Determinants of road traffic injury preventive behaviors among old pedestrians: An application of the PRECEDE model.

Abstract

Nowadays, road traffic injuries (RTIs), a major public health concern in many countries, have gained even greater significance among elderly, especially among elderly pedestrians who are one of important vulnerable groups of road users. This study aimed to identify factors influencing RTI preventive behaviors in older pedestrians using the PRECEDE model. A cross-sectional study was conducted in 2024 with 417 adults aged 60 years or older attending comprehensive health centers in Hamadan, located in the west part of Iran. Participants were selected using a multi-stage cluster sampling method. Data were collected via a validated, self-administered questionnaire based on the PRECEDE model, covering demographic characteristics, behavioral and environmental factors, as well as predisposing, reinforcing, and enabling factors. The study population consisted of 240 (57.6%) males and 177 (42.4%) females. Multi-variable analysis showed that environmental factors (β = 0.16, p < 0.01) and reinforcing factors (β = 0.12, p = 0.04) were significant positive predictors of preventive behaviors. Additionally, education level, marital status, hearing aid use, and insurance coverage demonstrated significant associations with RTI preventive practices (p < 0.05). The PRECEDE model offers a useful framework for understanding RTI preventive behaviors among old pedestrians. To reduce RTI incidence, public health interventions should prioritize environmental modifications and strengthen reinforcing factors, while tailoring safety programs to the specific demographic and physiological needs (e.g., sensory impairments) of the older population.