Review Article

Health Promotion Interventions on Helmet Use: A Systematic Review and Meta-Analysis of Pre-Test and Post-Test Studies



Background: We aimed to review the effectiveness of health promotion interventions in the use of helmet and to identify the types of effective health promotion strategies among the examined studies.

Methods: A systematic search was performed on the PubMed, Scopus, Cochrane, and Embase databases up to 1 Aug 2022 to find the studies evaluated the effectiveness of health promotion interventions for helmet use among target population. In this systematic review and meta-analysis, interventions with pre- post-test design were included. The dependent variable of the study is the percentage of participants who responded positively toward helmet use in the baseline and after the interventions. Random-effects models were used to pool study results.

Results: Overall, 1,675 articles were found in the initial search and entered into the Endnote software. Of these, 917 duplicate articles were removed, leaving 758 articles were screened based on title and abstract. Finally, 12 eligible articles were included in the review and five with pre and post-test design were included in the meta-analysis. The overall random-effects pooled estimation of persons wearing helmets before and after interventions was 70% (95%CI 21 –119; P<0.001), without a heterogeneity (I2 =0%; P=0.94), which means that the average percentage of changing to helmet use is 70%. Community-based education program was the most commonly applied for interventional studies. The next most commonly used approaches were campaign designing.

Conclusion: Wearing helmet approximately increased 70% among participant. Health promotion strategies may target helmet-wearing behavior to reduce head injuries in motorcyclist road traffic accidents.

1. Dalvi Q (2004). World Report on Road Traffic Injury Prevention by World Health Organization and World Bank (WHO, Geneva, April). Transport Reviews, 24:365-376.
2. Ayatollahi S, Hassanzadeh J, Ramezani A (2009). The burden of traffic accidents in South Khorasan province, Iran in 2005. Iranian Journal of Epidemiology, 4:51-57.
3. Alinia S, Khankeh H, Maddah SSB, Negarandeh R (2015). Barriers of pre-hospital services in road traffic injuries in Tehran: the viewpoint of service providers. Int J Community Based Nurs Midwifery, 3(4):272-282.
4. Graziano PA, Reid A, Slavec J, Paneto A, McNamara JP, Geffken GR (2015). ADHD symptomatology and risky health, driving, and financial behaviors in college: The mediating role of sensation seeking and effortful control. J Atten Disord, 19:179-190.
5. Yadollahi M, Gholamzadeh S (2019). Five-year forecasting deaths caused by traffic accidents in Fars Province of Iran. Bull Emerg Trauma , 7(4):373-380.
6. Abbasi M, Sadeghi M, Azami AA, et al (2016). Factors related to road traffic accidents leading to injury or death in Shahroud City. Safety Promotion and Injury Prevention (Tehran), 4:83-90.
7. Pfeifer R, Tarkin IS, Rocos B, Pape H-C (2009). Patterns of mortality and causes of death in polytrauma patients—has anything changed? Injury, 40(9):907-911.
8. Foroutan A, Heydari ST, Karvar M, et al (2019). Results of a campaign for motorcycle helmets advocacy in a city in southwest of Iran; a population-based intervention study. Bull Emerg Trauma, 7(4) :404-410.
9. Abedi L, Sadeghi-Bazargani H (2017). Epidemiological patterns and risk factors of motorcycle injuries in Iran and Eastern Mediterranean Region countries: a systematic review. Int J Inj Contr Saf Promot, 24(2):263-270.
10. Liu BC, Ivers R, Norton R, Boufous S, Blows S, Lo SK (2008). Helmets for preventing injury in motorcycle riders. Cochrane Database Syst Rev, 23(1): CD004333.
11. Rowland J, Rivara F, Salzberg P, Soderberg R, Maier R, Koepsell T (1996). Motorcycle helmet use and injury outcome and hospitalization costs from crashes in Washington State. Am J Public Health, 86(1):41-45.
12. Fanian H, Ghadipasha M, Goddousi A, Abedi MH, Farajzadegan Z, Kazemi Robati A (2007). Epidemiologic evaluation of traffic accidents in Isfahan,(2002-2003). Iranian Journal of Forensic Medicine, 13:87-91.
13. Sreedharan J, Muttappillymyalil J, Divakaran B, Haran JC (2010). Determinants of safety helmet use among motorcyclists in Kerala, India. J Inj Violence Res, 2(1):49-54.
14. Ranney ML, Mello MJ, Baird JB, Chai PR, Clark MA (2010). Correlates of motorcycle helmet use among recent graduates of a motorcycle training course. Accid Anal Prev, 42(6):2057-2062.
15. Papadakaki M, Tzamalouka G, Orsi C, Kritikos A, Morandi A, Gnardellis C, Chliaoutakis J (2013). Barriers and facilitators of helmet use in a Greek sample of motorcycle riders: Which evidence? Transportation Research Part F: Traffic Psychology And Behaviour, 18:189-198.
16. Mazloumi Ms, Mehri A, Morovati Sma, Falahzadeh H (2008). Application of extended model of planned behavior in predicting helmet wearing among motorcyclist clerks in Yazd (2007). J Birjand Univ Med Sci, 14 :9-15.
17. Liberati A, Altman DG, Tetzlaff J, et al (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.PLoS Med, 6(7):e1000100.
18. Estabrooks C, Goel V, Thiel E, Pinfold P, Sawka C, Williams I (2001). Decision aids: are they worth it? A systematic review. J Health Serv Res Policy, 6 :170–182.
19. Cochran WG (1954). The combination of estimates from different experiments. Biometrics, 10:101-129.
20. Egger M, Smith GD, Schneider M, Minder C (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315:629-634.
21. Campbell B, Heitner J, Amos Mwelelo P,et al (2022). Impact of SMS Text Messaging Reminders on Helmet Use Among Motorcycle Drivers in Dar es Salaam, Tanzania: Randomized Controlled Trial. J Med Internet Res, 24(4):e27387.
22. Germeni E, Lionis C, Kalampoki V, Davou B, Belechri M, Petridou E (2010). Evaluating the impact of a school-based helmet promotion program on eligible adolescent drivers: different audiences, different needs? Health Educ Res, 25(5):865-76.
23. Moghisi A, Mohammadi R, Svanström L (2014). Impact of safe community program on motorcyclists' safety with focus on helmet usage in 14 cities of IR Iran. Int J Inj Contr Saf Promot , 21(2):110-4.
24. Swaddiwudhipong W, Boonmak C, Nguntra P, Mahasakpan P (1998). Effect of motorcycle rider education on changes in risk behaviours and motorcycle-related injuries in rural Thailand. Trop Med Int Health, 3(10):767-70.
25. Williams RS, Graham J, Helmkamp JC, Dick R, Thompson T, Aitken ME (2011). A trial of an all-terrain vehicle safety education video in a community-based hunter education program. J Rural Health, 27(3):255-62.
26. Hounkpe Dos Santos B, Kpozehouen A, Glele Ahanhanzo Y, Daddah D, Lagarde E, Coppieters Y (2022). Implementation of a model of awareness-raising for taxi motorcyclists in Benin in relation to helmet use: a quasi-experimental study. BMC Public Health, 22(1):1424.
27. Babazadeh T, Kouzekanani K, Ghasemzadeh S, Matlabi H, Allahverdipour H (2019). The Role of a Community-Based Intervention in Promoting Helmet Use in a Non-probability Sample of Rural Motorcyclists in Iran. J Community Health, 44(4):828-835.
28. Bhatti JA, Ejaz K, Razzak JA, Tunio IA, Sodhar I (2011). Influence of an enforcement campaign on seat-belt and helmet wearing, karachi-hala highway, pakistan. Ann Adv Automot Med, 55:65-70.
29. Novak JA, Hafner JW, Aldag JC, Getz MA (2013). Evaluation of a standardized all-terrain vehicle safety education intervention for youth in rural Central Illinois. J Prim Care Community Health, 4(1):8-13.
30. Ratanavaraha V, Jomnonkwao S (2013). Community participation and behavioral changes of helmet use in Thailand. Transport policy, 25:111-118.
31. Ning P, Zong H, Li L, et al (2022). Effectiveness of a helmet promotion campaign, China. Bull World Health Organ, 100(5):329-336.
32. Organization WHO (1987). Community-based education of health personnel: report of a WHO study group [meeting held in Geneva from 4 to 6 November 1985]. ed. World Health Organization.
33. Ichikawa M, Nakahara S, Phommachanh S, Mayxay M, Kimura A (2015). Roadside observation of secondary school students' commuting to school in Vientiane, Laos. Int J Inj Contr Saf Promot , 22(2):111-5.
34. Ivers R, Kardamanidis K, Lo SK, Blows S, Zhang J, Stevenson MS (2003). Motorcycle rider training for preventing road traffic crashes. Cochrane Database Syst Rev,10 :CD005240 .
35. Organization WHO (2010). Data systems: a road safety manual for decision-makers and practitioners.
36. Thomson H, Jepson R, Hurley F, Douglas M (2008). Assessing the unintended health impacts of road transport policies and interventions: translating research evidence for use in policy and practice. BMC Public Health, 8:339.
37. Servadei F, Begliomini C, Gardini E, Giustini M, Taggi F, Kraus J (2003). Effect of Italy's motorcycle helmet law on traumatic brain injuries. Inj Prev, 9(3):257-60.
38. Aghamolaei T, Tavafian SS, Madani A (2011). Prediction of helmet use among Iranian motorcycle drivers: an application of the health belief model and the theory of planned behavior. Traffic Inj Prev, 12(3):239-43.
39. Khosravi Shadmani F, Soori H, Karami M, Zayeri F (2014). Priority Setting of Preventive Intervention for Road Traffic Injuries in Iran. Iranian Journal of Epidemiology, 10:33-44.
40. Lardelli Claret P, Luna del Castillo Jde D, Jiménez Moleón JJ, García Martín M, Bueno Cavanillas A, Gálvez Vargas R (2003). [An assessment of the effect of helmet use among cyclists and the risk of head injury and death in Spain, 1990 to 1999]. Med Clin (Barc), 120(3):85-8.
IssueVol 52 No 9 (2023) QRcode
SectionReview Article(s)
Health promotion Helmet use Motorcyclists Effectiveness Meta-analysis

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How to Cite
Jahangiry L, Eisazadeh S, Khabiri R, Sadeghi-Bazargani H, Bakhtari-Aghdam F, Ponnet K. Health Promotion Interventions on Helmet Use: A Systematic Review and Meta-Analysis of Pre-Test and Post-Test Studies. Iran J Public Health. 2023;52(9):1866-1876.