Interventions for motor vehicle crashes among Indigenous communities: strategies to inform Canadian initiatives.

OBJECTIVES Motor vehicle crashes (MVCs) are a leading cause of death for Canadian Aboriginal peoples; developing effective interventions should be a public health priority. While intervention research has been conducted outside of Canada, few formal program evaluations have been conducted in Canada. We reviewed Canadian and non-Canadian Indigenous road safety initiatives to inform future program development in Canada. METHODS A systematic review of the published and grey literature examining MVC intervention programs in Indigenous communities was performed. Studies published after 1980 reporting pre-post comparisons of MVC interventions in Indigenous communities were included in the review. These studies were assessed using a modified Participatory Action Research quality assessment tool. Haddon's Matrix of injury epidemiology and prevention was used to categorize crash-related risk factors targeted in the MVC interventions. SYNTHESIS A total of 11 studies met inclusion criteria, including 1 Canadian study and 10 non-Canadian studies. Successful intervention components included focus groups, training community members, educational activities, distribution of safety devices, collaboration with local law officials to enhance enforcement, driver-licensing courses, and incentive programs. Potential barriers to successful implementation and evaluation involved lack of incorporation of cultural and contextual factors, enforcement factors, and methodological limitations. CONCLUSION Several effective strategies to reduce MVCs can be adapted and implemented at the community and national levels. Future directions might include using multiple intervention components and incorporating a collaborative, culturally and contextually appropriate approach, while promoting evaluation initiatives and widespread dissemination of findings.