Introduction

Traffic safety is a global priority1, underscored by initiatives such as vision zero, the safe system approach, and the global plan for the decade of action2,3. Despite these efforts, the effective adoption of these strategies remains a challenge in some developing countries, often due to a lack of recognition of the intricate sociotechnical systems influencing road safety in low and middle-income countries (LMICs)4. The complexity of road traffic systems, coupled with context-specific factors, demands a more nuanced understanding to address the persisting severity of road traffic crashes (RTCs) in these regions5,6,7. Iran is in the Eastern Mediterranean region and is classified as a LMIC regarding income and economic conditions8. With a road mortality rate of 20.5 per 100,000 people, Iran has one of the highest road death rates in the region. Nearly 70% of the countries in this region are also categorized as LMICs and share similar road conditions9.

The burden of RTCs is substantial, exerting profound impacts on physical and psychological well-being and imposing a high-cost economic burden on many countries6. The disproportionate effect of RTC-related fatalities on LMICs, compared to their global share of vehicles, is a pressing concern5. Despite efforts made during the “decade of action for road safety” (2011–2020), significant challenges persist in achieving the goal of reducing casualties by half in LMICs10.

Addressing the primary cause of RTCs, several studies emphasize driver errors11,12,13. However, the international initiative recommends shifting responsibility to traffic system designers and decision-makers. Despite the success of some countries in adopting a safe system approach, many LMICs primarily focus on changing road users’ behaviors through law enforcement, education, and social campaigns4,14. This approach often overlooks latent factors, assuming drivers are the sole changeable component in RTCs15. Addressing drivers’ behaviors is essential, but as Khorasani–Zavareh et al. have shown in Iran and similar countries, relying solely on training and law enforcement may not lead to significant improvements16.

Although there are several studies have explored RTC causes from a systemic causality perspective in developed countries17,18,19,20, few studies within the LMIC context have adopted this approach21. Some studies emphasize a systemic approach and employ methods such as ACCIMAP22 and the systems theoretic accident model and process (STAMP)23,24. These studies highlighted the interconnected nature of events22, and the complex interactions across different levels of the traffic system as a socio-technical system23, and underscored the need for a comprehensive understanding of control and feedback mechanisms for effective interventions24. Focusing on LMICs like Iran, the studies highlight the importance of comprehensive RTC prevention strategies that integrate insights from across the entire traffic system, to tackle the complex issue of road crashes. The Iranian traffic system is characterized by complexity and unique sociocultural challenges, similar to those observed in other developing countries1,24,25.

In such countries, despite the prevalence of interventions targeting road user behavior4, road users often have a limited role in decision-making processes26. While understanding drivers’ perspectives is crucial for insights into potential improvements27, it is equally important to consider the perspectives of other traffic system components and involve all stakeholders for a comprehensive understanding of the complex traffic system28, especially the end users of road safety2,3. Most studies on RTCs in LMICs have relied on quantitative methods, police data, and non-road user perspectives21. Where there are challenges with legal investigations, limited crash data, and unique cultural, financial, and social factors29, there is a pressing need to prioritize understanding and incorporating the insights of those behind the wheel30,31 to inform policies and system improvements29. Some literature has utilized qualitative research to study drivers, obtaining valuable information on their attitudes, perspectives, and behaviors32,33,34. This approach has been used in developed and developing countries16,28.

This qualitative study aims to delve deeply into the causes of crashes in Iran as a LMIC country. The study focuses on drivers’ experiences and expands this understanding across different layers of the traffic system components. Considering that driver errors are the primary known cause of road traffic crashes (RTCs), this research seeks to provide a comprehensive understanding of the factors contributing to RTCs in Iran by incorporating insights from drivers’ experiences.

Methods

Participants

Participants were Iranian drivers with a crash or serious near-crash experience and experts from related stakeholders with at least ten years of experience. Using purposive sampling, we recruited 38 participants, comprising 18 drivers and 20 experts. Among the drivers, seven were non-professional, with volunteers from the public who willingly participated after comprehending the study’s scope. Professional drivers (PDs) were recruited from transportation terminals and health facilities. The experts in this study were from 13 governmental and non-governmental main departments of key related organizations, including the ministry of roads, traffic police, municipalities, standard organization, automobile manufacturers, active private companies in the road sector, and policy advisory research centers.

Data were collected through 46 interviews, as some participants were interviewed multiple times due to their high experience and valuable insights. As presented in Table 1, the mean age of experts was 38.4 (6.1), and the mean age of drivers was 40.5 (8.9) years. On average, the experts had 15.8 (6.6) years of experience, while the drivers had 17.4 (8.8) years of experience. A female and 19 males were experts, while 15 males and three females were drivers.

Table 1 Characteristics of the study participants.
Full size table

Data collection procedure

All semi-structured interviews, as outlined in Table 2, were conducted using a predetermined guide, with the main research question: “As a driver, who is the primary user of vehicles and the main recognized factor in causing crashes, please explain driving errors and their contributing factors based on your own experience?”.

Table 2 The interview guide for drivers.
Full size table

Participants were prompted to describe the underlying causes of driving errors based on their crash experiences and the occurrence of specific and dangerous driving mistakes. The interviews were audio-recorded with the participant’s consent, and relevant questions arising during discussions were noted for deeper exploration while ensuring the participants’ narratives remained uninterrupted. Participants were asked questions to clarify the role of different components and layers of the traffic system in causing these errors.

Following the interviews, emerging questions informed subsequent interview guides, particularly those concerning related organizations. After conducting several interviews with drivers, the research team visited relevant organizations based on their priority. The aim was to gain insight into the role of those organizations and other entities in the traffic system concerning driving errors and their causes based on analyzed interviews.

Analytic strategy

The interviews ranged from 35 to 95 min, were transcribed using recordings and the researcher’s notes, and then imported into MAXQDA v.2018 for efficient organization, management, and analysis. Content analysis was employed to identify meaningful patterns, themes, and codes in the interviews. The coding process was multifaceted, beginning with a comprehensive understanding of the entire interview text and followed by the assignment of relevant codes to specific text sections. Once coding for each interview was completed, the assigned codes were used to group similar and classifiable items into categories, organizing the data based on common themes or emerging topics. Any questions or ambiguities that arose during the coding process were recorded and later addressed in subsequent interviews for deeper understanding and clarification. The coding reliability was established through collaboration between the first and second authors. The first researcher, responsible for the initial coding, presented the results to the second author, a qualitative expert, multiple times during the research stages. The work continued collaboratively after obtaining the second author’s approval. This iterative process ensured consistency and reliability in the coding. Data collection continued until the first author determined that theoretical data saturation was achieved. Following this, the second author meticulously reviewed the results and confirmed the attainment of data saturation. Upon agreement, an additional interview was conducted to ensure that no novel concepts or themes emerged during this last interview. This rigorous and collaborative approach aimed to ensure the rigor and trustworthiness of the data analysis, ultimately leading to the identification of key themes and patterns within the interviews.

Results

The interview analysis revealed 10 themes and 53 categories contributing to driving errors (Table 3). Considering that these contributing factors are not isolated; they interact and influence each other in complex ways, the narrative structure of the results is presented in two sections. The first section covers four direct and main driver-related factors, including fatigue and drowsiness, distraction and inattention, unsafe behavior, and insufficient skills. The second section includes macro-level system challenges and their effect on error occurrence. Therefore, the dual presentation of the results highlights the complex interaction between individual and systemic factors in traffic safety, with Table 3 offering a categorical perspective and the text providing an integrated understanding of their collective impact.

Table 3 Themes and subthemes that were extracted from interviews.
Full size table

Driver-related factors

Fatigue and drowsiness

Participants stated several factors contributing to driver fatigue and drowsiness. Traffic experts highlighted that the driving-rest pattern of PDs is less amenable to top–down planning due to the conventional nature of the transportation system and owner-operated vehicles; “… I had to load cargo in Isfahan; I went to Bandar–Abbas and unloaded there, then load up with furnace oil and return… I had no choice but to stay awake.” (very experienced truck driver; participant (P) 13). The participants express that the interaction of these conditions with economic factors, slow transportation, and low-speed driving shape drives work patterns and increases driver fatigue.

Difficulties regarding the interaction of occupational conditions with life status cause more fatigue and dissatisfaction; “Imagine, on the highway, my truck shifted from eleventh to the second gear, but I didn’t wake up… I got off and cried a lot…There’s no future. I cannot even see my child growing up, no celebrations, and no leisure.” (Very experienced tanker driver; P7).

Some drivers express that the interaction of some traffic organization actions with social conditions aggravates job difficulties and fatigue. Factors such as long waits for loading, handling complex cargo and vehicle-related matters, work-related contacts with passengers and other individuals while resting, family expectations, and personal issues contribute to the worsening of these conditions; “We wait from midnight until 5 a.m. or maybe 7 a.m., hoping to go inside for loading. We’re awake and standing in line the whole time.” (P7). Because of such conditions, drivers resort to compensatory measures, such as consuming coffee, drugs, etc., to continue working and cope with sleep deprivation. Misguided beliefs about the effectiveness of these compensatory measures in alleviating drowsiness have led to chronic exacerbation of drivers’ sleep problems. Additionally, insufficient, and inappropriate rest intensifies fatigue and sleep deprivation issues.

The vehicle and road are other influential factors in drivers’ fatigue levels. The quality of vehicles, poor interior design, and the increasing aging of the country’s vehicle fleet contribute to fatigue issues; “seat is stiff; the car [a domestically manufactured vehicle] is shaking both ways (rocking both ways) and make skeletal pain… it causes fatigue because there is no space for your feet to be comfortable.” (An experienced pickup truck driver; P19).

Lack of highway attractiveness and resting place, inappropriate roadside margins, and visual strain because of road surfaces, along with glare caused by lights and bright signs on the roadsides and other vehicles, lead to significant drivers’ visual fatigue; “Potholes then tak tak tak, unusual noises coming from the road. The guardrail is bent on the roadside, with heaps of mud, dust, and weeds growing. Road maintenance is poor, the sign is crooked and dirty, and pooled water and sand are piled on the Jersey barrier. Salt sprinkles on them, and it is so ugly. It exhausts the driver visually. We all become psychotic and crazy on these roads.” (Experienced geotechnical engineer and CEO of a road construction company; P17). Combining undesirable road conditions with outdated and worn-out vehicles, especially on two-way roads, leads to extended traffic jams, resulting in fatigue and other adverse psychological states among drivers.

Driver inattention and distraction

“Often, when we go to the crash site, the driver says: “I don’t know… suddenly someone came from the other side.” I mean, his thoughts were not here. He was wondering about debt, tonight’s guests’ expenses…” (P20). This is how a very experienced RTC investigator and traffic police described the role of absent-mindedness. Internal factors such as cognitive distractions, anger, non-related driving worries, crash scene witnessing, and traumatic experiences may contribute to a lack of attention. Verbal harassment, which may be cursed to drivers by traffic system users, or intense arguments on penalties seen as unjust by drivers can contribute to distraction; “Sometimes, some police interactions with people so upset me. It is like they have taken someone like Bin Laden … Well, an overtake has been taken in this country with poor roads.’ (Very experienced and highly skilled PD; P3).

Engaging in secondary activities while driving or being distracted by factors unrelated to the primary task of driving, such as “They got their nose in a phone or are using opium.” (P3), can lead to inattentiveness on the road. Traffic safety specialists have also highlighted the use of mobile phones. Texting while driving, having the phone in their pocket, leaving phone notifications on, and phone access attempts are some of the circumstances that contribute to increased phone usage. The conversion of phones into indispensable tools for drivers represents one of the underlying reasons for using phones while driving; “Nowadays, it has become such that they call the driver for everything …to pick up the passenger… the car owner, passenger, cargo owner. They all call and you can’t ignore them, you must answer.” (Experienced bus driver; P24).

The focus on external factors, such as dangerous drivers, vehicle defects, and adverse road conditions, can also lead to driver distraction. Sometimes, drivers’ attention is diverted to road-related elements like potholes, speed bumps, road environmental distractions, signs, and facilities alongside the road; “I find myself forced to speed up and change lanes as I enter the tunnel to avoid the potholes…” (Experienced bus driver and owner; P4).

Reckless and unsafe driving

According to most participants, the driver’s unsafe and dangerous behavior is influenced by various factors, including personality traits, mental states, and the interaction of different traffic system components. Also, indirect factors such as trying to compensate for time and slowness in transportation, particularly in the public sector, and high-risk tolerance establish the bedrocks for these behaviors; “Sometimes compensation for time is due to the slowness of transportation caused by worn-out vehicles, road conditions, delays, and non-driving task, etc.” (Highly proficient transportation expert in an organization; P11).

Personality traits such as arrogance, pretentiousness, and adventurous driving cause some drivers to demonstrate and prove their superiority to others through false bravado. Some expert participants believed that pride, youthful enthusiasm, and excitement should be better managed in the traffic system; “You see, they do not grasp the danger surrounding them… it makes it easy to violate and stand up against the Police. They put down their phone or fasten their seat belt in front of the Police but then do the opposite” (Very experienced traffic police officer; P37).

Some features of the traffic system components may lead the driver to mental conditions such as anger, boredom, and discomfort, which can cause dangerous driving situations. The interaction between drivers and other elements of the traffic system and their role in creating an unsuitable driver’s mental state has been mentioned by both groups of participants; :If you pay ten million Tomans [currency unit] for a tire and then it doesn’t work more than four times, it gets on your nerves? You go to buy a spare part, but they give you a fake one… don’t you get nervous? And when you go to get your car fixed, but they take ten times the fee, don’t you get nervous? You must drive into the city, and a car comes close to you, harassing you, constantly hitting the brakes; you don’t you get frustrated?” (Very experienced PD; P7).

Non-compliance with traffic regulations and risky driving behavior may stem from psychological factors and dissatisfaction with road and vehicle conditions. The low quality of domestic vehicles, the worn-out fleet, and inadequate road conditions might contribute to behaviors that lead drivers toward risky actions. As a very experienced transportation expert from the road and transportation organization (P15) stated, “You can’t argue that there’s no money, the economy is a mess, the car is not good, and the roads are terrible, but people should still be careful and self-controlled. That’s not a realistic expectation.”

Inexperience and skill deficit

Participants reported on some errors and incidents that occurred due to various factors, such as delayed or improper reactions, sudden and severe braking, misjudgment of distance and speed, inability to multitask effectively, impaired decision-making, unfamiliarity with different vehicle characteristics, and the emergence of stress. A participant shared insight about how a lack of driving skills leads to overestimating risks and interacting with other drivers; “I went to overtake, and there was still quite a distance between us. He was afraid and hit the brakes, then threw the car out of the road… he thought the situation would have led to a fatal crash. It was obvious that he was inexperienced.” (Experienced car driver; P18). As a result, interactions between these drivers and others may foster an environment conducive to RTCs.

Driving at low speeds, braking suddenly, and causing traffic on the roads lead to interactions that result in mistakes made by other drivers. Drivers’ inclination, particularly those with low driving skills, to travel in the third lane creates a basis for hazardous interactions; “I always drive in the left lane because I am always stressed that a car may come from any direction and turn in front of me in other lanes. I am more comfortable because I can control at least one side.” (Young female driver; P16).

Participants commented that training and licensing processes fail to meet rigorous standards and may contribute to drivers’ lack of proficiency; “But really, the way they teach to get that certificate is mostly messed up. People’s lack of driving skills is obvious. I didn’t go through that training myself, but I see its results on the road.” (P4).

In Iran, five types of driving licenses are issued. Generally, the process involves meeting age requirements, completing written and practical exams, mandatory training programs at authorized driving schools, and adhering to the regulatory bodies responsible for issuing licenses. The written examination assesses knowledge of traffic regulations and laws, whereas the practical assessment evaluates the driving abilities of the applicant35. The practical training for obtaining a driver’s license is mainly conducted superficially, emphasizing a few basic skills assessed in the driving test. The instructor’s level of competence might significantly affect the learner’s skill development. Instilling fear in learners, especially female learners, and lack of opportunity to assess actual traffic behaviors may lead to further skill deficiencies in learner drivers. The interaction of these conditions with culture and people’s perspectives also plays a crucial role; “People’s opinion is that they should take multiple tests and be accepted. You see, our training methods are traditional, and it goes on traditionally… because you don’t have a suitable tool to test the learner”(P20). Part of this inadequate proficiency can be attributed to the legal gap. Despite intercity traffic restrictions for novice drivers during their inaugural year, this law has minimal practical implementation. The absence of a retraining mechanism during the license renewal process may significantly impact the insufficient familiarity with current driving regulations.

Macro-scale system challenges

All participants emphasized the profound impact of macroscopic factors on traffic safety. Policies and socio–economic factors directly impact road and vehicle infrastructure quality and indirectly result in problematic interactions among various traffic system components.

Road infrastructure and vehicles problem

The national strategy and approach in the automotive industry play a significant role in the difficulties faced due to the high vulnerability of this sector to international sanctions; “The biggest thing is knowledge. It is frustrating that we cannot just access that kind of knowledge because of these sanctions and all… It might even hold us back big time.” (Very experienced engineer of an automobile manufacturing company; P23).

Also, the approaches governing automobile manufacturing within the country contribute significantly to the problems. Experts in various fields have highlighted the “low-quality syndrome” prevalent in the conversations. Financial challenges, economic conditions, and misguided policies have led to the use of aging vehicles, especially in public transportation, resulting in the continued use of outdated cars and worsening traffic conditions. The combination of elevated maintenance costs and other factors has led to problematic cycles; “Vehicles are no longer renovated, and their quality goes down, and it becomes more difficult to improve safety…” (P15).

Most organizational participants have acknowledged that they struggle to meet the anticipated minimum standards for road maintenance due to financial limitations, personnel-related challenges, and other interconnected factors. Consequently, road maintenance procedures consistently encounter unintended and substantial delays, leading to structural deficiencies in the road infrastructure. The chronicity of these conditions also has a negative impact on the supervision process at various levels of the system; “I tell the contractor, ‘Sir, is your finisher’s tire broken?! ‘He says, ‘Mr. Engineer, I demand 20 billion Tomans [Iranian currency], and I’m just doing it as a favor’… Well, he’s got a point, you know.” (P17). Several participants in the road infrastructure sector expressed that, due to financial issues, the current priority is to maintain the existing state of the roads.

Traffic culture and education challenges

Participants express that undesirable cultural outcomes result from the interaction of the earlier-mentioned challenges, with superficial and non-systematic efforts in promoting traffic culture. Many participants have acknowledged the failure to implement remedial and sociocultural strategies in traffic policy-making, with most organizations tending to rely solely on penalizing drivers through law enforcement rather than implementing corrective and educational interventions; “Okay, so they set up the conditions for violations, and then let the police handle it by tickets. Then they say that the police are useless; they’re just incompetent. Police should come last, not first… Why should I fine people? Mr. Mayor, come and answer! Mr. Ministry of Roads, come and answer! Mr. Car Manufacturer, come and answer!” (High-rank traffic police officer; P13).

Furthermore, specific inappropriate and unprofessional practices within certain traffic organizations were noted to contribute to the deterioration of traffic users’ safety culture; “TV and radio aren’t doing much to promote a traffic safety culture; instead, they broadcast numerous counter-cultural messages. One of those ads shows kids ten risky and anti-culture traffic behaviors. Most of the time, the bad guys in movies… are the ones wearing helmets. In contrast, the cool and dependable characters ride motorcycles without helmets in many films” (P13).

Participants have also noted widespread violations and the prevalence of inappropriate traffic behaviors have led to the normalization of dangerous driving and a decrease in effective monitoring and control measures. These findings underscore the complex interplay of cultural, infrastructural, and enforcement factors in shaping traffic behavior and the challenges in promoting a positive traffic culture; “Our infrastructure pushes people to go against the flow, you know? Those no parking or absolutely no stopping signs, we destroyed completely the concept of signs by installing them excessively and exaggerating their level of danger. We installed signs without rules because we did not understand the people’s culture.” (Experienced traffic engineer and head of a traffic management department; P26). The widespread violations and the prevalence of inappropriate traffic behaviors have led to the normalization of dangerous driving and a decrease in effective monitoring and control measures.

Lack of higher authority and decision maker

Most participants highlighted that significant administrative issues within traffic-related organizations are a key factor contributing to the prevalence of driving errors. The absence of a unified and higher authority in traffic safety leads to a lack of consistency in traffic safety management; “We don’t have a central governing organization in charge of traffic safety. The Ministry of Roads is working, the Ministry of Health is working, and the Road Safety Commission is doing their things, a separate island. But they cannot sit together and reach a common understanding.” (Traffic safety researcher and faculty member; P33).

Moreover, the absence of effective traffic data exchange between organizations was identified as a hindrance to developing public and private transportation programs and negatively affects the planning of roadside infrastructure. This, in turn, impedes the execution of comprehensive traffic safety improvement plans. As a result, regulatory bodies tend to allocate responsibility to drivers and road users; “The local automaker says that my car has the highest level of quality and it’s all the drivers’ fault. The Ministry of Roads, which has not yet been able to road quality classification, says the drivers are to blame. Other organizations can’t get their work done, and they also point fingers at the people.” (University academic faculty member and collaborator with traffic organizations; P31).

Monitoring and accident investigation shortcomings

Multiple monitoring systems have been identified in the car manufacturing, road design, and construction sectors, leading to monitoring inefficiency; “The system should be project-oriented. Why should there be ten supervisors at different stages of a project? Just let me check the road with my equipment after it’s built. If it is not up to the expected standard, I won’t pay. It’s simple, but this is not happening.” (Very experienced oversight road construction engineer; P12).

According to participants, flexibility in quality control principles is prevalent at all levels of both sectors, often using economic conditions and societal problems as excuses; “… but they have defined input standards that they check and receive the parts based on. However, sometimes things get messed up…” (Experienced expert of Iran national standards organization; P28).

Furthermore, participants expressed that road user monitoring is imbalanced, emphasizing enhancing the surveillance of PDs, while specific high-risk drivers are not subject to such monitoring. They also highlighted unpleasant experiences with law enforcement, including inequality, penalty-oriented approaches, and a lack of deterrents for high-risk drivers; “So, imagine this cop hiding down a traffic bottleneck (mountainous inclined road). He waits for a big truck to get in front of around 40 cars so they can’t escape. They wait for someone to overtake, take a video of it, and fine them.” (A non-professional driver; P34).

In addition to surveillance issues, there are significant shortcomings in accident investigation and attributing accident causes to diverse factors, which significantly contribute to the sustainability of structural problems in the traffic system and the underlying behavioral patterns of drivers leading to RTCs. Most drivers who have experienced an accident stated that the police conduct superficial accident investigations and fail to identify the root causes of the accident. Organizational influence strongly skews the results due to extensive bureaucracy, leading to the avoidance of assigning a share of fault to organizations as much as possible; “The police usually suggest writing the drivers as 100% at fault to avoid causing more distress to the family of the deceased or injured [people]… This way, they can skip dealing with organizations, multiple stages of appeals, complaints, and all that time-consuming bureaucracy.” (P26).

This approach has resulted in human factors being identified as the leading cause in most RTCs, and based on these statistics, analyses, and decisions are formulated; “Check out this data list; 70% of it says stuff like driver drowsiness, sleepiness, I don’t know, not paying attention, etc. They all focus on the human factor and do not seek to have an in-depth analysis of the crashes at all.” (P31).

Discussion

This study aimed to investigate the factors contributing to driving errors in the context of Iran as a LMIC. While previous research has focused on the direct role of driver-related aspects in traffic safety28, and most traffic-related studies in LMICs have primarily relied on driver self-reported techniques21, this study sought to uncover the interplay of other factors, including organizational and contextual factors that influence drivers.

The participants emphasized the importance of addressing the contributing four primary direct factors (fatigue and drowsiness, distraction and inattention, risky driving behaviors, and inadequate driving skills and experience) that lead to driving errors. They suggested that understanding these factors is crucial for implementing effective interventions in the traffic system.

Although risky driving behaviors such as high speed are widely regarded as one of the primary causes of accidents36, some participants pointed out that lower speeds resulting from various factors, such as traffic, speed reduction measures, infrastructure issues, and worn-out vehicles, can create moving bottlenecks or reduce average travel speed, leading to improper compensatory actions by drivers. Studies have indicated that this situation results in longer travel times, increased traffic conflicts, and a higher rate of accidents37,38. The interaction of these conditions with loading problems and obligatory non-driving activities in cargo and public transportation may lead to driver fatigue, rushing, or frustration that may result in aggressive driving39.

Work and environmental conditions like heavy traffic, communication approaches, and established norms can significantly affect traffic behaviors and driving styles. Drivers may resort to strategies like anxious driving, multitasking, or mind wandering to cope with such situations40,41. For example, PDs participants often perceive cell phone use, as inevitable due to work conditions. It aligns with Hernandez et al. results that bus drivers have been reported to exhibit a higher likelihood of phone use40, while taxi drivers tend to engage in increased speeding42. Also, participants mentioned the critical role of traditional relationships between employers and PDs in traffic safety, which can pose a significant obstacle to implementing effective traffic safety interventions. In line with other research, the influence of the established norms and conventional communication approaches on driver behaviors, attitudes, and decision-making processes was highlighted43,44.

A minority of participants also mentioned the role of opium consumption while driving and its potential effect on decreasing drowsiness but they rarely mentioned alcohol consumption. Driving under the influence has been recognized as a significant contributing factor to RTCs in several studies, and receives special attention in policymaking45. In Islamic countries, limited studies have explored driving under the influence of alcohol consumption46, indicating significant alcohol consumption at lower rates than the global average47. This can be attributed to cultural norms and stringent legal prohibitions against alcohol consumption in these countries, along with the lack of mandatory protocols for blood sample collection and alcohol testing during RTC investigations, which may lead to the underrepresentation of this factor in such contexts48,49.

This study highlights various factors, such as organizational complexity, traffic management system, economic problems, traffic culture, built environment, road infrastructure, and vehicle problems on driver performance. In contrast to Salmon and colleagues’ research, where most drivers neglected more significant systemic factors and attributed the causes of driving errors to driver-centric factors28, participants in the current study considered the higher-level systemic factors highly influential in shaping driving errors. This study involved various stakeholders and aimed to understand the systemic roots of driving errors16,33.

Inadequate and inappropriate training, users’ emotional management, and increasing complexity and difficulty of drivers’ tasks due to external factors have contributed to the decline of cultural and traffic behavior standards. Epidemiological studies have established significant associations between adverse socio–economic conditions, fatigue, and inattention with traffic accidents in Iran50,51. Neglecting emotional needs and daily fatigue negatively affects taxi drivers’ motivation and safety behavior52. Systemic analysis methods have effectively demonstrated that various factors beyond driver control influence road safety and driving errors, and the interaction between different components in the traffic system can impact in-vehicle technologies53. Also, studies have emphasized the need to consider personal values and safety climate to promote safe behaviors on the road54. Additionally, the lack of coordination among organizations, economic conditions, outdated vehicle technology, and inadequate road conditions have resulted in drivers disregarding traffic regulations.

The participants emphasized the critical role of vehicles and road infrastructure in the occurrence of driving errors. While participants in similar qualitative studies in LMICs mentioned the role of vehicles less frequently, they did discuss similar issues related to road problems32. Khankeh et al. found the underlying factors of RTCs, including infrastructural issues such as road problems, inadequate facilities, unsuitable and worn-out vehicles, and management problems such as lack of a leading agency and appropriate data circulation16. Modeling in the same context suggests that interventions in the vehicle design domain can have the most significant impact on reducing traffic casualties55.

Road safety management and avoiding organizational complexities are key issues for reducing RTCs56. Iran’s road safety structure involves multiple organizations, including the Ministry of Roads and Urban Development, the Police, the Ministry of Health and Medical Education, the Forensic Medicine Organization, insurance companies, the Ministry of Justice, and other minor players57,58. Formally, The Road Safety Commission (RSC) operates as the lead agency under the Ministry of Roads and Urban Development. It is supported by various committees focusing on education, culture, injury rescue, road safety, fleet management, and traffic operations. However, its authority is disputed by some stakeholders, leading to the formation of several pseudo-lead agencies57.

The lack of a comprehensive information system and the limitations in the capacity to collect and manage traffic safety statistics are significant issues in Iran16,57. Despite the large volume of data collected by various organizations, challenges such as duplicated data collection, missing data, incomplete reports, differing and sometimes conflicting data collection methods and the lack of integration between systems persist1,48. Specifically, crash data collection by police focuses on aspects such as the location, type, contributing factors, and conditions of crash scenes, along with demographic and other circumstantial information. Typically, a police officer with an accident investigation certification attends the scene and completes the necessary forms within a few minutes48. These factors contribute to the inadequacy of a cohesive traffic safety database and hinder effective accident analysis and prevention strategies.

Our work reveals the influence of the absence of solid supervision and control between system layers on safety performance. The lack of supervisory measures and imbalance monitoring of different users is evident at the lower level of the traffic system. Safety can be enhanced through control and supervisory actions on system components59. Most interventions in LMICs have focused on behavioral and single-factor interventions related to drivers4. However, our participants pointed out the lack of integrated control and organizational mechanisms to improve traffic safety at different levels of the traffic system. The lack of central and guiding authority in the traffic domain, legal barriers, and difficulty in making traffic organizations accountable contribute to the system’s deviation from the expected operational level.

Interestingly, all participants believed that international sanctions have negative consequences in various areas, such as road infrastructures, automobile manufacturing, and economic factors, which may significantly contribute to RTCs. Furthermore, the participants highlighted the considerable consequence of internal organizational matters on the quality of infrastructures and interactions among various transportation system components.

Both the organizational participants and drivers believed that achieving higher objectives in reducing RTCs necessitates fundamental infrastructural, vehicular, and managerial interventions. However, a considerable portion of experts still primarily attribute RTCs to drivers. This is in line with Khankeh et al.’s study, where participants mainly acknowledged the role of infrastructures and vehicle factors in RTCs, but interventions were suggested primarily focusing on modifying road users’ behavior, particularly drivers16,33. Our findings suggest that enhancing road safety requires improving relationships between users and stakeholders within the traffic system. However, outdated infrastructures, lack of modern technology, and resistance to change can act as deterrents to adopting effective and systematic measures60.

Conclusions

This study aimed to provide an in-depth understanding of the complex factors contributing to driving errors in an LMIC context by involving all stakeholders in the traffic system. While acknowledging the significance of driver-related aspects in traffic safety, our findings emphasized the need to consider broader systemic influences for effective interventions. Our study highlighted the critical role of vehicles, road infrastructure, work conditions, economic challenges, and international sanctions in shaping driving errors and RTCs. Participants also emphasized the effect of organizational dynamics, communication approaches, and economic conditions on driver behaviors and road safety. The study underscored the importance of adopting a comprehensive and systemic approach, rather than a narrow blame-centric view focused solely on drivers, to enhance road safety. It advocates for a change in basic assumptions in approaching traffic safety, urging LMICs to embrace a holistic perspective. Although qualitative studies are less generalizable, given the similar conditions in low- and middle-income countries, other nations can undertake similar investigations. By understanding the intricate interactions within the traffic system and considering the multifaceted factors contributing to RTCs, authorities can implement targeted and effective interventions to foster safer roads and reduce traffic accidents.

Our study culminates in practical recommendations with significant implications for policymakers, traffic authorities, and stakeholders in LMICs:

Systemic approach to traffic safety: advocate for a transformative shift from a driver-centric to a systemic approach, actively involving drivers in decision-making processes at all levels of traffic organizations. This shift could be started with a reevaluation of the current accident investigation process and surveillance structures across all elements of the traffic system.

Integrated vehicle and infrastructure safety: recommend emphasizing the critical importance of enforcing existing vehicle safety standards and then enhancing vehicle safety standards, also improving maintenance, and investing in road designs tailored to LMICs’ unique challenges.

Policy and legislative reforms: propose specific reforms addressing challenges identified in the traffic system, including laws related to vehicle safety standards, driver training, and road infrastructure development.