Title: NIHR Global Health Research Group on Road Safety, University of Southampton
Funder: Department of Health and Social Care

Abstract: The University of Southampton (UoS) is in the top one percent of world research-led universities, and is a founding member of the UK Russell Group. Its position as a top UK research university was reaffirmed in 2014 following the publication of the national Research Excellence Framework (REF), which found 84% of UoS’ research activity to be internationally excellent/of world-leading quality. Central to this achievement are our international collaborations. UoS’ overarching mission is to ‘change the world for the better’ sustained by continuing to strengthen the societal impact of our research. Tackling the global issue of road safety for improved public health, particularly within LMICs, supports this mission. TRG is the locus for the University’s interdisciplinary transport research, enterprise, and knowledge exchange, with links across Faculties (including Medicine) and with local and national stakeholders. TRG sits within the Faculty of Engineering and the Environment (FEE), which ranked top in the UK for its Research Power Index in General Engineering (2014 REF). TRG (est.1967) is the UK’s first centre for transport research and teaching, and is amongst the leaders in the field. TRG has a long standing history in road safety research, centring on three core themes: Road accident predictive modelling, vulnerable road user behaviour and protection, and driver behaviour. Moreover, TRG has been central in advising on national road safety policy and practice (e.g. Hickford and Hall, 2004; 2009), and is a member of the Parliamentary Advisory Council for Transport Safety. TRG’s aim is to secure safer and more sustainable transport systems, both nationally and globally; viewing transport as a socio-technical system, addressing the interaction between technology (vehicles, infrastructure, informatics etc.) and society (users, operators, Government etc.). See: Research Capacity section for more detail. For the successful delivery of GHRG’s aims we have partnered with three leading academics in the Faculty of Medicine (ranked second by intensity-weighted grade-point average in UoA2, REF14), incl. Prof. Roderick, who sits on the steering group of the University’s Global Health Research Institute and Prof. Deakin who is employed by the NHS Trust as the Divisional Medical Director for Hampshire's South Central Ambulance Service. The GHRG builds on pre-existing links in LMICs at UoS. These include those with: Prof. Wu and Tsinghua University (links with the UK-China Intelligent Transport Systems Centre), BUET, (established by UoS on climate change, sea level rise, and their impact on delta regions); NUCE (established by Prof. Preston); Strathmore, established by Prof. Stanton in a previous project training Human Factors (HF) methods for a medical application. Three of these links are continued by TRG alumni at the overseas institution. The UoS has a strong track record of working in international projects, especially in the European Framework Programme. Recently, TRG has partnered with: other European Universities on HF in Automated Automobiles (e.g. Chalmers, Sweden; Delft, The Netherlands; IFSTTAR, France; and TUM, Munich), which aims to improve road safety via vehicle automation; and UK Universities on vehicle automation (e.g. EPSRC/JLR funded TASCC programme, incl. Birmingham, Cambridge, Surrey, and UCL). Whilst these projects focus on automobile automation, road safety is a key priority. The current STARS proposal aims to investigate broader aspects of road safety, sharing some of the methods and approaches used in the current projects on automation. A three-phased approach is proposed to model current road system performance, develop road safety solutions, and evaluate these using simulated and naturalistic studies. The research will focus on all road user groups (e.g. pedestrians; cyclists; motorcyclists; car, van, and lorry drivers) to develop sustainable interventions to reduce conflicts between road users. In Phase 1 each LMIC will collect data from a range of activities, including: observational studies, on-road trials, interviews with subject matter experts (SMEs), document review, and site assessments. Data will be collected from relevant LMIC stakeholders (e.g. road users, emergency responders, medical experts, engineers and designers, policy makers) to understand the various opinions on the nature and performance of different road types; and coupled with information audits to identify the most dangerous roads and their users (incl. the most vulnerable users). This audit will ensure the requirements generated are relevant to LMIC stakeholders. This data will be used to develop models for the current road system using two systems-based modelling methods: Hierarchical Task Analysis (HTA) (Stanton, 2006; Stanton et al, 2013), which normatively describes the system, i.e. what is currently happening; and Cognitive Work Analysis (CWA; Jenkins et al., 2009), an ecological interface design framework for formative modelling of what could potentially happen. Both methods are widely applied across other safety critical domains. It is acknowledged that decisions made at the design stage can have a significant impact on the level of death and injury on a road (WHO, 2015), and are therefore an essential component of the project. The outputs of each method will be used in a complementary manner to inform both the evaluation of the existing road system, and develop novel countermeasure specifications. An iterative approach involving regular communication between LMIC institutions will be used to review and refine the project outputs. Phase 2 will specify and prioritise countermeasures: (i) Stakeholder and SME (e.g. safety managers, road engineers and designers) engagement workshops to generate novel countermeasures to improve road safety (ii) CWA: to generate countermeasure design specifications in terms of tools, interfaces, task allocation, and social factors (i.e. how different road users interact with the system) (iii) CWA: to model the effects on system performance of candidate designs (Jenkins et al., 2009; Read et al., 2016). Input from SMEs from each of the partner organisations will be essential to ensure the validity of the resulting analyses. The output of this process will be a rank ordering of countermeasures (based on analysis using the models, existing evaluation literature, and economic modelling and opportunities for implementation) (iv) Countermeasure refinement using HTA and its range of extended analysis modules (e.g. error identification) to refine countermeasures identified in steps (i) and (iii). Phase 3 will evaluate and refine countermeasures using advanced driver simulation. This approach is a well-established and rigorous approach to test all possible system-based countermeasures. Equipment costs have been included to equip each LMIC institution with their own portable driving simulators. Between 4-8 simulator studies will be conducted at each institution, each likely comprising 24 participants per study consisting of relevant road users. This will include base-lining performance against countermeasures typically used in the target countries (developing these where they don’t exist). Phase two and three activities of design and evaluation will continue into the 3rd year. Where possible, solutions will be tested in naturalistic environments (e.g. new educational programs, new infrastructure solutions, new road policy and regulations, revised emergency response processes etc.) in preliminary studies. The first six months of the project will be used to: develop strong relationships within the project team across all of the institutions. Bi-annual face-to-face 5-day workshops hosted in turn by each institution will be used to support LMIC partners at each key project phase. In the intervening time regular support via Skype, email, and individual travel (as necessary) will also be provided. Months 0-6 will centre on: fostering strong links with relevant stakeholders through workshops, and undertaking information audits in the LMIC countries as a requirement generating exercise. This will also see the completion of the NIHR review, for which we will deliver the following targets: 1. Detailed work plan (remaining 30 months of the GHRG), incl. agreed milestones and project management plans (PRINCE2) 2. Definition of LMIC case study sites for initial data collection activities 3. Project risk register and proposed mitigating strategies (continually reviewed and updated at bi-annual meetings) 4. Stakeholder database 5. Identification of dissemination activities and timeline for dissemination plan 6. Start of the development of driving simulators for each of the 4 partner institutions (e.g. technical specification) 7. Start of observational studies (e.g. experimental design protocol). Medium-term aims include training partners in associated data collection and modelling methods, and implementation of these approaches in the LMIC target areas (i.e. Phases 1 and 2); simulator set up at each LMIC institution. Long-term aims are to design and evaluate emerging countermeasures from Phases 2 and 3. The impetus for the project is upskilling academics and practitioners in the LMIC institutions in road safety research and practice in their respective countries, to drive their road safety agenda forward and ensure a continued impact on global health by reducing accident rates and seriousness of injuries. The provision of desktop-based driving simulators for each LMIC partner will enable self-sufficiency in generating evidence-based practice for road safety research (see: Additional information for simulator specification). Research links will be sustained by staff/student exchanges, and levering in of complementary funding for research and knowledge exchange and developing with international bodies (WHO, International Transport Forum, Volvo Foundation, Toyota Foundation)

Lay abstract: Low- and Middle-Income Countries (LMICs) have more than twice as many road traffic fatalities (per head of population) compared to high-income countries (WHO, 2015). Whilst these countries represent 82% of the global population, they only represent 54% of registered motor vehicles, thus they have a disproportionate number of deaths relative to their level of motorisation (WHO, 2015). The overall goal of our GHRG is to reduce the number and severity of road accidents in LMICs through our underpinning philosophy of “local solutions for local problems”. Pre-existing relationships have enabled us to identify four target LMICs for collaboration in the GHRG. These represent a range of economic development: A least developed country (Bangladesh via Bangladesh University of Engineering and Technology), a low-income country (Kenya via Strathmore University), a lower-middle income country (Vietnam via National University of Civil Engineering), and an upper-middle income country (China via Tsinghua University). The estimated road traffic death rate per 100,000 of the population in these countries is as follows: Bangladesh (13.6), Kenya (29.1), Vietnam (24.5) and China (18.8). In contrast, the rate for the UK is 2.9 (WHO, 2015). We do not set out of impose a westernised view of road safety; instead we seek to capture the current challenges facing these countries and, in collaboration with our LMIC partners, develop and evaluate relevant and realistic solutions. Traditional road safety research has been characterised by the ‘3 E’s’ of Engineering, Enforcement and Education. Although they have provided guidance to engineers and policy makers, they do not go far enough at providing a holistic and integrated approach to road safety and fail to consider fully the wider system factors that shape road user performance and outcomes. The STARS project intends to tackle road safety from a ‘7 E’s’ perspective, with the inclusion of Ergonomics, Economics, Emergency response, and Enablement. There are four overarching objectives for achieving this work: 1. Capture the current situation in each LMIC through local data collection of the road transport system 2. Develop solutions and countermeasures from a socio-technical systems-based perspective based on the local data 3. Evaluate these solutions in simulated environments (a significant output of the project is establishing simulator facilities at each LMIC institution) 4. Disseminate findings at local and national levels in order to shape the interventions, policy and regulations to reduce road crashes and associated public health trauma. This will enable us to deliver measurable benefits, primarily targeting a reduction in loss of life from road crashes by designing safer systems, but also aiming to reduce injury severity by improving the coordinated multi-agency effort of emergency responders. Road traffic injuries incur a heavy economic burden, estimated to be $2 trillion worldwide in 2010 (iRAP, 2013; DfT, 2016).Therefore we will employ well-established techniques to demonstrate the economic costs of road accidents and gains which can be made through safer systems. We will also address the indirect benefits of safer road systems including increasing physical health through more active transport choices and the associated improvements in congestion and pollution. Above all, we aim to equip our target countries with the knowledge and resources to continue to make their roads safer after the project has finished.

Research activity codes: 3.5 RESOURCES AND INFRASTRUCTURE (PREVENTION)
Health categories: INJURIES AND ACCIDENTS