Photovoice: Children's perspectives on road traffic safety in ten countries

BACKGROUND - From 2008-2012, Safe Kids Worldwide implemented a community-based participatory research photojournalism project entitled, PHOTOVOICE: Children's Perspectives on Road Traffic Safety, to gain an enhanced understanding of children's walking environments in 10 low-, middle- and high- income countries.METHODS - Safe Kids organizations conducted photography training and pedestrian safety education sessions with more than 2,255 students and collected observational and behavioral surveys, discussion notes, walking maps, and pre- and post-tests through convenience sampling. Findings were used to identify high-risk areas and make appropriate environmental modifications to improve pedestrian safety through education, engineering and advocacy. RESULTS - Pedestrian safety knowledge scores increased by an average of 25% (p<0.0001) from pre- to post-tests. Behavior surveys showed that among children, most walk to and from school, most walk alone, and most feel safest while walking in areas near home. Observational surveys showed that infrastructure deficiencies were the highest-rated problem for sidewalks. Highest observed unsafe environments included sidewalks blocked by cars, trash and vendors; lack of painted crosswalks and lack of traffic signals. Permanent modifications were made to the environments where children walk in 39 communities in the US and more than 10 communities in countries based on the findings of the participatory research. CONCLUSION - The participatory research project not only increased pedestrian safety knowledge and behavior in communities but also served as an effective needs and risk assessment tool. The results also showed that the project is feasible and replicable across low-, middle- and high income countries.