Methods Design mixedmethods study, incorporating a cluster randomized controlled trial. Data mixture of Geographical Information Systems data collision locations, road safety interventions, telephone interviews, and questionnaires. Randomization 239 electoral wards clustered within 57 local authorities. Participants 615 politicians representing intervention and control wards. Intervention a package of tailored information including maps of pedestrian injuries was designed for intervention politicians, and a general information pack for controls.

Outcome measures Primary outcome number of road safety interventions 25months after randomization. Secondary outcomes politicians interest and involvement in injury prevention cost of interventions. Process evaluation use of advocacy pack, facilitators and barriers to involvement, and success.

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  • Funding: Department of Health grant number 001009.

  • Competing interests: None.

  • Ethics approval: As this study did not include patients or staff of the NHS, the local research ethics committee decided that it did not come under their remit and declined to offer an ethical opinion. The study was approved by the Research Ethics Committee of the School of Medicine, Swansea University.