Background Examining community perspective on an issue is not only a key consideration in research on road safety but also on other topics. There is substantial theoretical and empirical knowledge on built environment factors that contribute to pedestrian injury but how the community views these factors is least studied and constitutes the focus of this study. Our study investigated how respondents ranked the relative importance of selected built environment factors that contribute to pedestrian injury risk in Kampala city, Uganda and examined the underlying pattern behind the rankings.
Methods Eight hundred and fifty-one pedestrians selected from 14 different road sections in Kampala city were asked to rank each of the 27 built environment variables on a 4-point Likert scale. Point score analysis was used to calculate scores for the different built environment variables and rank them in order of perceived contribution while factor analysis was used to determine the pattern underlying the responses.
Results Factor analysis isolated two factors that explained 92% of the variation in respondents’ rankings: ‘road adjacent trip generators and attractors’ and ‘structure of traffic flows’. This finding implies that pedestrians in Kampala city perceived trip generators and attractors adjacent to the road and the structure of traffic flows as major explanations of the influence of the built environment on pedestrian injury risk.
Conclusion While these rankings and factors identified may not necessarily equate to actual risk, they are important in providing an understanding of pedestrian injury risk from the perspective of the community.
- cross sectional study
- low-middle income country
- risk perception
Data availability statement
Data are available upon reasonable request. The authors are pleased to share the dataset upon receiving a reasonable request. Interested parties may contact the corresponding author.
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WHAT IS ALREADY KNOWN ON THIS TOPIC
Theoretically derived built environment factors associated with pedestrian injury risk.
WHAT THIS STUDY ADDS
Community ranking of the built environment factors that contribute to pedestrian injury risk.
Identifying the underlying pattern in the ranking of several built environment variables that contribute to pedestrian injury risk.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
Road traffic practitioners’ understanding of what built environment factors pedestrians assess as important and what the underlying patterns of these might be.
Getting community perspectives on an issue is currently at the centre of public health, environmental and development research.1–3 For example, Latulippe and Klenk4 emphasise the need to create room for a diversity of perspectives in research and practice to identify issues that might have not been captured by professionals whom Robert Chambers has referred to as ivory tower experts.5 Public health research has generally relied primarily on quantitative methods of inquiry.6 Even though it has evolved to include social epidemiology, community views are still largely ignored. The importance of securing community perspective is reflected in the increasing emphasis on knowledge coproduction and participatory approaches, which seek to cogenerate knowledge with the involvement of local stakeholders that is useful.7 8
Researchers have developed models showing the dimensions of the built environment and how they contribute to pedestrian and overall road traffic injury risk. In their foundational work, Cervero and Kockelman9 indicated that the built environment concept consisted of three core dimensions, namely, density, diversity and design (3Ds). More dimensions were later added to this well-cited model such as destination accessibility and the distance to transit.10 11 These dimensions have led to several specific factors being identified and used in pedestrian road safety empirical research. The theoretical and empirical research that led to the generation of these factors mainly used secondary data and quantitative methods.12–16 However, a systematic analysis of the community perspective on these factors is lacking in the literature. Moreover, existing research on the perspective of pedestrians and overall road traffic injury risk17–25 has focused on a few selected factors but not on as many as possible of the factors advanced by Ewing and other researchers.
How the community views these factors is the core research problem and constitutes the contribution of this study to knowledge. This objective is achieved by asking respondents to rank 27 built environment variables on a 4-point Likert scale. Why is this knowledge necessary? It could point decision-makers to community knowledge and understanding of how these factors contribute to pedestrian injury as a basis to address them. This study answers two questions: (1) How do pedestrians in Kampala city, Uganda rank the relative importance of built environment factors contributing to pedestrian injury risk? (ii) Is there a pattern in the way pedestrians in Kampala city rank the built environment factors that contribute to pedestrian injury risk?
Study design and setting
A cross-sectional survey in Kampala, the capital of Uganda, was conducted. Kampala has a day population of 2.9 million, 60% of which comprise the working class.26 It is estimated that 50% of workers in Kampala walk to and from work.27 Kampala is also a hub for all public transport in the country which consists of taxis or minibuses and commercial motorcycles, commonly referred to as boda bodas.28
Study population and study sample
The study population or community was adult pedestrians in Kampala city. The study sample included those that were found walking in selected spots on interview days.
The sample size was calculated using the appropriate formula for such studies29; considering a 95% CI, 50% prevalence of pedestrians in Kampala city27 and 5% maximum error. The sample size was adjusted for clusters existing using a design effect of 2. A 10% non-response was considered as observed in an earlier study.21 A total of 851 pedestrians were selected.
The study adopted both stratified random and convenience sampling techniques. Stratified random sampling was used to select road sections for interviewing pedestrians while convenience sampling was used to select pedestrians to interview at the selected road sections (whoever showed up at a selected interview location during the days and times the research assistants were present and consented was admitted into the study). For this study, we stratified 1582 crash locations identified from a previous study that used 5-year crash data (2015–2019) from the traffic police30 into five categories (from very high risk to very low risk) based on total pedestrian crash frequency. Each category had different probabilities of selection of a road section as an interview location. All locations classified as very high risk were selected, while three locations from each of the remaining strata were randomly sampled totalling up to a list of 14 road sections. Details of the most prominent traffic attractors around the road sections selected for conducting interviews as well as the nature of the road design alongside other sampling strategy details are provided in table 1.
Pedestrian intercept interviews were conducted in the selected road sections by trained research assistants. A semistructured questionnaire was used to collect pedestrian information including demographics and the rankings of the perceived contribution of 27 different built environment variables (listed in table 2) to pedestrian injury risk. The list of variables to be considered for ranking was generated based on built environment variables identified as being associated with pedestrian injury from previous research.12–14 16 31 32 Some of the built environment variables were protective of injury risk such as speed calming measures while some increased risk such as arterial roads. The variables selected were examined thoroughly to determine their global use as well as application to Kampala. Some variables such as market and trading centres, taxi parks and fuel stations were added as new variables based on the city of Kampala. For each of these 27 built environment variables, respondents were asked to indicate to what extent they perceived its presence influenced pedestrian injury risk. This was regardless of the direction of influence (whether positive or negative). Respondents then ranked the contribution of the variables to pedestrian injury risk on a 4-point Likert scale ranging from 4 (extremely high), 3 (high), 2 (moderate) and 1 (low).
The questionnaire was interviewer administered. Face validity was established by having colleagues in the same research area read through the questionnaire to ascertain the relevance of the questions on the tool. Before its use, the tool was pilot tested among pedestrians at a roundabout in Kampala city. Necessary modifications were made and the validated tool was then translated to the most common local dialect in Kampala. The questionnaire was then converted to electronic format using Kobo Collect software33 and loaded onto a Kobo Collect-enabled mobile device. Data collection took place for 3 months (November 2021 to January 2022).
Data management and analysis
Data were downloaded online from Kobo Collect as an Excel file. The Excel file was then exported to STATA V.14 software (Stata, 2015) for analysis. Numerical values, or point scores, were allocated to the various categories of importance as follows; extremely high—4, high—3, moderate—2 and low—1. The overall ranking of the contribution of each variable to pedestrian injury risk was measured using point score analysis by totaling the point scores for all the pedestrians interviewed, for the variable in question. Point score analysis was used to rank variables in order of perceived contribution.
To reduce the number of built environment factors to a manageable number and establish a pattern among them, factor analysis, a data reduction technique, was used.34 Principal component analysis (PCA) is another data reduction technique; however, factor analysis and not PCA was used because while factor analysis derives a mathematical model from which factors are estimated, PCA merely decomposes the original data into a set of linear variates. As such, only factor analysis can estimate the underlying factors relying on various assumptions for estimates to be accurate. The major assumption of factor analysis is that these algebraic factors represent real-world dimensions; the nature of which must be “guessed at” by inspecting which variables have high loads on the same factor. The suitability of the data for factor analysis was assessed using appropriate statistical tests. The first step in factor analysis was to determine the correlation among the variables. From the correlation matrix, there was generally moderate to low correlation among the variables. The correlation matrix was then rotated using varimax orthogonal rotation and was used to place factors in positions where variables with high correlations (loadings) on it could be isolated. The rotation produced factors and factor loadings; factor loadings tell us about the relative contribution that a variable makes to a factor.34 An Eigenvalue is the sum of the squares of factor loadings. Eigenvalues explain how much of the total variance is explained by each of the newly derived variables. The Eigenvalue was used to determine which factors were significant and would, therefore, be retained for further description and analysis on account of the Kaiser criterion (Eigenvalues >1). Next, a confirmatory scree plot was performed for factor validation. The naming of each factor was done after examination of the common characteristics of the variables that loaded highly on it.
One thousand, one hundred and ninety-two (1192) pedestrians were approached out of which eight hundred and fifty-one (851) were interviewed and three hundred and forty-one (342) refused to answer because they did not have time. The overall response rate was 60%. Five hundred and seventy (67.1%) of the respondents were male while the rest were female. The mean age of respondents was 33 years (SD=12.14; median=30) with the youngest respondent being 18 years and the oldest 72 years. Five hundred and fifty-four (65.1%) lived in Kampala while the rest lived outside Kampala. Mean years lived in Kampala were 14.5 (SD=10.65; median=11) with 1 year being the minimum and 68 years the maximum. The majority of the population (82.2%) worked in Kampala. Mean years worked in Kampala were 8 (SD=8.36; median=6) with less than 1 year being the minimum and 50 years the maximum. Nearly half (49.9%) were businessmen, followed by professionals (13.8%) and students (12.2%). Other occupations included drivers, casual labourers, security guards, farmers, and support staff; each making up less than 10%. The taxi was the most dominant means of transport used (41.5%), followed by walking (24. 9%) and commercial motorcycles (22.2%). Other means were private vehicles (7.4%) and cycling (3.9%). The majority of the respondents had not been involved in a traffic crash before (66.3%). Most of those involved in a crash before had been involved as pedestrians (73.5%). The bulk of the respondents had attained up to the secondary level of education (47.3%), followed by tertiary education (33.3%), primary education (16.8%) and no education (2.6%). Overall, the respondents sampled had diversity in age and experience.
Respondents’ rankings and factors generated
Results of total scores for Likert-scale option for each variable are shown in table 3. The presence of worship places, residential land use and fuel stations were ranked as the top three built environment variables having the highest influence on pedestrian injury risk while the presence of bars, highways and junctions were ranked to have the lowest influence on pedestrian injury risk.
Two factors, accounting for 92% of the variability in road users’ rankings, were retained as principal on the basis of the Kaiser criterion (Eigenvalues >1) (table 4) and the confirmatory scree plot (figure 1). Variables mostly closely related to factor 1 (factor loadings 0.6000 and above ranging from 0.6081-0.6882) were: worship places, commercial activities, residential land use, taxi parks and industries. Moderately related variables to factor 1 (factor loadings 0.5000–0.5900) were: health centres, fuel stations and retail shops. Factor 1 was, therefore, named ‘road adjacent trip generators and attractors’. This factor accounted for 76% of the tracer percentage. This finding implies that pedestrians in Kampala city considered trip generators and attractors adjacent to the road to be a major influence on pedestrian injury risk. Variables most closely related to factor 2 (factor loadings 0.7000 and above ranging from 0.7436-0.7673) were: vehicular volumes, pedestrian volumes and population density. Moderately related variables to factor 2 (factor loadings 0.5000–0.6900 were: bends and width of roads. Factor 2 was, therefore, named ‘structure of traffic flows’, accounting for 16.07% of the tracer percentage. This result implies that pedestrians in Kampala city perceive the structure of traffic flows as a major explanation of the influence of the built environment on pedestrian injury risk. Variables with negative relationship included presence of highways for factor 1 and presence of traffic lights and social economic status for factor 2.
Factor analysis isolated ‘road adjacent trip generators and attractors’ as key contributors to pedestrian injury in Kampala city, Uganda. A keen look at variables that closely related on factor 1 (worship places, commercial activities, residential land use, taxi parks, industries, health centres, fuel stations, retail shops) reveals that these social, cultural and economic activities are the origins and destinations of trips for different purposes.35 Being located near roads implies that pedestrian trips associated with these sites face injury risk during interaction with other modes of transport, especially if the road infrastructure and users do not adhere to high safety standards.36 The safety-in-numbers phenomenon has been a point of discussion claiming that each pedestrian is safer if more pedestrians are there.37 However, it could be argued that numbers are only protective if the infrastructure around is safer and road users adhere to safer behaviour. The insight from this finding is that the respondents look at the location of certain commercial, social and cultural activities located next to roads as contributing to pedestrian injury risk, which, from literature and experience in Kampala, could be related to interaction among trips generated and attracted or quality of safety in road infrastructure by which these locations are accessed.38 Some of the built environment variables that closely related to this factor may be based on the context in which the study was done. The essence of transport is to enhance the ability of these places to be reached safely,36 but this consideration is not usually the case in this study’s context. The above trip attractors and generators are generally designed in Kampala city without adequate safety consideration in their planning and development or the process of approval for the plans38 despite the existence of guidelines.39 In addition, they also have poor accessibility with inadequate consideration for pedestrians in terms of service, space and road infrastructure.38 This situation contrasts with that obtained in some high-income countries, which have improved accessibility with pedestrian infrastructure present.40
Factor 2, ‘structure of traffic flows’, had vehicular volumes, pedestrian volumes and population density closely related to it followed by road width. This finding shows that respondents identified underlying issues related to amount, direction and interaction in traffic that could lead to injury risk to pedestrians. Overall, this factor points to ensuring safety in the flow of traffic as well as features of the road infrastructure such as road width that can increase risk, not only to pedestrians but also to other road users.40 In the context of Kampala city, planning experience reveals shortcomings in planning for traffic flow. For example, most of the national road network comprises two-way single-carriageways, with no median to separate opposing traffic flows.38 Kampala’s transportation system is mostly dominated by a mix of pedestrians, private vehicles, taxis (matatu), motorcycles and heavy-duty vehicles due to shortage of public transport means.28 This traffic mix, coupled with the ever-growing city population and poor traffic control methods, leads to crashes that sometimes result in permanent injuries and death.
A major limitation of this study was the omission of sidewalks and zebra crossings among the built environment factors to be ranked. This omission could have introduced information bias. We focused on the larger road infrastructure that would still create pedestrian risk, alluding to the quality of infrastructure at crossing points such as at junctions and intersections. The questionnaire also did not measure the direction of the relationship, whether the influence was perceived as positive or negative. This might have introduced a framing effect in the responses where people responded differently based on how they perceived the question. Another limitation is the use of convenience sampling, a non-random sampling technique that introduces the bias of the observer in selecting whom to interview. However, due to the transient nature of the study population and non-response, options such as quota sampling were not feasible. Finally, this study was conducted in a capital city in a low-income country, which could limit its external validity. While perceptions are useful, inferring risks from those perceptions may be incorrect in some settings.
Despite these limitations, this study makes a key contribution by providing community perspectives on the contribution of the built environment variables that have been associated with pedestrian injury risk through ranking on a Likert scale from highest to lowest. It also identifies the underlying pattern in the pedestrians’ ranking of these built environment variables that contribute to pedestrian injury risk. While these rankings may not necessarily equate to actual risk, they are important in providing an understanding of pedestrian injury risk from the perspective of the community.
This study examined road users’ rankings of the contribution of the built environment to pedestrian injury risk in Kampala city, Uganda. Factor analysis reduced 27 factors to two main factors, which were named ‘road adjacent trip generators and attractors’ and ‘structure of traffic flows’. These two factors explained 92% of the variance in road user responses. This study adds to existing research by assessing community perspectives through ranking within the context of a low-income setting at the scale of a city while incorporating many built environment variables.
Data availability statement
Data are available upon reasonable request. The authors are pleased to share the dataset upon receiving a reasonable request. Interested parties may contact the corresponding author.
Patient consent for publication
This study involves human participants and was approved by Makerere University School of Public Health Research and Ethics committee and the Uganda National Council for Science and Technology under protocol number: HS960ES. Participants gave informed consent to participate in the study before taking part.
We thank Professor David Guwatudde and Dr. Khayesi Meleckidzedeck for their supervision and support during the execution of this work that formed part of my doctoral research. We thank Dr. Olive Kobusingye for securing the funding to conduct this work. The authors also thank the research assistants for braving the field and the many respondents that availed their time to respond to the research questions.
Contributors EB-Z is responsible for the overall content as guarantor and accepts full responsibility for the finished work right from the conduct of the study, access to the data, and controlling the decision to publish. EB-Z conceptualized the study, colducted data collection, analysis and writing the original manuscript draft. RN conducted analysis and reviewed the manuscript. MM supervised the study as well as reviewed the manuscript. All authors contributed to the writing of the paper.
Funding This work was supported by the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung (BMBF)) (01KA1608) as part of the Research Networks for Health Innovation in Sub-Saharan Africa funding initiative. The funder had no role in design of the study and in writing the manuscript.This work was supported by the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung (BMBF)) (01KA1608) as part of the Research Networks for Health Innovation in Sub-Saharan Africa funding initiative. The funder had no role in design of the study and in writing the manuscript.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.