Health Promotion Interventions on Helmet Use: A Systematic Review and Meta-Analysis of Pre-Test and Post-Test Studies
DOI: 10.18502/ijph.v52i9.13569
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Summary
This systematic review and meta-analysis evaluates the effectiveness of health promotion interventions aimed at increasing helmet use among motorcyclists. The study addresses the significant public health burden of road traffic accidents, particularly in developing countries where motorcyclists account for a substantial proportion of fatalities. Since head and neck injuries are the leading preventable cause of death for this demographic, and helmet use can reduce injury risk by approximately 70%, the authors sought to identify which health promotion strategies effectively encourage helmet adoption. The researchers conducted a systematic search of PubMed, Scopus, Cochrane, Embase, and MagIran databases up to August 2022, adhering to PRISMA guidelines. From an initial pool of 1,675 articles, 12 eligible studies were included in the review, encompassing randomized controlled trials, intervention-control group studies, quasi-experimental designs, and pre-post-test studies conducted between 1998 and 2022 across various countries including Iran, the USA, Thailand, and China. For the meta-analysis, five studies with pre-post-test designs were selected. Data extraction focused on participant demographics, intervention types, and changes in helmet usage percentages. Quality assessment was performed using a specific tool for pre-post intervention designs, and statistical analysis employed random-effects models to pool results, with heterogeneity assessed via Cochran’s Q-test and I² statistics. The meta-analysis revealed that health promotion interventions increased helmet wearing by an average of 70% (95% CI: 21–119; P<0.001). The pooled estimate showed no significant heterogeneity (I² = 0%; P=0.94). Among the reviewed studies, community-based education programs were the most frequently applied intervention strategy, followed by campaign designing, community participation, and advocacy combined with law enforcement. Other approaches included SMS text messaging and programs based on the Theory of Planned Behavior or Health Belief Model. While some studies reported significant increases in knowledge and positive attitudes, others noted mixed results regarding actual behavior change, particularly when interventions lacked enforcement components. The findings indicate that health promotion strategies, particularly community-based education and public campaigns, significantly improve helmet-wearing behavior. The authors conclude that these interventions are effective tools for reducing head injuries in motorcyclist road traffic accidents. They recommend that countries with high motorcycle accident prevalence and weak legislation prioritize these strategies. Additionally, the study calls for further randomized controlled trials to better isolate the effectiveness of specific health promotion strategies and to address limitations in current research designs.
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| Stage | Outcome | Tool | Model | Prompt | Attempts | Completed |
|---|---|---|---|---|---|---|
| discover | success | Crossref | — | — | 1 | 2026-06-20 |
| archive | success | openalex | — | — | 5 | 2026-06-26 |
| extract | success | cached | — | — | 2 | 2026-06-26 |
| clean | success | clean | — | — | 1 | 2026-06-25 |
| chunk | success | chunk | — | — | 1 | 2026-06-25 |
| embed | success | embed | Qwen/Qwen3-Embedding-8B | — | 1 | 2026-06-25 |
| promote | success | — | — | — | 1 | 2026-06-20 |
| summarize | success | llm | qwen3.6-27b-prismaquant | summ-v5 | 1 | 2026-06-26 |
| tag | success | vector_similarity | — | — | 6 | 2026-06-25 |
| verify | success | — | — | — | 1 | 2026-06-26 |
Summary generated by qwen3.6-27b-prismaquant on 2026-06-26; verification: verified.
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- Applied Guidance: countermeasure evaluation