Assessment of increased knowledge about traffic accidents prevention, one month after a presentation included in the program "it can happen to you" of AESLEME

Road traffic accidents cause over 1.3 million deaths annually worldwide and substantial morbidity and economic losses. In the EU, approximately 23,000 people die and 1.5 million are injured each year; Spain ranks among the safer countries but still records around 1000 deaths and over 130,000 injuries annually. While multiple prevention measures exist (infrastructure improvements, enforcement, restraint systems, safer vehicle design), school-based road safety education is considered key for establishing safe mobility habits. However, the effectiveness of school campaigns is under-studied and shows mixed or limited evidence regarding crash prevention. AESLEME, a Spanish NGO with three decades of experience, provides road safety education led by health professionals and crash survivors who share personal stories to enhance credibility and engagement. Grounded partly in Protection Motivation Theory, which emphasizes perceived severity and vulnerability, the program aims to convey both knowledge and emotional salience. The study’s objective was to assess whether a school-based AESLEME presentation increases students’ road safety knowledge one month after delivery.

Prior research and public health guidance emphasize multifaceted road safety strategies (WHO, DGT). Evidence on school-based traffic safety education is mixed: some reviews and trials report limited or unclear effects on crash reduction, while others suggest benefits when programs are educationally robust and tailored to student profiles. Psychological measures of attitudes can be complex and may not predict future crashes. Protection Motivation Theory supports the role of perceived severity and vulnerability in behavior change. Studies have associated greater knowledge and risk perception with safer behaviors among youth, though some authors argue that increased knowledge alone does not necessarily translate into safer behavior due to social and contextual influences, including parental and peer norms. Programs may be strengthened through experiential components like supervised practical training in safe urban circuits.

Design: Pre–post quasi-experimental study with a convenience sample based on school accessibility and willingness to participate. Participants: 8106 students aged 12–14 years (last year of primary and first two years of secondary school) across multiple Spanish regions. Intervention: AESLEME instructors (health professionals and crash survivors) delivered 60–90 minute interactive presentations covering epidemiology of road accidents, risk factors, prevention measures, and consequences (including personal testimonies of spinal cord injuries). Measures: Two identical 12-item multiple-choice tests (four options; one correct) approved by the Spanish Directorate-General for Traffic were administered in class: one immediately before the presentation and another one month later; each took approximately 10 minutes. Questionnaire collected demographics and school/region identifiers; responses were anonymous. Outcomes and analysis: Responses were scored correct/incorrect. Due to anonymity, individual-level pairing was not possible; analyses compared aggregate averages and percentages of correct answers before vs. after. Odds ratios (ORs) for correct vs. incorrect answers and chi-squared tests with 95% confidence intervals were computed using Epi Info StatCalc, overall and stratified by region. Additional descriptive summaries examined distributions of total correct answers (in quartiles) pre- vs. post-intervention.

• Sample: 8106 students (ages 12–14) completed both pre- and one-month post-tests. • Overall Spain: Correct answers increased from 45,005 to 56,529 out of 97,272 total responses (12 questions × 8106 students) pre vs. post; chi-squared = 2726, p < 0.00001; OR = 1.61 (95% CI: 1.58–1.64), corresponding to a 61% increase in odds of correct responses (95% CI: 53%–64%). • Regional ORs (increase in odds of correct answers): Andalusia OR 3.78 (95% CI: 3.54–4.04; +278%); Aragón OR 1.89 (95% CI: 1.75–2.05; +89%); Canary Islands OR 1.08 (95% CI: 1.05–1.12; +8%); Castilla-La Mancha & Madrid OR 3.41 (95% CI: 2.99–3.90; +241%); Extremadura OR 2.26 (95% CI: 2.11–2.42; +126%); Basque Country OR 1.68 (95% CI: 1.64–1.73; +68%). • Distributional shifts: In Spain, the proportion of students scoring in the highest quartile (10–12 correct) rose from 12.2% pre to 29.62% post; lowest quartile (1–3 correct) decreased from 28.57% to 20.29%. Notable regional improvements included Andalusia (Q4 from 4.25% to 60.95%) and Castilla-La Mancha/Madrid (Q4 from 9.1% to 61.6%). • Age and sex showed no meaningful differences in outcomes within this narrow age band.

The intervention achieved its objective of increasing road safety knowledge, with statistically significant gains sustained one month post-presentation across Spain and all reported regions. The combination of factual content and emotionally resonant testimonies likely enhanced attention and retention, aligning with Protection Motivation Theory by increasing perceived severity and vulnerability. The consistency of effects across diverse settings and instructors supports the reliability and generalizability of the educational approach within similar school contexts. Although knowledge gains do not directly equate to behavioral change or crash reduction, prior literature suggests that robust, context-appropriate education coupled with practical experiences can contribute to safer behaviors. The null findings for age and sex within this narrow range are consistent with expectations that these variables exert minimal influence on short-term knowledge acquisition in early adolescence.

This large-scale, school-based study demonstrates that AESLEME’s road safety presentations significantly increase students’ knowledge one month after delivery, with an overall 61% increase in the odds of correct answers and regional gains ranging from 8% to 278%. The approach—integrating didactic content with survivor testimonials—appears effective and replicable across regions. Future research should assess longer-term knowledge retention, translation into behavioral change, and impacts on crash and injury outcomes using longitudinal cohort designs with appropriate control groups. Enhancements such as practical on-road simulations or supervised safe-circuit training and integration with broader family and community road safety climates may further improve effectiveness.

• Anonymous testing precluded individual-level paired analysis and limited the range of statistical methods. • Post-test administration depended on school logistics, leading to incomplete regional coverage; however, collaborating schools are not believed to introduce response bias. • The study measures knowledge gain, not behavior or crash outcomes; thus, causal inference about accident prevention cannot be made without long-term follow-up. • Convenience sampling may limit generalizability beyond similar school settings and age groups.