Effects of a multi-level intervention on pedestrians’ behavior among Iranian health worker supervisors: a randomized controlled trial

BackgroundPedestrian injury is a global public health concern. Multi-level community-based health education campaigns offer promise to reduce the burden. The current study investigated the effect of a multi-level intervention based on the socio-ecological model (SEM) to improve pedestrian safety by...

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Main Authors: Sepideh Harzand-Jadidi, Maryam Vatandoost, David C. Schwebel, Homayoun Sadeghi-bazargani, Fatemeh Bakhtari Aghdam, Hamid Allahverdipour
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-05-01
Series:Frontiers in Public Health
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Online Access:https://www.frontiersin.org/articles/10.3389/fpubh.2025.1485934/full
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author Sepideh Harzand-Jadidi
Maryam Vatandoost
David C. Schwebel
Homayoun Sadeghi-bazargani
Fatemeh Bakhtari Aghdam
Fatemeh Bakhtari Aghdam
Hamid Allahverdipour
author_facet Sepideh Harzand-Jadidi
Maryam Vatandoost
David C. Schwebel
Homayoun Sadeghi-bazargani
Fatemeh Bakhtari Aghdam
Fatemeh Bakhtari Aghdam
Hamid Allahverdipour
author_sort Sepideh Harzand-Jadidi
collection DOAJ
description BackgroundPedestrian injury is a global public health concern. Multi-level community-based health education campaigns offer promise to reduce the burden. The current study investigated the effect of a multi-level intervention based on the socio-ecological model (SEM) to improve pedestrian safety by training health worker supervisors in Iran, with the expectation that they would disseminate their learned knowledge more broadly in the population.MethodsEighty-two health worker supervisors in Tabriz, Iran were randomized to an intervention or control group, with 41 assigned to each group. Participants in the intervention group received both live pedestrian safety education and offline training through a virtual WhatsApp group. Messages, pictures, and short videos about pedestrian safety were sent to participants, and solutions were discussed in the group settings. The control group had no training. Self-reported pedestrian behavior was assessed before and after the intervention.ResultsAt baseline, there were no significant differences between the intervention (82.48 ± 8.54) and control (81.05 ± 8.55) groups in pedestrian behavior scores (t = 2.01, p = 0.001). After the intervention, the average score of pedestrians’ behaviors of the intervention group increased significantly compared to the control group (87.98 ± 5.83 vs. 80.37 ± 9.03), (t = 3.61, p = 0.0002). All five subscale scores of PBQ, including adherence to traffic rules and recommendation, violations, positive behaviors, distraction, and aggressive behaviors showed similar and significant changes in the intervention group compared to control group.ConclusionApplication of a multi-level intervention based on the socio-ecological model improved self-reported pedestrian behavior of health worker supervisors. Using multi-level interventions by targeting health workers, who then disseminate their learning to the public, could enhance pedestrian safety across society.
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spelling doaj-art-0643c119ea3d4473b56f1fad30168fd62025-08-20T03:48:57ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-05-011310.3389/fpubh.2025.14859341485934Effects of a multi-level intervention on pedestrians’ behavior among Iranian health worker supervisors: a randomized controlled trialSepideh Harzand-Jadidi0Maryam Vatandoost1David C. Schwebel2Homayoun Sadeghi-bazargani3Fatemeh Bakhtari Aghdam4Fatemeh Bakhtari Aghdam5Hamid Allahverdipour6Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranDepartment of Health Education & Promotion, School of Health, Tabriz University of Medical Sciences, Tabriz, IranDepartment of Psychology, University of Alabama at Birmingham, Birmingham, AL, United StatesRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranDepartment of Health Education & Promotion, School of Health, Tabriz University of Medical Sciences, Tabriz, IranDepartment of Health Education & Promotion, School of Health, Tabriz University of Medical Sciences, Tabriz, IranBackgroundPedestrian injury is a global public health concern. Multi-level community-based health education campaigns offer promise to reduce the burden. The current study investigated the effect of a multi-level intervention based on the socio-ecological model (SEM) to improve pedestrian safety by training health worker supervisors in Iran, with the expectation that they would disseminate their learned knowledge more broadly in the population.MethodsEighty-two health worker supervisors in Tabriz, Iran were randomized to an intervention or control group, with 41 assigned to each group. Participants in the intervention group received both live pedestrian safety education and offline training through a virtual WhatsApp group. Messages, pictures, and short videos about pedestrian safety were sent to participants, and solutions were discussed in the group settings. The control group had no training. Self-reported pedestrian behavior was assessed before and after the intervention.ResultsAt baseline, there were no significant differences between the intervention (82.48 ± 8.54) and control (81.05 ± 8.55) groups in pedestrian behavior scores (t = 2.01, p = 0.001). After the intervention, the average score of pedestrians’ behaviors of the intervention group increased significantly compared to the control group (87.98 ± 5.83 vs. 80.37 ± 9.03), (t = 3.61, p = 0.0002). All five subscale scores of PBQ, including adherence to traffic rules and recommendation, violations, positive behaviors, distraction, and aggressive behaviors showed similar and significant changes in the intervention group compared to control group.ConclusionApplication of a multi-level intervention based on the socio-ecological model improved self-reported pedestrian behavior of health worker supervisors. Using multi-level interventions by targeting health workers, who then disseminate their learning to the public, could enhance pedestrian safety across society.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1485934/fulltraffic accidentpedestrianssafe behaviorhealth workerssocio-ecological modelmulti-level intervention
spellingShingle Sepideh Harzand-Jadidi
Maryam Vatandoost
David C. Schwebel
Homayoun Sadeghi-bazargani
Fatemeh Bakhtari Aghdam
Fatemeh Bakhtari Aghdam
Hamid Allahverdipour
Effects of a multi-level intervention on pedestrians’ behavior among Iranian health worker supervisors: a randomized controlled trial
Frontiers in Public Health
traffic accident
pedestrians
safe behavior
health workers
socio-ecological model
multi-level intervention
title Effects of a multi-level intervention on pedestrians’ behavior among Iranian health worker supervisors: a randomized controlled trial
title_full Effects of a multi-level intervention on pedestrians’ behavior among Iranian health worker supervisors: a randomized controlled trial
title_fullStr Effects of a multi-level intervention on pedestrians’ behavior among Iranian health worker supervisors: a randomized controlled trial
title_full_unstemmed Effects of a multi-level intervention on pedestrians’ behavior among Iranian health worker supervisors: a randomized controlled trial
title_short Effects of a multi-level intervention on pedestrians’ behavior among Iranian health worker supervisors: a randomized controlled trial
title_sort effects of a multi level intervention on pedestrians behavior among iranian health worker supervisors a randomized controlled trial
topic traffic accident
pedestrians
safe behavior
health workers
socio-ecological model
multi-level intervention
url https://www.frontiersin.org/articles/10.3389/fpubh.2025.1485934/full
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