People’s Survey Question
Part 1: Basic Details
- In what country do you live?
- What is your age?
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older
Trans diverse / gender non-conforming
Describe your own gender
- Highest level of education completed
No schooling completed
Completed primary school (12 years old)
Completed junior secondary (16 years old)
Completed high/secondary school (18 years old)
Other (please specify)
- What is your monthly household income? (Please include salary, pensions, remittances and all other sources of income for the household) (in US dollars)
Not employed/no income whatsoever/dependent on others
Less than 50 USD a month
50 – 250 USD a month
251 – 500 USD a month
501 – 1000 USD a month
1001 – 5000 USD a month
Above 5000 USD a month
Part 2: Feeling safe or unsafe
- As a road user, what is your general feeling of safety on the road in the following situations?
Very unsafe Unsafe Safe Quite safe Very safe Not applicable
As a pedestrian
As a passenger in public transport
As a passenger in private vehicle
As a driver
As a rider/driver of a 2 or 3 wheeler (motorcycle or scooter)
As a passenger on a 2 or 3 wheeler (motorcycle or scooter)
As a cyclist
- What reasons make you feel unsafe as a road user? (Mark all that apply)
Driving under influence of alcohol and/or drugs
Non-use of seatbelts
Non-use of helmets
Non-use of child seat
Road rage and aggressive drivers
Poor road infrastructure
Poor vehicle maintenance/Unsafe vehicles
Poor emergency response
Other (please specify)
- How would you rank the importance of road safety as a public * health issue?
Not important at all
Part 3: Your life experiences on road traffic crashes
By “road traffic crash” we mean an occurrence where a vehicle collides with another vehicle, and/or pedestrian, animal, road debris, or other stationary obstruction, such as a tree or utility pole, resulting in injury, death, vehicle damage, and property damage.
- Estimate the number of people that you personally know that have died in road crashes?
- Estimate the number of people that you personally know that have been injured due to a road crash?
- Have you ever lost any of the following family members due to a road traffic crash?
Brother or sister
No, never lost a direct family member
- Do you personally know someone living with a disability caused by a road traffic crash?
Part 4: Impacts of road crashes on households
- Did you ever stay out of work to take care of someone injured in a road traffic crash?
- Did you or your children ever have to abandon school (for health, psychological, financial or other reasons) after a road traffic crash?
- Did a relationship you had with a spouse, fiancé, life partner end/divorce due to the consequences of a road traffic crash?
- How many times have you contributed money to help cover funeral or medical cost related to road traffic crashes?
Part 5: Infrastructure
- Has damage (as the result of a road traffic crash) to any of the following infrastructures ever negatively affected you? Please mark all that apply.
Not applicable (never had any infrastructure damage due to car crash affect me).
Telephone/ internet infrastructure
Damage to the road infrastructure (signage, surface etc)
Public buildings (school, clinic etc.)
Other (please specify)
Part 6: Physical and Psychological Health
- Did you ever have to take medications daily/regularly due to a road traffic crash for any condition (physical and/or psychological)?
- Have you ever experienced psychological problems as a result of a road traffic crash? (a crash you were in or that a loved one was in)
- Have you avoided things, places or people associated with a road crash experience? (for example: you travel less, you use different transport, you use different routes, you avoid people)
- Do you live in fear that you or someone you love might be involved in a crash again?
- Did you experience any of the following after a road traffic crash that affected you and/or your loved ones?: depression, hopelessness, anger, nightmares, flashbacks, panic attacks, sleep disturbance, poor concentration?
- Did you need to seek professional help from a psychologist/counsellor to deal with the post-crash trauma (your own crash or that of a loved one)?
- Was there a psychologist/counsellor available to you at an affordable cost?
- Have YOU personally been INVOLVED in a road traffic crash?
Road crash survivors only:
The survey has brought you here because you marked that you have personally been in a road traffic crash.
- How many times have you been involved in a car crash (over the course of your life)?
- Were you injured? To what degree?
- Are you living with a disability caused by a road traffic crash?
- Have you ever missed work due to having a road traffic injury?
- Did you lose your source of income/job because of a road traffic crash? (for example, your car, which you were using to generate income was destroyed)
- Did you or your family members/friends have to sell any assets to cover your medical costs?
- Do you have a personal testimony that would help us to capture more accurately the impact of road traffic crashes on your life or the lives of the people close to you? Please share with us?