| Abstract |
Introduction: During the last decades of the 20th century, it was recognized that,
apart from biological factors, human behavior can also play a crucial role in the
protection of health. As a result, significant impetus was given to the development of
scientific disciplines targeting to change dysfunctional behaviors and promote health
(e.g. Health Psychology, Health Education, Social Marketing). Health Communication,
in the context of which the implementation of this PhD thesis was realized, is one such
discipline, encompassing the study and use of communication strategies to inform and
influence individual and community decisions that enhance health.
Aim: This PhD thesis sought to provide an integrated approach to the needs and
effectiveness of a preventive intervention, with a view to identifying specific
requirements needed for designing targeted communication messages focusing on
prevention. Specifically, an effort was made to develop based on the concepts of the
Health Belief Model, implement and evaluate a helmet promotion program targeting
adolescents passing from a “pre-driver” to a “driver” status (~16 years).
Μethods: The study consisted of two phases. During the first phase, 12 focus groups
were conducted with a total of 70 students attending three randomly selected highschools
in Athens, Greece, in order to explore factors contributing to adolescent
decision-making on helmet wearing. The groups were segmented by gender
(male/female) and helmet use (users/non-users). Qualitative data were analyzed by
employing thematic content analysis.
During the second phase of the study, the intervention along with the
educational material (i.e. a helmet instructional video, posters and an educational
leaflet) were developed based on the qualitative findings. Subsequently, the program
was implemented and evaluated by employing a cluster randomized controlled trial.
For this purpose, 12 randomly selected high-schools (4 public, 4 private and 4
vocational) situated in Attica, Greece, were sorted by type and randomly assigned to
receive the intervention or serve as controls. Self-report data on helmet-related
knowledge, attitudes and practices were collected at baseline from 741 2nd grade
students and immediately after program completion. Linear mixed models with
random student effects were used to estimate mean changes in scores for each
treatment group and corresponding between groups differences of changes.
Results: Results of the qualitative study showed that students reporting frequent
helmet use were characterized by a high perceived threat of a TWMV-related injury,
which seemed to be associated with both prior experience of an injury and receiving
information on helmet wearing from “significant others”. Students reporting helmet
non use were characterized by a low threat perception, possibly attributed to
adolescent egocentrism and accompanying feelings of invulnerability or to lack of
knowledge and experience in risk identification. A sharp contrast was noted regarding
the most important perceived benefit of helmet use, expressed among users as
“protection in case of a road crash”, whereas among non-users as “avoiding tickets
from Traffic Police”. Main barriers to helmet use, as identified by non-users, included:
low perceived efficacy of helmets; peer pressure; high helmet cost; as well as beauty
and style reasons.
Results of the cluster randomized controlled trial showed that the “Stick it well
on your head!” program yielded a significant improvement in helmet-related
knowledge, which was evident for students attending all types of secondary education.
Yet, the impact of the program on participants’ attitudes and practices appeared to
vary across different school types. Although the intervention was associated with
statistically significant positive changes among students attending public and
vocational schools, no effects were found with respect to helmet-related attitudes and
practices of students enrolled in private education. Of note, individuals enrolled in
private education had the lowest frequency of TWMV use. Specifically, only a 18.2% of
participants attending private schools reported using a TWMV either “always” or
“often”, whereas the equivalent percentage in public schools was 38.6% and in
vocational schools 61.1%.
Conclusions: The overall results of the study provide evidence for the effectiveness of
targeted, theory-driven preventive interventions. It is concluded that such
interventions could prove more efficient than conventional, non-targeted interventions
dominating so far in the field of prevention.
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Η δύναμη των επικοινωνιακών μηνυμάτων στην πρόληψη των οδικών τροχαίων ατυχημάτων
