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Dear Editor,
We read with great interest the article by Kelleher et al., titled "Testing a New Care Model: Implementing a Virtual Driving Assessment in Primary Care" (1). This article thoughtfully addresses an essential aspect of adolescent preventive health care, proposing the implementation of a Virtual Driving Assessment (VDA) within primary care clinics. The authors have provided valuable insights into the potential role of primary care physicians in reducing motor vehicle accidents among young novice drivers in the United States. Reflecting on our own experiences as family physicians practicing in Spain, we would like to offer our perspective regarding the adaptability and relevance of this promising intervention within our national context.
In Spain, the epidemiological scenario of adolescent motor vehicle accidents differs notably from that described by Kelleher et al. (1), mainly due to significant legal and cultural distinctions. Here, adolescents may legally obtain a driving license for cars only at the age of 18, coinciding precisely with the legal drinking age. This intersection creates unique challenges, especially given the evidence indicating frequent alcohol consumption among Spanish adolescents prior to reaching the legal drinking age. Consequently, road safety interventions aimed at this demographic must specifically account for the combined risks associated with alcohol consumption and driver inexperience.
The concept of integrating a virtual driving assessment into primary care aligns well with existing preventive health frameworks in Spain. Nevertheless, adaptations are necessary for it to be relevant and effective. For instance, while Spanish adolescents under 18 cannot drive automobiles legally, many are permitted to operate mopeds from the age of 15. The morbidity linked to moped accidents in this younger age group is substantial and well documented. Ove Njå et al (2) highlighted the significant health burden imposed by moped-related injuries among teenagers, underscoring the importance of targeted preventive efforts at younger ages. Therefore, adapting the VDA to simulate realistic situations commonly faced by moped riders, such as limited visibility, navigating urban environments, and reacting appropriately to unexpected hazards, could serve as a valuable preventive tool integrated into routine primary care visits.
Moreover, given that legal access to alcohol and driving licensure coincide in Spain, explicitly incorporating scenarios of impaired driving into the VDA would be essential. Recent statistics published by the Spanish National Traffic Directorate (3) consistently show alcohol to be a significant contributor to youth traffic accidents. Providing virtual experiences that vividly illustrate the dangers of driving after alcohol consumption might resonate strongly with Spanish adolescents, effectively reinforcing safer driving behaviors. Indeed, Shope and Bingham (4) previously demonstrated that targeted, scenario-based educational interventions significantly reduce risky driving behaviors among adolescents.
Additionally, the Spanish education system offers a natural pathway for early preventive interventions. School-based health programs are well-established across Spain, regularly addressing various adolescent health risks. Integrating a version of the VDA into these programs could maximize the reach and effectiveness of preventive education. As indicated by Simons-Morton et al. (5), school-based preventive programs enhance knowledge and positively influence adolescent behavior when integrated with primary healthcare initiatives. Such collaboration between primary care professionals and educators could establish a comprehensive framework for adolescent road safety.
We also envision potential regulatory or administrative links between successful completion of the VDA and obtaining a driver's license. Currently, medical certification from primary care physicians is mandatory before licensure in Spain, presenting an ideal opportunity to incorporate feedback from a virtual assessment. This connection would not only encourage adolescents to complete the assessment but also facilitate physicians’ ability to provide tailored safety recommendations. Literature supports the efficacy of physician-delivered advice in promoting healthier behaviors and decision-making among young adults (6–8).
Moreover, motivational interviewing could enhance the impact of virtual driving assessments when conducted by primary care physicians following the test. Rollnick, Miller, and Butler (9) extensively reviewed evidence indicating the effectiveness of brief motivational conversations in reducing risky behaviors such as alcohol use and dangerous driving among adolescents. By applying this approach during follow-up consultations, primary care providers could reinforce safer driving decisions, capitalizing on the adolescents’ increased awareness and readiness to change their behavior following the VDA.
The potential for broader collaboration beyond healthcare settings also deserves consideration. Spain has witnessed effective inter-ministerial road safety campaigns, such as "Ponle Freno" promoted by Fundación Atresmedia (10) in TV advertisements, which successfully engaged adolescents and reduced accident rates. Integrating a virtual driving assessment within such initiatives could expand the intervention's reach, combining public health, educational outreach, and community involvement into a unified preventive strategy. This collaborative approach would enhance public acceptance and potentially increase adolescents' participation in safety assessments.
Routine integration of the VDA into the existing Programa de Salud Infantil y Adolescente preventive check-ups in Spain could further enhance its acceptance and effectiveness. Many authors have demonstrated that systematic incorporation of preventive health measures significantly improves adherence to recommended behaviors (11). By embedding driving safety evaluations into regular adolescent health visits, primary care could contribute substantially to normalizing the practice of regular driving safety assessments as an essential component of adolescent health promotion.
Collaboration between primary care and driving schools could also be beneficial. Driving schools are trusted institutions among adolescents, providing practical training and education prior to licensing. Gregersen et al. (12) highlighted the enhanced effectiveness of driving education when coordinated with real-world practice scenarios. By integrating virtual assessments into the curriculum provided by driving schools, adolescents could benefit from more realistic exposure to complex driving scenarios, better preparing them for real driving conditions.
Furthermore, incentivizing participation through practical benefits, such as insurance discounts, may increase compliance and motivation among young drivers. Curry et al. (13) previously identified incentives as effective tools in motivating safer driving practices. Spanish insurance companies could feasibly offer discounts to adolescents who demonstrate safe driving competencies through validated virtual assessments, thereby creating tangible economic benefits that encourage safer driving behaviors.
Finally, adapting the VDA to incorporate culturally relevant scenarios, particularly related to nighttime driving after social events, could significantly enhance the tool’s applicability and acceptance in Spain. Williams (14) showed that social contexts involving nightlife significantly increase adolescent accident risks, thus emphasizing the importance of developing assessment tools reflecting the specific cultural environment in which adolescents operate. By simulating realistic local scenarios, the virtual assessment could more effectively promote safer decision-making among Spanish adolescents.
In our opinion, Kelleher et al. provided an interesting experience for integrating virtual driving assessments into preventive healthcare. By considering the unique Spanish context, adaptations that address age-specific, legal, cultural, and social factors can greatly enhance the effectiveness and acceptance of such interventions. We strongly support the further exploration of these adapted interventions in primary care and educational settings, confident they hold substantial potential to improve adolescent driving safety and reduce preventable accidents.
REFERENCES:
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