Attempts to increase vehicle safety-belt use among industry workers: What can we learn from our failures?

A multiple intervention level hierarchy was evaluated with systematic implementation of successive interventions over a period of two years. Successive applications of written prompts, goal-setting, goal-setting plus feedback, and promise-card commitment interventions did not significantly impact the safety-belt use of 556 employees at a manufacturing plant in southwest Virginia. A modest increase in safety-belt use (from 59% to 68%) occurred only when a promise-card commitment strategy was combined with an incentive/reward strategy. These data support a multiple intervention level hierarchy which suggests that repeated attempts to change behavior with interventions at the same level of intrusiveness will not affect behavior uninfluenced by the first attempt at that level. A flow of behavior change model (Geller, 1999) is used to explain the impact of interventions on people at different stages of readiness for behavior change and to extend the multiple intervention level model. Suggestions are given for selecting the most appropriate behavior change strategy Ear large-scale applications.