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Highway Safety Behavioral Strategies for Rural Areas (2023)

Chapter: Toolkit (Task 7)

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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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Suggested Citation:"Toolkit (Task 7)." National Academies of Sciences, Engineering, and Medicine. 2023. Highway Safety Behavioral Strategies for Rural Areas. Washington, DC: The National Academies Press. doi: 10.17226/27196.
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108 Toolkit (Task 7) Using the information identified in Phase I of this project, Task 7 included the creation of the “toolkit” that will provide key rural stakeholders, who address traffic safety, with guidance about applying best- practice strategies to improve traffic safety by changing behaviors. Task 7 was broken into four subtasks including (7A) identifying and reviewing existing toolkits; (7B) developing the toolkit outline, format, and process; (7C) drafting the toolkit contents and layout; and (7D) sharing the draft toolkit for usability. Identifying and Reviewing Existing Toolkits The goal of the first subtask was to identify and review existing toolkits addressing traffic safety as well as other public health issues (such as the reduction of misuse of controlled substances, violence prevention, etc.) to inform the design and contents of the toolkit. To support this effort, the research team reviewed 14 different resources addressing traffic safety as well as other health issues. Table 29 summarizes the resources (e.g., documents and websites) that were reviewed. These were selected based on the Phase 2 workplan. Additional documents were added based on the experience of the research team or recommendations of those interviewed (see below). Table 29. Existing Resources Reviewed Resource Name Format NHTSA’s Countermeasures that Work (Tenth Edition) document FHWA’s Proven Safety Countermeasures website FHWA’s Improving Safety on Rural Local and Tribal Roads Safety Toolkit website FHWA’s Roadway Safety Data Program Toolbox website The Community Guide website IHS Selected Evidence-Based Strategies for Preventing Injuries document AAAFTS Evidence-Based Behavior Change Campaigns to Improve Traffic Safety Toolkit document Traffic Injury Research Foundation’s Community-Based Toolkit for Road Safety Campaigns website FHWA’s Local Road Safety Plan Do It Yourself Website website National Center for Rural Road Safety’s Rural Intelligent Transportation System Toolkit website Rural Health Information Hub’s Rural Transportation Toolkit website Substance Abuse and Mental Health Services Administration website Connecting Transportation & Health document HiAP Guide document

109 The project team reviewed and captured the following information for each resource: • Resource name and link • A brief description of the resource (e.g., intended audience, basic purpose, basic contents) • Specific content relevant to rural traffic safety • Any noteworthy design features such as how the resource is organized or how each idea is described (such as intervention type, audience, outcomes, etc.). The full write-up for each resource can be found in Appendix E with a summary table found in Table 30. Table 30. Summary of Reviews of Existing Resources Resource Name Format Content Relevant to Rural Traffic Safety Noteworthy Design Features NHTSA’s Countermeasures that Work (Tenth Edition) document Several behavioral countermeasures for rural areas Comprehensive, organized by problem areas FHWA’s Proven Safety Countermeasures website Many engineering countermeasures for rural areas Accessible information searchable on website FHWA’s Improving Safety on Rural Local and Tribal Roads Safety Toolkit website Guides planning to improve rural/tribal traffic safety using a seven-step process Technical content included in a hyperlinked website FHWA’s Roadway Safety Data Program Toolbox website Extensive content organized in four categories: manage, analyze, collect, and research Easy to use interface; however, the large number of resources may seem overwhelming The Community Guide website Several behavioral strategies for rural/tribal communities Straightforward table including level of evidence of effectiveness IHS Selected Evidence- Based Strategies for Preventing Injuries document Includes three core strategies: car seat use, seat belt use, and impaired driving prevention Short, easy to use document AAAFTS Evidence-Based Behavior Change Campaigns to Improve Traffic Safety Toolkit document Content on campaigns which is relevant (but not specific) to rural/tribal communities Clear guidance describing steps with additional information in appendices Traffic Injury Research Foundation’s Community- Based Toolkit for Road Safety Campaigns website Content on campaigns which is relevant (but not specific) to rural/tribal communities A series of fact sheets on different aspects of road safety campaigns

110 Table 30. Summary of Reviews of Existing Resources (Cont.) Resource Name Format Content Relevant to Rural Traffic Safety Noteworthy Design Features FHWA’s Local Road Safety Plan Do It Yourself Website website A four-step process for developing a local road safety plan usable by rural/tribal communities Website is easy to navigate and includes short videos National Center for Rural Road Safety’s Rural Intelligent Transportation System Toolkit website 42 rural transportation critical need fact sheets for transportation practitioners Guidance is provided in separate PDF documents; includes a primer about the toolkit Rural Health Information Hub’s Rural Transportation Toolkit website Extensive content about rural transportation, but very little addressing safety None noted Substance Abuse and Mental Health Services Administration website Resources addressing contributing factors to impaired driving Some resources are complex; some are more accessible and action oriented for practitioners Connecting Transportation & Health document Content that supports growing connections with public health which is relevant to rural/tribal communities Important ideas are highlighted and easy to identify Health in All Policies Guide document Content that supports growing connections with other stakeholders (e.g., public health, policy makers) which is relevant to rural/tribal communities Well organized and includes “Food for Thought” sections In addition, the research team conducted four interviews with stakeholders to gather additional insights about available resources and the outline. The stakeholders were also asked about any additional resources. Table 31 lists the individuals who were interviewed. These individuals were selected because they routinely work with rural communities on traffic safety in a variety of roles. Table 31. Individuals Interviewed Name and Role Matthew Ulberg, P.E. Montana Local Technical Assistance Program Director Adam Larsen, Safety Engineer & Safety Program Manager, Tribal Transportation Safety, FHWA LCDR Molly Madson, Injury Prevention Specialist, Indian Health Service Samuel Sinclair, Regional Program Manager, NHTSA

111 The interview questions were reviewed and approved by the Institution Review Board for research with human subjects at Montana State University (the full protocol is included in Appendix F). These individuals were asked the following questions: • What is your primary role and who do you typically work with? • What resources or information do you rely on most heavily in your work? • Alternative, if needed: when you’re stuck, what do you reach for or where do you look online? • Why are these your preferred resources? What do you like best about them? • Do you use any of the following resources with those you serve? • What do you like about these resources? • What do you find challenging? • When you think about those you serve, what would make these resources more effective? • Any specific suggestions for how the resources could be improved for rural traffic safety? • What do you wish you had to facilitate traffic safety improvements in tribal and rural areas? • Do those you serve engage in a process to guide what they do? If so, what process? If not, would a process be helpful? • Currently, the thought is to divide the toolkit into two separate categories including general process information and intervention specific information. What are your thoughts on this? • Do you have any other suggestions as we move forward in developing a resource for those working on rural traffic safety? The interviews provided an opportunity for the research team to better understand the challenges and needs of rural and tribal communities as they address traffic safety – especially using behavioral countermeasures/strategies. The interviews also revealed insights about how current resources were being used (or even if practitioners were aware of the existing resources) and what additional resources might be helpful. The following is a summary of the key themes revealed in the interviews. • Primary Role – All those interviewed provided various forms of technical assistance to either other stakeholders or to individuals directly working on improving traffic safety in rural and/or tribal communities. • Resources or Information Utilized – The most noted resources were NHTSA’s Countermeasures that Work and FHWA’s Proven Safety Countermeasures (also mentioned were AASHTO documents and FHWA’s Every Day Counts). Some had their own documents that they had developed (e.g., IHS’s Selected Evidence-Based Strategies for Preventing Injuries). – Besides Countermeasures that Work and Proven Safety Countermeasures, other resources listed in Table 29 were not widely recognized.

112 • Perceived Value and Challenges of Resources – Countermeasures that Work and Proven Safety Countermeasures were recognized as comprehensive and generally accepted as the core resources for traffic safety work. – It was noted that resources need to be short, avoid too much jargon, and be readily accessible for practitioners with diverse (and sometimes limited) professional backgrounds and often limited time. – Online training can be a challenge for some rural areas because of limited internet and computer access. – Some contexts require more cultural knowledge such as understanding historical trauma and issues of sovereignty when working with tribal communities. • Resources Needed in Rural and Tribal Areas – Lack of financial resources supporting traffic safety work was a common theme. In some cases, there are no staff who have time to work on traffic safety. In some cases, traffic safety work is performed by outside consultants. • Processes Used to Guide Traffic Safety Work – Basic planning processes are being used. Sometimes these are inhibited by a lack of local data. Sometimes, planning in rural areas is facilitated by state efforts (where state staff assist local areas in planning by providing data and facilitated processes). The injury prevention program overseen by the Indian Health Service provides grants and technical assistance to tribal communities to support their planning and implementation work. Developing the Toolkit Outline, Format, and Process The review of existing resources and interviews guided the development of proposed outline. The review revealed that there are several very strong resources available that may be under-utilized. The interviews revealed that many of those addressing rural traffic safety have limited time to focus on safety and often have less education/experience addressing traffic safety. The review and interviews highlighted issues such as accessibility (both in terms of accessing the resource as well as language, etc.), content (e.g., avoid repeating existing content and add new needed content), and ease of use (e.g., layout and graphical design). The research team proposed that the toolkit be a standalone PDF document. This format allows it to be readily shared on various websites (as well as printed and distributed if necessary). The proposed audiences for the toolkit include (but are not limited to): technical assistance providers, local/regional practitioners, engineers, public health practitioners/educators, policy makers, law enforcement, healthcare/EMS, and cooperative extension. The guidance avoids academic jargon, uses accessible language, and provides practical steps and actions appropriate for the proposed audiences. Instead of re-inventing existing resources, the guidance provides brief summaries so users can select which resources are most appropriate. As noted in the Phase 1 Final Report, very few behavioral countermeasures/strategies have been rigorously evaluated in rural contexts. Therefore, this toolkit includes information about adapting countermeasures/strategies with evidence of effectiveness found in urban areas to rural contexts. The guidance on adapting countermeasures/strategies is based on understanding how the countermeasure/strategy works (established in the section by introducing simple theories of change). The toolkit also includes information about growing evaluative thinking – an approach to growing more evidence about the effectiveness of countermeasures/strategies.

113 The following was the proposed outline for the toolkit. 1. Introduction a. Brief overview of the purpose of the toolkit, the intended audience, and how to use it b. Promote use across disciplines (e.g., use by traffic safety advocates, public health, planners, and engineers) i. Promote shared and specific responsibility for traffic safety ii. Connect to Safe System Approach c. Identify resources to support rural and tribal traffic safety improvement i. Promote the value of planning as a mechanism to secure funding ii. List potential resources to assist 1. Examples like the Safe Streets and Roads for All (SS4A) Program (federal funding available directly to localities including tribal communities which can support planning) 2. Others 2. How Behavioral Countermeasures/Strategies Work a. Introduce a simple theory of change b. Provide examples 3. Guidance on Process: What to do next a. Describe a high-level process: assess, plan, do, evaluate i. Provide summary of existing resources about process b. Promote use of diverse coalitions i. Provide summary of existing resources about coalitions 4. Guidance on Identifying, Selecting, and Adapting Countermeasures/Strategies for Rural and Tribal Communities a. Describe differences and similarities between engineering and non-engineering approaches i. Promote reducing silos between “behavioral” and “engineering” approaches to reducing fatalities and serious injuries b. Identify strategies appropriate for rural and tribal communities i. Include guidance on road types and issues common in rural areas ii. Include strategies/countermeasures identified in Task 4 iii. Include reference to GHSA’s forthcoming “Spotlight on Rural Road Safety” c. Identify guidance on processes to select countermeasures d. Provide guidance on adapting Countermeasures/Strategies i. Adapting countermeasures for local conditions while preserving effectiveness ii. Factors that Improve Effectiveness 1. Provide a tool stakeholders can use to consider factors that impact effectiveness 5. Guidance on Ways to Grow Evaluative Thinking a. Consider assessing the process and outcomes i. Provide simple examples b. Provide summary of existing resources about evaluative thinking Draft Toolkit Contents and Layout After receiving approval for the toolkit outline from the project panel, the research team began meeting at regular intervals to discuss and draft various sections of the toolkit. Each chapter of the toolkit includes an overview of the chapter topic, examples from rural or tribal communities, and additional resources. To make the toolkit easily understandable, tables, figures, and call out boxes are utilized to call out important information.

114 The toolkit, entitled Guidance for Improving Roadway Safety in Rural and Tribal Settings, contains the following chapters: • Introduction • How Behavioral Countermeasures/Strategies Work • Guidance on Process: What to Do Next • Guidance on Identifying, Selecting, and Adapting Countermeasures/Strategies for Rural and Tribal Communities • Guidance on Ways to Grow Evaluative Thinking Chapter 1: Introduction includes an overview of the Safe System Approach including details on the six principles and five elements. It also details who the toolkit is for, how to use the toolkit, and provides information on the training video (see Task 8). This chapter includes call out boxes highlighting quotes from the U.S. National Roadway Safety Strategy (U.S. DOT 2022a) and Equity Action Plan (U.S. DOT 2022b), and the additional resources listed in this chapter include potential sources of funding for rural and tribal communities. Chapter 2: How Behavioral Strategies Work provides a high-level overview of how behavioral countermeasures/strategies work and how to use a logic model to be more effective in selecting, adapting, and implementing countermeasures/strategies in the reader’s community. The chapter includes an example logic model (with additional ones in an appendix), a callout box on why logic models are valuable and provides a link to an additional training video and template on creating logic models. Chapter 3: Guidance on Process: What to do Next discusses the steps and resources to develop a plan to improve roadway safety. This can be useful to the reader in being more effective long term and in obtaining funding. The chapter discusses the planning processes laid out in three resources, benefits of participation by diverse stakeholders, and coalition resources. A callout box in this chapter provides some insights on community types based on the analysis conducted in Phase 1 Task 2 of this project. Chapter 4: Identifying, Selecting, & Adapting Countermeasures/Strategies discusses how rural and tribal communities can select countermeasures that are appropriate and feasible to implement in their community and whether adapting it to their local setting will maintain its effectiveness. The chapter starts with an overview of behavioral (laws, policies, rules; enforcement and adjudication; education; and intervention) and engineering (roadway design, roadway treatment, and managing energy). It then provides resources for identifying countermeasures. Appendix B provides examples for nine rural settings identified in the Phase I Task 3 interviews. Appendices C and D provide the names of countermeasures with evidence of effectiveness from the NHTSA (Venkatraman et al., 2021) and FHWA resources (FHWA, 2022). Next, the chapter provides a list of factors that communities should consider when selecting behavioral strategies and four reasons the reader may need to adapt a strategy. The callout boxes include an explanation of the stoplight approach for adaption and an example adaption in a rural community. The chapter closes with additional resources on adaption. Chapter 5: Guidance on Ways to Grow Evaluative Thinking discusses how to assess implemented strategies for what worked and did not work for the next time it is implemented. The chapter includes an overview of process and outcome evaluations, how they relate to the logic model created, and potential

115 ways to add evaluations. The chapter provides additional evaluation and evaluative thinking resources, as well as a link to find an evaluator partner. The layout of the toolkit was created to prioritize accessibility and usability. The final toolkit was created to be readily shared as a portable document format (PDF). It is best viewed through an Adobe PDF reader. The tabs on the side provide for easy navigation between the chapters. Text changes were also used to highlight particular information. Basic information is provided in regular text, highlighted information is in colored boxes, and key ideas regarding addressing equity are shown in highlighted boxes. Share Draft Toolkit To assess accessibility and usability of the draft toolkit, the research team shared it with a sample of stakeholders before submitting it to the project panel. Participants (federal, state, local, and tribal contacts of the research team) were recruited using email. Usability describes how well “people who use the product can do so quickly and easily to accomplish their own tasks” (Dumas, 1999). In assessing the usability of the guidance document, the research team sought to understand: • How well can readers quickly understand what the document is about? • How confident are readers that they can create a logic model? • How confident are readers that they can find resources to guide planning to improve traffic safety? • How confident are readers that they can find resources to identify potential countermeasures/strategies to improve traffic safety? • How confident are readers that they can find resources to help guide adapting a specific countermeasure/strategy for a community? • How confident are readers that they can identify potential process measures to assess for a behavioral countermeasure/strategy? The research team also asked participants for suggestions for improvements and additional resources. The research team divided the document into individual chapters (which included associated appendices) and then asked participants to complete an online survey using the Qualtrics platform. Users were presented one chapter (with associated appendices when applicable) at a time and then asked to complete questions about that chapter. The research team also asked the participants to watch the training video. Participants were also asked to identify their primary roles and at what levels (i.e., federal, state, local, and/or tribal) they mostly worked. Participants were provided two weeks to complete the survey which was estimated to take about two hours (which the research team recognized was a lot of time). Five individuals completed the survey which is a reasonable number for usability testing (Dumas, 1999). Table 32 shows the language used in the introduction to the usability survey. Table 33 shows the questions used to assess the roles and focus levels for the participants and summarizes the responses. Participants had a variety of roles and included individuals working at state and local levels.

116 Table 32. Introduction to Usability Survey Introduction This survey will ask you to read and provide feedback on a resource being developed to improve traffic safety in rural and tribal settings. There are five chapters and one training video to review. The survey will require about 2 hours to complete. You can stop and return to the survey at any time. We greatly appreciate your time in providing us feedback. If you have any questions or problems, please contact Jay Otto at jayotto@montana.edu. Thank you! Table 33. Roles and Focus Levels of Participants in Usability Study First, let us learn a little bit about you. What describes your current role? (Mark all that apply.) • Work to improve traffic safety within a specific community or region (3) • Provide technical assistance or guidance to individuals working to improve traffic safety (3) • Oversee funding or programs supporting traffic safety efforts (3) • Engineering or Maintenance • Public Health (2) • Other At what level do you primarily work? (Mark all that apply.) • Federal • State (3) • Local (3) • Tribal • Other

117 Table 34 summarizes responses about whether readers could understand the contents of the document. Overall, readers indicated they understood the contents and their responses to the open-ended question about the contents aligned. Table 35 summarizes responses about Chapter 2 which focuses on logic models. Readers were also asked to watch the training video (https://youtu.be/WHE8yyqqhCs) and review the appendices associated with Chapter 2. Overall, readers reported a high level of confidence that they could create a logic model for a countermeasure/strategy. None of the participants had ideas for specific additional information to include for this chapter.

118 Table 34. Summary of Responses About Chapter 1 Chapter 1 Please click on this link and read the Table of Contents and Chapter 1. [link] Were you able to read the Table of Contents and Chapter 1? Yes (5) No (0) After reading the Table of Contents and the Introduction, how well do you understand what this document contains? • Not well at all • Slightly well • Moderately well (2) • Very well (3) • Extremely well In your own words, what is this document about? • “This document is about improving rural roadway safety through the use of the safe systems approach.” • "That rural roads are more dangerous than other roads and we need to figure out how to change that, by utilizing the Safe System Approach.” • "Improving roadway safety in rural or tribal communities. A guide to help communities that may have limited resources. One critique I have is the term on pg. 2 ‘Redundancy is crucial’. In my experience, redundancy has a negative connotation. The description that comes after is good, but I this the headline of ‘Redundancy is crucial’ is not effective. Maybe something like ‘The system is the sum of its parts.’” • "This document is a tool to aid in pulling together those that are connected by a need/desire to address the dangers of rural roads. This tool will provide strategies and resources to implement a Safe System Approach, which is multifaceted, including safer people, safer roads, safer vehicles, safer speeds, and post-crash care." • “Explaining how to approach roadway safety”. Table 36 summarizes responses about Chapter 3 which focuses on planning resources. Overall, readers reported a high level of confidence that they could find resources to guide planning efforts. They also identified several references in the document that were new to them. One did note that the layout of the tables could be improved. This was improved in the final version. Table 37 summarizes responses about Chapter 4 which focuses on finding, selecting, and adapting countermeasures/strategies. Overall, readers reported a high level of confidence that they could find resources to identify potential countermeasures/strategies and reported a high level of confidence that they could make adaptions. They identified one resource that could be added: the Crash Modification Factors Clearinghouse. They also offered suggestions regarding formatting (i.e., bolding certain words, improving Green-Yellow-Red content) and clarifying a symbol used in Appendix C (i.e., “+”). This was addressed in the final version. Table 38 summarizes responses about Chapter 5 which focused on evaluation as well as comments about the guidance document overall. Readers reported a high level of confidence that they could identify potential process measures to assess for behavioral countermeasures/strategies.

119 Table 35. Summary of Responses About Chapter 2 and Associated Appendices Chapter 2 and Associated Appendices Please click on this link and read Chapter 2 and the associated appendices. [link] Were you able to read Chapter 2? Yes (5) No (0) Please click on this link and watch the training video on Logic Models. [link] Were you able to watch the training video on Logic Models? Yes (5) No (0) After reading Chapter 2 and watching the training video, how confident are you that you could create a logic model for a countermeasure/strategy (assuming you could find the information that you needed)? • Not at all confident • Slightly confident • Moderately confident (1) • Very confident (2) • Extremely confident (2) What additional information could help you be more confident to create a logic model for a countermeasure/strategy? • “It would depend on the particular strategy or countermeasure, so it’s hard to say. My guess that cost information would be hard to track down in some cases.” • “Very good video. Do not have any better ideas.” • “The video was super helpful and very well done. After initially reading Chapter 2, it felt like something was missing, then the link to video was shared! The video compliments the chapter very well.” • “Further discussion during Guide Calls with MSU, to work through process, get feedback, practice working the steps and completing the boxes, working with community partners to see how this process to include others in the work.” • “None, very well put together.”

120 Table 36. Summary of Responses About Chapter 3 Chapter 3 Please click on this link and read Chapter 3. [link] Were you able to read Chapter 3? Yes (5) No (0) After reading Chapter 3, how confident are you that you could find resources to guide planning to improve traffic safety? • Not at all confident • Slightly confident • Moderately confident • Very confident (5) • Extremely confident What material in this chapter was unexpected or new to you? • “The information on coalition resources, that is not something I necessarily find easily, so it’s nice to have it at the user's fingertips in a resource like this.” • “None.” • “I'm a public health professional, so the concepts in this chapter about engaging stakeholders, using data, and choosing solutions was very familiar.” • “The resources from NHTSA and the coalition resource links are new to me and I have been working in this field for a long time. Most working in public health have such limited time to ‘do the work’ we immediately spring to action without researching, gathering, reviewing and learning from available resources.” • “None” What suggestions do you have to improve this chapter? • “The tables can get a bit busy. It’s all good information that needs to be presented, but it also can be a bit much to get through rather than quick and to the point.” • “None.” • “I like it. It's simple and straightforward. Figure 3 and Table 1 are simple, yet effective. This does not take rocket science or advanced degrees to figure out. It takes a community of people concerned about an issue to solve it together.” • “I really like how each chapter is laid out with the five areas. This chapter provided a great overview of the process of Assess, Plan, Do, Evaluate and Learn.” • “Good.”

121 Table 37. Summary of Responses About Chapter 4 Chapter 4 Please click on this link and read Chapter 4. There are also appendices which you can briefly scan. [link] Were you able to read Chapter 4? Yes (5) No (0) After reading Chapter 4, how confident are you that you could find resources to identify potential countermeasures/strategies to improve traffic safety? • Not at all confident • Slightly confident • Moderately confident (1) • Very confident (2) • Extremely confident (2) After reading the guidance on adapting strategies, how confident are you that you could find resources to help guide adapting a specific countermeasure/strategy for a community? • Not at all confident • Slightly confident • Moderately confident • Very confident (5) • Extremely confident What suggestions do you have to improve this chapter? • “One other reference to include might be the Crash Modification Factors Clearinghouse. It also provides an indication of whether a countermeasure is effective and all countermeasures and the research/study behind them have been vetted by experts.” • “https://www.ghsa.org/sites/default/files/2021- 09/Countermeasures%20That%20%20Work%2C%2010th%20%20Edition.pdf Link did not work.” • “Bold the first line for each of the four reasons on pg. 23. On pg. 24, bullet out the ‘Green, Yellow, Red’ points in the green text box for readability.” • “This is another great chapter with so many wonderful resource links! Where has this been all my life (career)? :) I love how you included specific examples in specific communities, this makes it more tangible.” • “Appendix C - When looking at the Effectiveness column unless I missed it there is no definition on what the symbol ‘+’ is.”

122 Table 38. Summary of Responses About Chapter 5 and the Entire Document Chapter 5 Please click on this link and read Chapter 5. [link] Were you able to read Chapter 5? Yes (5) No (0) After reading Chapter 5, how confident are you that you could identify potential process measures to assess for a behavioral countermeasure/strategy? • Not at all confident • Slightly confident • Moderately confident (2) • Very confident (3) • Extremely confident Thinking about the document overall, how understandable is the document? • Not at all • Somewhat • Moderately • Very (4) • Extremely (1) Overall, how appealing is the document? • Not at all • Somewhat • Moderately (1) • Very (3) • Extremely (1) Overall, how valuable is the document to you? • Not at all • Somewhat • Moderately • Very (1) • Extremely (4) Overall, how valuable is the document to individuals working with rural and tribal communities to improve traffic safety? • Not at all • Somewhat • Moderately • Very (1) • Extremely (4)

123 Table 38. Summary of Responses About Chapter 5 and the Entire Document (cont.). Chapter 5 (cont.) What suggestions do you have to improve the document? • “Aside from my prior comments, none. It is a straightforward and easy to follow document.” • “The Figure 3 graphic on pg. 9 is very low resolution. Replace it with a higher resolution image. The content in the larger colored textboxes is great but gets somewhat lost because the text is paragraphed and all the same color. Considered bulleted out these boxes more or using a few different fonts for headers and body copy. The blue ‘Belief’, yellow ‘Behaviors’, and red ‘Consequences’ in Figure 1 is visually appealing and effective. Consider how this graphic and/or colors could show up more throughout the document.” • “You have done a great job providing examples, anytime they are provided it helps solidify the information is understood and initiates creative brainstorming by seeing what others have done in the field and if it can apply to your own area. It may be too large but showing a ‘case’ of one location (could even be fictitious) go through the entire process to show how they worked with community stakeholders, assessment tools, creation of a logic model, utilization of the Countermeasures/strategies, and specifics of the evaluation process would aid so much.” • “Very good document.” In general, readers reported the document was understandable, appealing, and had valuable content (valuable for themselves and for those working with rural and tribal communities to improve traffic safety). They reported high levels of confidence that they could apply the content. The participants identified several opportunities for improvement which the research team addresses in the final version.

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Rural roads have a higher risk of fatality or serious injury than urban roads due to factors such as varying terrain, wildlife, and long distances between services.

BTSCRP Web-Only Document 4: Highway Safety Behavioral Strategies for Rural Areas, from TRB's Behavioral Transportation Safety Cooperative Research Program, documents the overall research effort that produced BTSCRP Research Report 8: Highway Safety Behavioral Strategies for Rural and Tribal Areas: A Guide. Supplemental to the document is a PowerPoint presentation that outlines the project.

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