Improving children’s traffic safety from a safety literacy perspective: A randomized trial

Objective: Road traffic injuries are a leading cause of child death. This study evaluated the effectiveness of an integrated intervention comprised of adult guidance of peer discussion in response to traffic safety videos eliciting emotions of fear and threat, plus and engagement in a virtual reality (VR) pedestrian environment to improve children’s traffic safety literacy, including skills to negotiate traffic safely. Methods: Following screening, 120 children aged 9 to 13 years who scored high or low in traffic safety literacy were randomly assigned to a control (N = 60) or intervention (N = 60) group, stratified by traffic safety literacy and gender. All children completed baseline and post-intervention assessments to assess traffic safety literacy and street-crossing behaviors in a VR environment. Between assessments, children in the intervention group received adult-guided peer discussion training to improve traffic safety knowledge and attitudes, and also engaged in VR-based street-crossing behavioral training once a week for four weeks. Children in the control group received routine safety education in school. Results: Three primary results emerged: (a) children in the intervention group with low baseline traffic safety literacy demonstrated significantly greater improvement in all aspects of traffic safety literacy (traffic knowledge, traffic safety attitudes, traffic behaviors, and traffic safety self-efficacy) compared to children in the intervention group with high baseline traffic safety literacy and all children in the control group; (b) all children in the intervention group demonstrated safer and more efficient traffic behavior in the VR following training compared with children in the control group; (c) children in the intervention group demonstrated improved traffic behavior throughout their training despite a methodological challenge emerging with a two-week delay between the third training and the fourth training due to COVID-19 restrictions. Conclusions: The intervention effectively improved children’s traffic safety literacy, especially among those children with low literacy at baseline.