Knowledge Enhances Your Safety (KEYS) is a curriculum developed for older drivers who maintain driving privileges while coping with visual limitations that increase crash risk. KEYS’ goal is to promote safe driving through self-awareness of vision impairment and adopting self-regulatory strategies. We discuss KEYS’ theoretical framework based on the tenants of the Social Cognitive Theory, Health Belief and Transtheoretical Models, and Principles of Self-Regulation and Regulatory Self-Efficacy. Baseline and 6-month posttest evaluations tested its efficacy in terms of theoretical construct outcomes. KEYS’ participants improved self-perceptions of vision impairment, perceived a greater number of benefits in the performance of self-regulatory behaviors, and moved closer to the preparation and action/maintenance stages of change. Results indicate that high-risk older drivers benefit from educational interventions that promote self-awareness and self-regulation of driving. Future work will evaluate KEYS’ efficacy for high-risk older drivers in promoting driver behavior changes and its impact on crash involvement.
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References
1.
AAA Foundation for Traffic Safety. (2003). The older and wiser driver. Available at http://www.aaafoundation.org and http://www.seniordrivers.org
2.
Alexy, B. (1984). Goal setting and health risk reduction. Nursing Research, 34(5), 283-288.
3.
Ball, K., & Owsley, C. (1992). The useful field of view test: A new technique for evaluating age-related declines in visual function. Journal of the American Optometric Association, 64, 71-79.
4.
Ball, K., Owsley, C., Stalvey, B., Roenker, D.L., Sloane, M.E., & Graves, M. (1998). Driving avoidance and functional impairment in older drivers. Accident Analysis and Prevention, 30, 313-322.
5.
Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice-Hall.
6.
Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, 122-147.
7.
Bandura, A. (1986a). The explanatory and predictive scope of self-efficacy theory. Journal of Social and Clinical Psychology, 4, 359-373.
8.
Bandura, A. (1986b). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.
9.
Bandura, A. (1996). Self-efficacy: The exercise of control. New York: Freeman.
10.
Barancik, J.I., Chatterjee, B.F., Greene-Cadden, Y.C., & Michenzi, E.M. (1986). Motor vehicle trauma in northeastern Ohio: Incidence and outcome by age, sex, road-use category. American Journal of Epidemiology, 74, 473-478.
11.
Dubbert, P., & Wilson, G. (1984). Goal-setting and spouse involvement in the treatment of obesity. Behavior, Research, and Therapy, 22, 227-242.
12.
Evans, L. (1996). Comment: The dominant role of driver behavior in traffic safety. American Journal of Public Health, 86, 784-786.
13.
Ferrini, R., Edelstein, S., & Barrett-Conner, E. (1994). The association between health beliefs and health behavior change in older adults. Preventive Medicine, 23, 1-5.
14.
Ferris, F.L.I., Kassoff, A., Bresnick, G.H., & Bailey, I. (1982). New visual acuity charts for clinical research. American Journal of Ophthalmology, 94, 91-96.
15.
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). “Mini-mental state:” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198.
16.
Fulton, J.P., Buechner, J.S., Scott, H.D., DeBuono, B.A., Feldman, J.P., Smith, R.A., & Kovenock, D. (1991). A study guided by the health belief model of the predictors of breast cancer screening of women ages 40 and older. Public Health Reports, 106, 410-420.
17.
Haber, D. (1993). Health contracts with older adults. Clinical Gerontologist, 14(2), 44-49.
18.
Hakamies-Blomquist, L. (1993). Compensation in older drivers as reflected in their fatal accidents. Accident Analysis and Prevention, 26, 107-122.
19.
Janke, M.K. (1994). Mature driver improvement program in California. Transportation Research Record, 1438, 77-83.
20.
Janz, N.K., & Becker, M.H. (1984). The health belief model: A decade later. Health Education Quarterly, 11, 1-47.
21.
Johnson, C., & Keltner, J. (1983). Incidence of visual field loss in 20,000 eyes and its relationship to driving performance. Archives of Ophthalmology, 101, 317-375.
22.
Kelly, G.A. (1955). A theory of personality: The psychology of personal constructs. New York: Norton.
23.
Kelly, R., Zyzanski, S., & Alemagno, S. (1991). Prediction of motivation and behavior change following health promotion: Role of health beliefs, social support, and self-efficacy. Social Science and Medicine, 32, 311-320.
24.
Kirscht, J. (1974). Research related to the modification of health beliefs. Health Education Monographs, 2, 455-469.
25.
Kohler, C.L., Grimley, D., & Reynolds, K. (1999). Theoretical approaches guiding the development and implementation of health promotion programs. In J.M. Raczynski & R.J. DiClemente (Eds.), Handbook of health promotion and disease prevention (pp. 23-49). New York: Kluwer Academic/Plenum.
26.
Lefrancois, R., & D’Amours, M. (1997). Exposure and risk factors among elderly drivers: A case control study. Accident Analysis and Prevention, 29, 267-275.
27.
Lent, R., & Hacket, G. (1987). Career self-efficacy: Empirical status and future directions. Journal of Vocational Behavior, 20, 347-382.
28.
Maes, S., & Gebhardt, W. (2000). Self-regulation and health behavior: The health behavior goal model. In M. Boekaerts, P.R. Pintrich, & M. Zeidner (Eds.), Handbook of self-regulation (pp. 343-368). New York: Academic Press.
29.
Martinez, R. (1995). Older drivers and physicians. Journal of the American Medical Association, 274, 1060.
30.
Mayer, J.A., Jermanovich, A., Wright, B.L., Elder, J.P., Drew, J.A., & Williams, S.J. (1994). Changes in health behaviors of older adults: The San Diego Medicare preventive health project. Preventive Medicine, 23, 127-133.
31.
McCoy, G.G., Johnson, R.A., Duthie, R.B. (1989). Injury to the elderly in road traffic accidents. Journal of Trauma, 29, 494-497.
32.
McKnight, A.J., Simone, G.A., & Weidman, J.R. (1982). Elderly driver retraining (DOT HS-806 336). Alexandria, VA: National Public Services Research Institute.
33.
Meichenbaum, D.H., & Smart, I. (1971). Use of direct expectancy to modify academic performance and attitudes of college students. Journal of Counseling Psychology, 18, 531-535.
34.
Mischel, W., Cantor, N., & Feldman, S. (1996). Principles of self-regulation: The nature of willpower and self-control. In E.T. Higgins & A.W. Kruglanski (Eds.), Social psychology: Handbook of basic principles (pp. 329-360). New York: Guilford.
35.
Murakami, E., & Wagner, D.P. (1997). Comparison between computer-assisted self-interviewing using GPS with retrospectice trip reporting using telephone interviews. Washington, DC: Federal Highway Administration, U.S. Department of Transportation.
36.
National Highway Traffic Safety Administration. (1993). Traffic safety plan for older persons. Washington, DC: U.S. Department of Transportation.
37.
National Highway Traffic Safety Administration. (1995). Traffic safety facts 1994: A compilation of motor vehicle crash data from the fatal accident reporting system and the general estimates system. Washington, DC: National Highway Traffic Safety Administration, National Center for Statistics and Analysis, U.S. Department of Transportation.
38.
National Highway Traffic Safety Administration. (1997). Traffic safety facts. Washington, DC: National Center for Statistics and Analysis.
39.
National Safety Council. (1997). Coaching the mature driver. (Available from National Safety Council, 1121 Spring Lake Drive, Itasca, IL 60143)
40.
Nigg, C.R., Burbank, P.M., Padula, C., Dufresne, R., Rossi, J.S., Velicer, W.F., Laforge, R.G., & Prochaska, J.O. (1999). Stages of change across ten health risk behaviors for older adults. The Gerontologist, 39, 473-482.
41.
Nigg, C.R., Courneya, K.S., & Estabrooks, P.A. (1997). Maintaining attendance at a fitness center: An application of the decision balance sheet. Behavioral Medicine, 23, 130-137.
42.
Owsley, C., Ball, K., McGwin, G., Jr., Sloane, M.E., Roenker, D., L., White, M.F., & Overley, E.T. (1998). Visual processing impairment and crash risk among older adults. Journal of the American Medical Association, 297, 1083-1088.
43.
Owsley, C., Ball, K., Sloane, M.E., Roenker, D.L., & Bruni, J.R. (1991). Visual/cognitive correlates of vehicle accidents in older drivers. Psychology and Aging, 6, 403-415.
44.
Owsley, C., & McGwin, G., Jr. (1999). Vision impairment and driving. Survey of Ophthalmology, 43, 535-550.
45.
Owsley, C., McGwin, G., Jr., & Ball, K. (1998). Vision impairment, eye disease, and injurious motor vehicle crashes in the elderly. Ophthalmic Epidemiology, 5(2), 101-113.
46.
Owsley, C., & Sloane, M.E. (1990). Vision and aging. In F. Boller & J. Grafman (Eds.), Handbook of neuropsychology (Vol. 4, pp. 229-249). Amsterdam: Elsevier Science.
47.
Owsley, C., Stalvey, B., & Phillips, J. (in press). The efficacy of an educational intervention in promoting self-regulation among high-risk older drivers. Accident Analysis and Prevention.
48.
Owsley, C., Stalvey, B., Wells, J., & Sloane, M.E. (1999). Older drivers and cataract: Driving habits and crash risk. Journal of Gerontology: Medical Sciences, 54A(4), M203-M211.
49.
Pallonen, U.E., Leskinen, L., Prochaska, J.O., Kaariainen, R., & Salonen, J.T. (1994). A 2 year self-help smoking cessation manual intervention among middle-aged Finnish men: An application of the transtheoretical model. Preventive Medicine, 23, 507-514.
50.
Prochaska, J. (1991). Assessing how people change. Cancer, 67, 805-807.
51.
Prochaska, J.O., & DiClemente, C.C. (1992). Stages of change in the modification of problem behaviors. In M. Hersen, R.M. Eisler, & P.M. Miller (Eds.), Progress in behavior modification (Vol. 28, pp. 184-218). Sycamore, IL: Sycamore Publishing Company.
52.
Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47, 1102-1114.
53.
Prochaska, J.O., DiClemente, C.C., Velicer, W.F., Ginpil, S., & Norcross, J.C. (1985). Predicting change in smoking status for self-changers. Addictive Behaviors, 10, 395-406.
54.
Rose, M.A. (1996). Effect of AIDS education program for older adults. Journal of Community Health Nursing, 13(3), 141-148.
55.
Rosenstock, I. (1960). What research in motivation suggest for public health. American Journal of Public Health, 50, 295-302.
56.
Rosenstock, I.M. (1974). Historical origins of the health belief model. Health Education Monographs, 2, 328-335.
57.
Rosenstock, I.M. (1990). The health belief model: Explaining health behavior through expectancies. In K. Glanz, F.M. Lewis, & B.K. Rimer (Eds.), Health behavior and health education: Theory, research and practice (pp. 39-62). San Francisco: Jossey-Bass.
58.
Rubenstein, L. (1994). Strategies to overcome barriers to early detection of cancer among older adults. Cancer, 74, 2190-2193.
59.
Schlag, B. (1993). Elderly drivers in Germany: Fitness and driving behavior. Accident Analysis and Prevention, 25, 47-56.
60.
Schunk, D. (1989). Self-efficacy and achievement behaviors. Educational Psychology Review, 1, 173-208.
61.
Schwarzer, R. (Ed.). (1992). Self-efficacy: Thought of control and action. Washington, DC: Hemisphere.
62.
Stalvey, B., & Owsley, C. (2000). Self-perceptions and current practices of high-risk older drivers: Implications for driver safety interventions. Journal of Health Psychology, 5, 441-456.
63.
Strain, L.A. (1991). Use of health services in later life: The influence of health beliefs. Journal of Gerontology, 46(3), S143-S150.
64.
Strecher, V., DeVillis, B., Becker, M., & Rosenstock, I. (1986). The role of self-efficacy in achieving health behavior change. Health Education Quarterly, 13, 73-91.
65.
Stutts, J.C. (1998). Do older drivers with visual and cognitive impairment drive less? Journal of the American Geriatric Society, 46, 854-861.
66.
Tobin, D.L., Reynolds, R.V.C., Holroyd, K.A., & Creer, T.L. (1986). Self-management and social learning theory. In Holroyd, K.A. & Creer, T.L. (Ed.), Self-management of chronic disease: Handbook of clinical interventions and research (pp. 29-55). New York: Academic Press.
