Development of a Participatory Model for Road Traffic Death Prevention Driven by the District Health Board (DHB): The A²S³HC Model

Abstract

     This participatory action research (PAR) aimed to develop a spatial-based safety intervention in Chaloem Phra Kiat District, Buriram Province, to  (2) develop a participatory model for road-traffic death prevention through the DHB mechanism; and (3) evaluate a pilot implementation of the resulting model on knowledge and safe-riding behavior. A sequential multiphase mixed-methods design was applied within a three-phase participatory action research (PAR) cycle following Kemmis and McTaggart's Plan–Act–Observe–Reflect framework, conducted between 2023 and 2026. Phase 1, a retrospective descriptive study, analyzed secondary data from the Thai Road Safety Center database (n = 407) using descriptive statistics and univariable logistic regression conducted by the research team. Phase 2, a participatory qualitative design, convened a model-development forum using the ORID process with purposively selected DHB network members (n = 30). Phase 3 implemented the resulting model's four components across the study area, evaluated at the community level through process evaluation and at the individual level through a one-group pretest-posttest quasi-experimental design among purposively selected motorcyclists involved in a crash or a traffic-law violation in the study site (n = 41).

     Univariable analysis showed that victim role was significantly associated with death: drivers had substantially lower odds of death than passengers (crude OR = 0.21; 95% CI = 0.09–0.51; p < .001), whereas sex, time of crash, and helmet/seatbelt use were not significantly associated with death in this analysis. These descriptive and univariable findings informed the A²S³HC model, comprising four components: Analysis and Agreement, Spot Improvement/Signage/Social Measures, Helmet Campaign, and Checkpoint. In Phase 3, six high-risk points were addressed, a community surveillance network was established, and the individual-level program raised traffic-law knowledge scores by 4.29 points (95% CI = 3.54–4.84; p < .001; Hedges' g = 2.01 [1.48, 2.54]) and improved safe-riding behavior scores by 1.02 points (95% CI = 0.95–1.09; t = 29.007; p < .001).