February 6, 2003
Where behavior and injury collide: Conference examines using behavior change to prevent ‘accidents’
A significant decrease in the motor-vehicle death rate for Americans – 90 percent fewer deaths per million vehicle miles between 1925 and 1995 – shows that efforts to raise safety standards and change personal behavior can be highly successful. Vehicles and roads have improved designs, while more people wear seat belts and fewer drink and drive.
Using what’s been learned from similar efforts to prevent injury at both the individual and community levels was the focus of “Behavioral Approaches to Injury Control,” a one-day conference sponsored by the Harborview Injury Prevention and Research Center. Experts on behavior change from around the country joined UW colleagues Jan. 23 to present health-behavior change theories, customized injury-prevention messages, and strategies for including community values and policy makers in a broad approach to injury prevention.
“We’ve been wrestling with behavior change since we began our work in injury control,” said Dr. David Grossman, HIPRC director, as he welcomed participants from across the United States. “Behavior forms the foundation of most of our work, and today’s event offers strategies we can apply to the human factors in injury prevention.”
While there’s an almost infinite number of variables that may affect the performance of a behavior, only a limited number of variables need to be considered to understand, predict, change or reinforce a specific behavior, explained Dr. Martin Fishbein, of the Annenberg Public Policy Center of the University of Pennsylvania. Fishbein presented the four major theories of behavior and behavior change, emphasizing the importance of obtaining key information before embarking on an injury-prevention campaign.
Knowing the target population, identifying and clearly defining the behavior to be changed or reinforced, and conducting research to identify important beliefs are key steps in developing an intervention, Fishbein said.
Applying models of health behavior to a specific intervention was the theme for a presentation by Dr. Chris Dunn of the UW Department of Psychiatry and Behavioral Sciences. Dunn discussed behavior-change counseling, a talking treatment being used to reduce risky behaviors among patients treated in Harborview’s Emergency Department. The approach is non-confrontational but directive. Brief, bedside interventions may be as effective as weeks of standard counseling therapy.
Tailored health communications – making injury-prevention information relevant to its recipients – was the theme of a talk by Dr. Matthew Kreuter, founder and director of the Health Communication Research Laboratory at the Saint Louis University School of Public Health. This approach has been effective in changing other behaviors, Kreuter said, including diet, smoking and child immunization.
Behavioral change at the community level works best when those whose behavior is to be changed are directly involved in planning an intervention, according to Dr. Andrea Gielen of the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health. Gielin cited Mothers Against Drunk Driving and the Injury Free Coalition for Kids as examples of successful programs that employ grass-roots organizing that “start where the people are.”
The Centers for Disease Control and Prevention, a co-sponsor of the one-day conference, actively supports behavioral science approaches to injury control, said Dr. David Sleet of the CDC’s National Center of Injury Prevention and Control. “As much as we would like to hope otherwise,” Sleet said, “Most injuries cannot be resolved by introducing a vaccine-like technology, as the technology must be proven safe, adopted by people and used properly to be effective.”
Proceedings from “Behavioral Approaches to Injury Control” will be posted on the HIPRC Web site (http://www.hiprc.org) in the near future.
