BMJ 2002;324:1129 ( 11 May )

Papers

Safety education of pedestrians for injury prevention: a systematic review of randomised controlled trials

Olivier Duperrex, research fellow in community paediatrics and public health, ^a Frances Bunn, review group coordinator of Cochrane Injuries Group, ^b Ian Roberts, professor of epidemiology and public health. ^b

^a Institut de Médecine Sociale et Préventive, CMU, CH-1211 Geneva 4, Switzerland, ^b Public Health Intervention Research Unit, London School of Hygiene and Tropical Medicine, UK

Correspondence to: O Duperrex Olivier.Duperrex{at}imsp.unige.ch

Objectives: To quantify the effectiveness of safety education of pedestrians.
Design: Systematic review of randomised controlled trials of safety education programmes for pedestrians of all ages.
Main outcome measures: Effect of safety education on pedestrians' injuries, behaviour, attitude, and knowledge and on pedestrian-motor vehicle collisions. Quality of trials: methods of randomisation; and numbers lost to follow up
Results: We identified 15 randomised controlled trials of safety education programmes for pedestrians. Fourteen trials targeted children, and one targeted institutionalised adults. None assessed the effect of safety education on the occurrence of pedestrian injury, but six trials assessed its effect on behaviour. The effect of pedestrian education on behaviour varied considerably across studies and outcomes.
Conclusions: Pedestrian safety education can change observed road crossing behaviour, but whether this reduces the risk of pedestrian injury in road traffic crashes is unknown. There is a lack of good evidence of effectiveness of safety education for adult pedestrians, specially elderly people. None of the trials was conducted in low or middle income countries.

What is already known on this topic Road traffic crashes are a leading cause of death and disablement, and pedestrians are particularly vulnerable road users Several organisations strongly recommend road safety education As resources are limited, a key question concerns the relative effectiveness of different prevention strategies, including road safety education of pedestrians What this study adds This systematic review showed safety education for pedestrians could improve children's knowledge and change their observed road crossing behaviour However, effects on pedestrian injury were unknown There is a lack of good evidence of effectiveness of safety education for adult pedestrians, especially elderly people, and in low and middle income countries

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