EFFECT OF A NURSE-LED TRAINING PROGRAMME ON KNOWLEDGE OF RISKY BEHAVIOURS AMONG MOTORCYCLE OPERATORS

2.0 Introduction

A review of literature was done using journals and textbooks on the following:

Definition of risky behaviors, types, manifestation, effect, preventive measures, road transport and safety, prevalence of motorcycle accident, concept of risky behaviour, component of Human behaviours, key variables of human behaviour changes conceptual model for knowledge to action model, Application of the model.

2.1 Definition of Risky Behaviour

These are series of activities and lifestyle behaviour that makes a person to be vulnerable to injury or harm that could cause disability (temporary or permanent) or instant death depending on the severity of the injury.(Onifade, Adurodola,&Amao, 2012).

2.2 Types of Risky Behaviour

The risky behaviours are classified into the following three categories as applied to the nature of the respondents as follows:

Traffic related risky behaviours: these include those risky behaviours associated with the disobedience or flouting of the road signs, traffic rules and regulations.

Substance-abuse related behaviours: these includes those risky behaviours associated with alteration of the mental status and alertness of the motorcycle operators which makes the operators to lose control and attention while riding making the motorcycle operator and the passenger to be prone to accident of varying degree and outcome.

Health –related risky behaviours: these are those risky behaviours that affect the health of the motorcycle operators leading to accidents or making the motorcycle operators and other people on the road as well as the passenger to be prone to injury, trauma, or death.

Other types could be road related in which the motorcycle operator is aware of the bad road at a particular bend or curve and still indulges in over speeding or disobedience to the traffic rules or it could be motorcycle related in which the motorcycle operator uses the motorcycle with defects for transportation like absence or dull head lamps, faulty brakes, poorly serviced motorcycle, absence of horn and riding with worn out tyres.

2.3 Manifestations of Risky Behaviours

Risky behaviours manifest in several ways. These could include over speeding e.g. riding above 50km/hr, riding without a protective gear like hand gloves, eye goggles and helmet, carrying more than one passenger with or without luggage, calling or receiving calls while riding, use of headphones while riding, riding under alcohol influence, flouting overtaking rules, riding on a fast lane, ignoring the traffic light indicator, lane violation, signal violation, riding when fatigued, carrying a passenger less than 8years old and riding under alcohol influence.

2.4 Effects of Risky Behaviours

These risky behaviours make the motorcycle operators more accident prone in the event of an accident. They could lead to worse outcomes such as more severe injuries, or prolonged coma .It could also include fracture of different bones of the body ranging from the skull to any part of the body e.g. the shoulder, skull, hip bone fracture,femoral fracture,radius and ulnar dislocations, amputation, loss of limbs,teeth, severe bleeding and death.

2.5 Preventive Measures

1. Learning of the road traffic signs, rules and regulation before becoming a motorcycle operator
2. Learning and riding at the acceptable speed limit.
3. Non violation of all traffic rules and traffic signals.
4. Avoidance of alcohol prior or during motorcycle operation
5. Wearing of reflective jacket at night
6. Seeking prompt medical attention when sick and getting due rest especially when fatigued.
7. Avoidance of the use of alcoholic beverages prior riding
8. Due maintenance of motorcycle and repair and replacements of damaged parts of motorcycle.
9. Keeping to all other highway codes and regulations.

2.6 Road Transport and Safety

Experts in the transportation industry have consistently emphasized the fact that nations with poorly developed transportation system will likely be among the less developed countries of the world because ‘immobility perpetuates poverty.’ Therefore, the relevance of motorized means of transportation within any given locality cannot be overemphasized, since access to and maintenance of, a carefully structured system of transportation remains the fulcrum around which the wheel of society turns, and is the pivot for industrialization, social interactions, choice of residence, and infrastructural developments (Oluwaseyiet al., 2014). Nations cannot attain any height of sustainable development if they do not have an efficient and sustainable transport system. Once a nation truly decides to embark on a large scale development of its transportation system, it must ensure that it not only improves access to the citizens’ places of vocation and residential areas, but in a safe and healthy manner, such that the risks of death and long-term disabilities are eliminated or reduced to the barest minimum (Lukasik &Szymanek, 2012).

Traffic safety is a general term that refers to the safety of all types of traffic: air, rail, and road. Similarly, safety of transport is the most important principle of each operating transport system. It is a basic component of all metrics of success .It could also be referred to as the negative performance of the traffic system to generate traffic accidents that involve injury or fatality. At the individual level, traffic safety is related to the absence of danger and experience of security. It could also be explained as the concept of traffic system which could be explained by systems theory which described the processes of the traffic system as dynamic and complex interactions between and among elements at various levels. The three main elements are usually identified as: the roadway infrastructure, the road-user, and the vehicle. It appears that "information noise" does not cover only the definition of road traffic safety. For example, the definitions of such key concepts as „road accident”, collision, crash, incident, near-accident, fatal accident, safety critical event, injury accident, accident severity, traffic violation and many others – are different depending on the source.

Traffic produces" different states of threats and adverse events, and some of them may be recorded. In particular it relates to near misses are the best available proactive predictor of safety. The first classification of events preceding the incidents concerned industry and was presented in the form of a model of the triangle, from the name of the author called later as Heinrich´s Triangle. Below the modern "road" version of Heinrich’s triangle. Hypothetical frequencies of "road events" comes from the many empirical studies, but they should be interpreted cautiously: driver error without hazard (1.000.000) = driver error with hazard (100.000) = near misses (10.000) = minor injury (1.000) = serious injury (100) = disabling injury (10) = fatal.

Basic dimensions of traffic safety: The easiest way road safety problem can be written in the following formula: the traffic safety problem = exposure x risk x consequences.

This record was the first time used in a simple descriptive model. These were introduced as the concept of "three basic dimensions of traffic safety" which are: risk = accidents/exposure or risk = (injures/exposure); consequences = (injures/accidents) or consequences = (fatalities/injures); andexposure (exposure of risk), defined by the measurement of exposure to accidents.

Nigeria has sought to develop its own transport system that would meet global standards. Various motorized means of transportation have been employed, including buses, mini-buses, and cabs. These conventional means of public transportation were besieged by recurring and worsening problems such as rapid industrialization, poorly planned urbanization, collapsing infrastructure and road networks, population explosion despite progressively decreasing number of vehicles leading to congestion, prolonged waiting and travelling times at bus stations, and inadequate security. This need made the demand for motorcycle higher among many commuters who usually experience difficulties getting to and from their residential or official quarters (Olubomehin, 2012).It was partly the failure of the regular means of commuting from one part to another that led to the emergence and perpetuation of the motorcycle also popularly used as an established mode of transportation in Nigeria. Motorcycle operation involves the use of motorcycle for commercial purpose, using it to operate within the communities and the local vicinities especially in the developing countries. The commercial motorcycle has been known by different appellations in different parts of the nation: Kabu-Kabu, Achaba, Last Flight, Going, Akauke or Alalok and Okada in Sokoto, Jos, Benin city, Lokoja, Kafanchan, Cross Rivers, AkwaIbom, and South- western states respectively. About 70 percent of most urban and semi-urban city dwellers in Nigeria largely depend on motorcycle operators for public transport services (Oluwaseyiet al., 2014).

The spread of the commercial motorcycle vocation was fuelled by the relatively cheaper spare parts, maintenance costs and greater fuel economy. Once they were introduced, commuters found that the motorcycles could go to areas where conventional vehicles could not go to and could beat traffic jams. These increased the patronage and made it a thriving vocation (Olubomehin, 2012).For a transport system to be sustainable, it should allow the basic access and development needs of individuals, companies and societies to be met safely, in a manner consistent with human and ecosystem health; it must also promote equality within and between successive generations, be affordable, operate fairly and efficiently, offer a choice of transport mode and support a competitive economy as well as balanced regional development and limits emissions and waste within the planet’s ability to absorb them. Such a system should use renewable resources at or below their rates of generation, and non-renewable resources at or below the rates of development of renewable substitutes, but must minimize the impact on the use of land and generation of noise Therefore, a properly functional transport system is pro-ecologic, economically viable and, above all, safe.

The development of such a sustainable, efficient and effective public transport system is connected, to a large extent, to the levels of safety experienced by commuters (Kruger &Landman, 2015). Safety can be guaranteed to a large extent by the efficient management of the different risks associated with the mode of transportation. Each mode of transportation has a variety of organizational and technological standards which each player in the industry must comply with to ensure overall safety of that means of transportation. Thus, the most important principle of all sustainable transport systems is safety; it is an indispensable component in all the indicators/parameters for measuring their success (Centre for Sustainable Transportation, 2011).

Road transportation has continued to remain a public health concern due largely to the heavy social costs it generates. These are largely from consequences of crashes/accidents, environmental degradation and congestion. Before the year 2000, global burden of road accidents was estimated at around 1% of the gross national product (GNP) in low-income countries, 1.5% in middle-income countries and 2% in high-income countries! Even in the nations of the European Union, a staggering 260 billion euros was estimated to have been spent in 2001 alone on various road transportation issues ranging from ‘costs’ from accidents, congestion, air pollution and noise. The breakdown of the expenditure revealed that road traffic accidents alone accounted for 58% of the whole, while congestion, emission/air pollution, and noise pollution took up 19%, 15% and 8% respectively (European Union, 2011). Thus, one of the main objectives in the efficient management of a sustainable road system of transportation is the elimination of road accidents, or at the least, limiting the number of ghastly/fatal accidents.

In other to improve the levels of safety of road transport, the various risk components need to be properly evaluated and addressed. An unsafe transport system refers to a failure of that means of transportation to prevent traffic accidents, especially those that cause long-term disabilities or death. For each individual, traffic safety must be related to the absence of danger and the feeling of security. Thus safety involves a dynamic and complex interplay of components which can be broadly categorized under the following elements: the roadway component and design, road-user, and the vehicle (Lukasik &Szymanek, 2012).

The risk of experiencing an unfavourable outcome during a journey is related to the exposure. Practically, for a particular exposure to accidents, a risk is the expected road safety outcome. The outcome is usually the number of accidents or victims of a certain type, but technically need not be. For instance, it could be in financial terms from the consequences of road accidents on the economy (European Commission, 2011). It then implies that when the infrastructure, road-user or vehicle is defective, there exists a higher risk of an unfavourable safety outcome. This idea has led to the formulation of various safety models to reduce the potential risks of road transportation.

The Netherlands, Sweden and United Kingdom have witnessed significant improvements in their statistics as a result of these models. For example, to facilitate traffic risk reduction, The Netherlands implemented various strategies which evolved from legislation on traffic rules and regulations, through improved road construction, passive safety, influencing road-user behavioural changes, simulating decentralization, sustainable safety measures, in-vehicle speed assistance, autonomous active safety, and finally to co-operative active safety.

To monitor the various strategies for risk reduction, safety performance indicators (SPIs) have been introduced to mirror those operational conditions of the road traffic system that affect the functions of the system in relation to its safety. The SPIs have basic ability to identify operational conditions of the road traffic system that are unsafe, and their non-relatedness to specific safety interventions. SPIs are designed to serve as aids in assessing the current safety conditions of a road traffic system, measuring impacts of various safety interventions, and recommending areas for innovative improvement (European Commission, 2011). Road safety can be assessed in terms of the social implications of accidents and injuries. However, simply counting crashes or injuries cannot perfectly reveal the level of safety of a road system. This is because accidents depict the worst outcomes of lack of safety in a transport system.

Safety Performance Indicator (SPI) is any variable which can complement the statistics of crashes or injuries to evaluate changes in the functions of road traffic systems, and can identify the early occurrence of safety problems before these concerns lead to accidents.Basic features of SPIs are their ability to measure unsafe operational conditions of the road traffic system and their independence from specific safety interventions. SPIs are aimed to serve as assisting tools in assessing the current safety conditions of a road traffic system, monitoring the progress, measuring impacts of various safety interventions, making comparisons, and for other purposes.

They employ information from numerical statistics and quality assurance records in arriving at a decision on how well a road safety programme has performed in relation to its objectives. The key areas of consideration include speed, the use of alcohol and drugs, compliance with protective systems, daytime running light, vehicles, design of roads, and trauma management (European Commission, 2011).The current reality is that while traffic engineers and safety regulators have focused largely on the roadway infrastructure and the vehicle, they hardly emphasize the information needs, limitations and mental capabilities of the roadway users. While risk factors contributing to motorcycle crashes include errors linked with road users, poorly designed roads and signs, and vehicle defects, studies have revealed that the human factors contributing to motorcycle accidents include the rider’s age, health fitness, pattern of alcohol use, fatigue, and level of education (Horswill. &Helman, 2012).

These accidents occur largely because a lot of the motorcycle riders are not licensed, have no regard for traffic rules and other road users, operate under the influence of alcohol, and have more than the stipulated number of commuters on each motorcycle (Onifadeet al., 2012). Studies aimed at identifying the factors associated with the rising incidence of motorcycle -related traffic crashes revealed that over-speeding, wrong methods of overtaking on the highway, bad roads, sudden mechanical faults, alcohol abuse and lack of compliance with Road Safety Highway Codes were major causes (Aderamo&Olatunjoye, 2013;Ogunmodede &Akangbe, 2013).

In the risk assessment are used two basic methods: 1. reference method, 2. substitution method. In more commonly used reference method is compared the calculated risk with a known and accepted individual and group risk or level of risk of natural hazards. Most risk area is divided into three levels:

1. Acceptable risk: is a risk, which for the purposes of life or work, everyone who might be impacted is prepared to accept assuming no changes in risk control mechanisms.

2. Tolerable risk: is a risk within a range that society can live with (1) so as to secure certain net benefits. It is (2) a range of risk that we do not regard as negligible or as something we might ignore, but rather as something we need to (3) keep under review and (4) reduce it still further if and as we can.

3. Unacceptable risk: risk cannot be justified except in extraordinary circumstances.

Risk selection shall be made between widely accepted risk and unacceptably risk. Between these two limits risks there is "tolerable area of risk” to which are used criteria for acceptance of risk.

ALARP (As Low as Reasonably Practicable) was introduced by the Health and Safety Executive. According to this principle - the best is choice so “low-risk as it is practically reasonable". In the ALARP model “area” of risk increase is divided into three areas/regions.

1. Broadly Acceptable Region (Risk is tolerable without reduction. But it is necessary to maintain assurance that it remains at this level);

2. ALARP or Tolerability Region (Risk is tolerable only if its reduction is impracticable or if the cost of reduction is grossly disproportionate to the improvement gained);

3. Unacceptable Region (Risk cannot be justified except in extraordinary circumstances).

Areas 1 and 2 are divided into broadly acceptable threshold, while areas 2 and 3 divides limit of tolerability threshold. In transport interpretation ALARP rule would be as follows: technical condition of means of transport, transport infrastructure elements, working processes (for example road traffic) – are so safe, as far as the estimated risks for them - separately and all together - "as low as it is practically reasonable". Risk control is then keeping residual acceptable at level of acceptable risk, such as a specific indicator calculated for the data from a specific year or period of time.

2.7 Prevalence of Motorcycle Accidents

The literature is replete with studies evaluating the overt components of the human contributions to motorcycle accidents. For example, most of the cyclists tend to be within the 20 – 30-year age bracket, a chronological period characterized by high-risk driving behaviours. This age group has been found in different studies to be related to a higher incidence of road traffic crashes in motorcycle operators, possibly because these individuals are inexperienced, more daring and reckless in their attitude (Ogunmodedeet al., 2012).Seventy-three percent of motorcycle operators interviewed in Oyo State (considered as one of the educationally-advantaged states in Nigeria) were found to have at most a secondary level education, while approximately 6% had no formal education whatsoever. This may mean that a good proportion of the motorcycle operator may not be able to appropriately decode and interpret highway codes/signs, thereby making them more accident-prone (Ogunmodedev &Akangbe, 2013).

Motorcycle operators conduct their business under various weather conditions. Sometimes, they are exposed to such harsh climate that they decide to indulge in alcoholic beverages, such as the locally brewed intoxicants in other to cope with the ensuing challenging health situations (Olubomehin, 2012). As shown by a study from southwestern Nigeria, the alcohol-drinking habits of motorcycle operator is facilitated by the proximity of alcohol peddlers and drinking points near their garages and parks (Oluwadiya&Akinola, 2012; Onifadeet al., 2012).Using subjective method of evaluation (i.e. perceiving the smell of alcohol on the motorcycle operators), motorcycle operators in Zaria, Northern Nigeria, and Jamaica were observed to be riding under the intoxicating influence of alcohol (Aganga, Umoh, &Abechi, 1983).This has also been accompanied by other high-risk behaviours that have led to fatalities on the highways, involving the operators and/or their commuters such as careless driving, reckless overtaking and non-compliance with traffic signals (Odero et al, 1997; Nakahara, Chadbunchachai, Ichnikawa, Tipsuntornsak, &Wakai, 2005; Clarke, Ward, Bartle &Truman, 2007).

According to Johnson (2012), motorcycle crashes continue to contribute significantly to the prevalence and patterns of road traffic accidents in the south of Nigeria. Of the 200 male commercial cyclists studied, 68.0% reported having been involved in at least one road crash, with 87.5% of those crashes occurring within one year before the study. Sixty-five percent of the riders attributed the last accident they had to excessive speeding, but almost 92% of the accidents occurred without protective helmets on the riders. Almost three-quarters of the injuries sustained by the riders were to the extremities. Significantly, more riders were under the influence of alcohol and driving with excessive speed when the crashes occurred.In a Kenyan district hospital, a study revealed that the high rates of head, chest and leg injuries in motorcyclists were responsible for the fatalities or severe morbidities they sustained. The authors also observed that non – compliance with helmet use was significantly related to the occurrence of head injuries (Duncan, Faraj& Chebiwot,2015).

Faults in the other factors involved in the interplay of traffic safety – roadway and vehicle – can also contribute to road traffic accidents. For instance, the Federal Road Safety Corps (FRSC) stated that during the wet season in Nigeria, motorcycle crashes are more likely to occur because of the water-filled pot-holes in the failed portions of our highways, and the slippery surfaces of the roads. These can make it difficult to predict the depth of the defects or necessitate wobbling movements of the cycles to avoid the defective portions of the roads on the one hand, or cause a loss of control/failure of the brake system on the other hand (FRSC, 2007).Going forward, it appears that the influence of the mental status of the motorcycle operator on the incidence of accidents has been overlooked. The FRSC has also suggested that motorcycle accidents continue to occur because the riders have the mentality that ‘they are the kings on the road’ (FRSC, 2007). This may be a manifestation of a covert self-destructive tendency in a number of these riders.

2.8 Concept of Risky Behaviours

Risky behaviours can be regarded as the destruction of something by itself voluntarily. When viewed from the perspective of human personality, it can refer to self-destructive habits that are counter-productive, and which deny oneself fulfillment. These habits, the most extreme of which is suicide, cause pain knowingly or otherwise. Self-destruction connotes that people knowingly engage in deeds that will cause them to fail, bring them harm, or clearly has negative effects on them or their projects. Unfortunately, in most instances, the manifestations are more covert (such as habitually engaging in professional suicide). Diverse self-damaging patterns, such as repeatedly engaging in things that regularly backfire, to habitual self-harm/recklessness come under the umbrella of risky behaviours.

Risky behaviours and attitudes cause the individuals to refuse help from those who have their best interests at heart, and make them continue unhealthy habits that they know will eventually result into permanent harm. The self-sabotaging individual exhibits both conscious and unconscious behaviours that compromise their happiness, health and long-term fulfilment. Many actually know that a particular course of action is bad but they fail to take action or do anything to remedy the situation, thus setting themselves up for a guaranteed failure or harm. Instead of proactively dealing with an unpleasant situation in life, they organize pity-parties for themselves and remain inactive, or even go to the extreme of harming themselves. Some proceed to alcohol and drug abuse, a self-evident destructive behaviour, thereby bringing a vicious cycle of misery to themselves, their relatives and the society at large.

Those who have experienced failure in any human endeavour, such as academic pursuit, may subconsciously alienate themselves from their peers by deliberately putting up different irritating, repelling or anti-social behaviours. Unnecessary self-sacrifice and being in love with their miserable condition may be another way some destroy themselves, thinking it makes them feel noble and fulfilled. They will refuse to be helped, reject mental health evaluation and attempt to hide negative emotions, which only accumulate to be violently released at a later date. Sometimes they do not feel worthy of love and so manifest unpleasant tendencies like jealousy, domestic violence, battery etc. Others resort to chronic gambling, refusal to eat, unhealthy eating habits, poor sleep, neglecting the maintenance of the general well-being of their bodies, and allowing their psychological health issues (e.g. depression) to linger thereby delaying recovery.

Psychologists have speculated that these self-deprecating attitudes are either coping or defence mechanisms put up to survive under stress, pressure or social demands, or ways of maintaining comfort or familiar zones (such as feelings of worthlessness, staying at the familiar bottom of the social ladder). To buttress this, Freud argues that individuals pursue a destructive path that leads to their downfall/death because of an impulsive internal death drive. This also explains why people deliberately harm themselves, although they are sometimes not aware of it. Such behaviours are common when victims feel they are less well considered by others than they would have loved to be.These risky habits can be linked with the staggering figures that fatalities from accidents involving motorcyclists in Nigeria contribute to the statistics on road traffic crashes (Johnson, 2012). These self-harming behaviours have been categorized under traffic-related, health-related and substance-abuse-related risky behaviours.

According to Ngim&Udosen (2012), the crushing desire to make high daily returns leads to impatience and over-speeding among the commercial motorcyclists, further creating the right scenario for road traffic accidents.Self-deprecatory tendencies can also lead to a gross disregard for other road users, poor maintenance of their motorcycles, and flagrant flouting of basic traffic regulations. Other risky behaviours such as driving under the influence of alcohol, indulgence in tobacco consumption and abuse of other psychoactive substances lead to impaired judgment on the highway and failure to appreciate events correctly. These condemnable social habits, which have been evidently linked with fatalities and severe morbidities from crashes are indulged in by motorcycle operators (Ngim&Udosen, 2012). Even though studies have revealed that riders who put on protective devices suffer less severe injuries during crashes, these easily accessible gears are largely neglected by commercial motorcyclists during operations despite their obvious benefits (Horswill&Helman, 2012).

2.9 Components of Human Behaviour:Planned behaviour

This theory was proposed by IcekAjzen in 1985. The theory was developed from the theory of reasoned action, which was proposed by Martin Fishbein together with IcekAjzen in 1980 (Ajzen,1990). The theory of reasoned action was in turn grounded in various theories of attitude such as learning theories, expectancy-value theories, consistency theories (such as Heider'sbalance theory, Osgood and Tannenbaum's congruity theory, and Festinger'sdissonance theory) and attribution theory (Fishbein,&Ajzen,1990). According to the theory of reasoned action, if people evaluate the suggested behaviour as positive (attitude), and if they think their significant others want them to perform the behaviour (subjective norm), this results in a higher intention (motivations) and they are more likely to do so.

A high correlation of attitudes and subjective norms to behavioural intention, and subsequently to behaviour, has been confirmed in many studies. Sometimes because of circumstantial limitations, behavioural intention does not always lead to actual behaviour. Since behavioural intention cannot be the exclusive determinant of behaviour where an individual's control over the behaviour is incomplete, Ajzen introduced the theory of planned behaviour by adding a new component, "perceived behavioural control." By this, he extended the theory of reasoned action to cover non-volitional behaviours for predicting behavioural intention and actual behaviour. The theory has since been improved and renamed the reasonedactionapproach by Ajzen and his colleague, Martin Fishbein.

1. Key Variables of Human Behavioural Concepts
2. Normative beliefs and subjective norms
3. Normative belief: the interpretation and meaning an individual gives to a social normative pressure or relevant others' beliefs that he or she should or should not perform such behavior.
4. Subjective norm: the interpretation and meaning an individual gives about the particular behaviour, which is influenced by the judgment of significant others (e.g., parents, spouse, friends, teachers)
5. Control beliefs and intended behavioral control

a. Control beliefs: an individual's beliefs about the presence of factors that may facilitate or hinder performance of the behaviour(Fishbein&Capella, 2006). The concept of perceived behavioral control is conceptually related to self-efficacy.

1. Intended behavioral control: an individual's perceived ease or difficulty of performing the particular behaviour. It is assumed that perceived behavioral control is determined by the total set of accessible control beliefs.
2. Purposeful intention and planned behavior
3. Purposeful intention: an indication of an individual's readiness to perform a given behavior. It is assumed to be an immediate antecedent of behavior(Ajzen, 2002) is based on attitude toward the behavior, subjective norm, and perceived behavioral control, with each predictor weighted for its importance in relation to the behavior and population of interest.
4. Planned behavior: an individual's observable response in a given situation with respect to a given target. Ajzen said a behavior is a function of compatible intentions and perceptions of behavioral control in that perceived behavioral control is expected to moderate the effect of intention on behavior, such that a favorable intention produces the behavior only when perceived behavioral control is strong.

Models on Purposeful Intention and Planned Behaviour

Human behaviour is guided by three kinds of consideration, behavioural beliefs, normative beliefs, and control beliefs. In their respective aggregates, behavioural beliefs produce a favourable or unfavourable attitude toward the behaviour; normative beliefs result in subjective norm and control beliefs gives rise to perceived behavioural control.In combination, attitude toward the behaviour,subjective norm, and perceived behavioural control lead to the formation of a behavioural intention (Ajzen, 2002). In particular, perceived behavioural control is presumed to not only affect actual behaviour directly, but also affect it indirectly through behavioural intention (Noar&Zimmerman, 2010).As a general rule, the more favourable the attitude toward behaviour and subjective norm, and the greater the perceived behavioural control, the stronger the person's intention to perform the behaviour in question should be. Finally, given a sufficient degree of actual control over the behaviour, people are expected to carry out their intentions unhindered.

2.11 Conceptual Model for Knowledge to Action Model

Knowledge to action model is a model applied for the enhancement and implementation of interventional activities and programmes. It was postulated by Graham and colleagues in the early 2000 in Canada using the outcome of the reviewed 31 theories of planned action.The model basically consists of two major parts: knowledge creation and an action cycle each of which could be further divided into sub parts. These parts are dynamic and can influence each other. It is a model aimed at helping those concerned with dissemination of knowledge in other to be able to achieve sustainable, evidence-based interventions.

Knowledge dissemination and translation involves: synthesis, dissemination, exchange and ethically sound application of knowledge to improve health and provide more effective health services and practice to strengthen the healthcare system.The model could be applied and utilized in implementation of evidenced –based practice in the health care settings, academic settings, rehabilitation groups, with the goals aimed at transforming the society, nursing and other health professionals (Graham, Logam, Harrison, Straus, Tetroe, Caswell, &Robinson,2006).

2.12 Components of the Model

1. Knowledge creation: this consists of
2. Knowledge inquiry which searches for knowledge from different sources like theories, literatures, researches and many others.
3. Synthesis: entails putting together all the information gathered from the inquiry made to make it concrete and meaningful.
4. Product tools: these are items to be used in utilization of the meaningful concepts and ideas enquired.
5. Action cycle: encompasses the following: Identification of problem, adaptation of knowledge to the problem, assessment of barriers to knowledge use, implementation of intervention, knowledge monitoring and evaluation of outcomes.

Identification of problem is the beginning of the action cycle. It involves review of selected knowledge. This stage may proceed in two directions. It may either lead to adaptation of knowledge to the problembeen solved (local content), or it may proceed from problem identification to assessment of barriers to knowledge use (e.g. poor understanding, incorrect interpretation of knowledge).Or, it may proceed to implementation of interventioninvolving utilization of checklist, questionnaire, and observationetc.,knowledge monitoring, seeking appraisals of intervention to ensure and find out its effectiveness,and evaluation of outcomes. This could be done using feedback, post- test, checklist rating and many others. Sustenance of knowledge entails continuous utilization of the new knowledge. This is important to ensure that practice or habit formed does not get forgotten or become unused.

Figure 1: Knowledge-to-action process conceptual model (adapted from Caswell, Graham, Harrison, Logan, Robinson, Straus and Tetroe (2006))

2.13 Application of the Model

Knowledge to action model is very relevant to this study because it focuses on filling the vacuum created by poor, absence or inadequate knowledge through knowledge creation and action cycle which entails series of interrelated dynamic steps taken to ensure that knowledge is gained and sustained.Risky behaviours is an example of vacuum created and caused by absence or inadequate knowledge behaviours leading to indulgence in unacceptable behaviour as judged by the societal values. This risky behaviours are often times in contradiction to laws and rules guiding the society which when violated sometimes could cause harm, permanent injury or even death to the individual involved in such a behaviour. This risky behaviour is identified at knowledge inquiry.

Knowledge creation involved the following three levels which are knowledge inquiry, knowledge synthesis and knowledge tools. Knowledge on how to solve the identified problem is then sought through literature review, and other means and in other to make it to have the local content the motorcycle operators were involved and the commonly affected areas were identified. These are the violation and disregard for traffic rules due to incorrect interpretation of the traffic rules, misuse of substances that can alter mental alertness prior commencement of motorcycle operation and neglect of health rules at the individual’s detriment. Furthermore, in order to assess the barriers to correct knowledge use and to select appropriate intervention modalities a pre-test was conducted .the result of the pre-test was therefore utilized to select impactful implementation and intervention .Evaluation of the disseminated knowledge and information was carried out utilizing a post –test.