Conference Sparks Dialogue on Behavioral Approaches to Injury Control

Injury Free Coalition for Kids of Seattle

Date: Thu, Jan 23, 2003

Organizer/Sponsor: Harborview Injury Prevention and Research Center at the University of Washington

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 (HIPRC). Experts on behavior change from around the country joined University of Washington colleagues in Seattle, Washington, on Jan. 23, 2003, 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 as he welcomed participants from across the U.S. "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 Martin Fishbein, Ph.D., 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. Data derived from this research can then be used to determine which behavioral factors need to be addressed in the intervention in order to change or reinforce the behavior. Messages or strategies can then be developed, but the intervention must first be tested to make sure that it will be accepted and that it works.

Applying models of health behavior to a specific intervention was the theme for a presentation by Chris Dunn, Ph.D., of the UW Department of Psychiatry and Behavioral Sciences. Dunn discussed motivational interviewing and behavior-change counseling, talking treatments 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 Matthew Kreuter, Ph.D., 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. Tailoring works, he explained, because people are more likely to process information when they perceive it to be personally relevant. These messages, in turn, are retained for longer periods and are more likely to lead to permanent attitudinal change.

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 Andrea Gielen, Sc.D., 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 David Sleet, Ph.D., 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."

Small groups led by HIPRC investigators tackled issues of alcohol and injury, interpersonal violence, and child passenger safety during the afternoon session. Each group applied the concepts discussed by the main speakers to develop specific injury-control activities, as well as to identify research areas that offer the potential to advance the sciences of injury control, and health behavior and behavior change.

The one-day conference was coordinated by Drs. Brian Johnston and David Grossman, with support from Luann D'Ambrosio and Marni Levy. Proceedings from "Behavioral Approaches to Injury Control" will be posted on the HIPRC web site (www.hiprc.org) in the near future.