Global Evidence on Helmet Use and Misuse: A Public Health Perspective on Prevalence, Determinants and Barriers

Helmet wearing is crucial to prevent injuries which is influenced by diverse variables. There are some factors which affect helmet use or non-use resulting in fluctuations in helmet use rate, globally. This study aimed at estimating global helmet use rate and identifying related barriers and determinants.

A systematic review and meta-analysis was performed till January 2024 through PubMed, Scopus, ScienceDirect, and Web of Knowledge databases using predefined keywords. Related journals and references of the selected articles were reviewed. Two authors independently screened the retrieved citations, assessed methodological quality, and extracted data using an extraction form. Subgroup analysis and sensitivity analysis were performed to explore differences based on study characteristics, and random effect model was used for meta-analysis through Stata 16.

Based on meta-analysis results, including approximately one million people, overall helmet use rate (OHUR) in motorcyclists and passengers were estimated to be 0.54 [0.48-0.59 with 95 CI, I² = 99.9] and 0.32 [0.15-0.49 with 95 CI, I² = 99.9], respectively. Correct helmet use rate (CHUR) in motorcyclists was 0.43 [0.32-0.53 with 95 CI, I² = 99.9] and 0.18 [0.12-0.24 with 95 CI, I² = 9] in passengers. Identified determinants and barriers were classified in eight categories, including psychological and cognitive, socio-demographic, travel characteristics, road characteristics, motorcycle, time/weather condition, law enforcement, and miscellaneous.

Although approximately half of the motorcyclists and a third of the passengers have used helmet, the correct use was very low. Psychological and cognitive factors were the most important barriers to helmet use. Creating and maintaining a positive attitude in motorcyclists about safety effects of helmet through diverse methods such as peer-groups education, social campaigns, and so forth is recommended. Moreover, developing compatible, comfortable, and affordable helmets should be followed to overarch barriers.