Seat belt use in pregnancy and postpartum: A comparison of two behavioral models

In the United States, trauma incurred during motor-vehicle crashes is a frequent cause of pregnancy complications and maternal deaths, however, the literature examining behavioral drivers of seat belt use is limited. This study aimed to describe self-reported seat belt behavior among pregnant and postpartum individuals, provide motherhood-specific reasons for unbuckling, and identify specific behavioral constructs associated with seat belt behavior.

Survey participants were asked questions about their seat belt use and unbuckling behavior. They were then randomized to answer questions about their seat belt behavior from one of two leading behavioral frameworks-the Health Belief Model and the Theory of Planned Behavior. An iterative process was utilized to compare multiple regression models for each behavioral framework.

While examining which constructs from the Health Belief Model and the Theory of Planned Behavior were associated with seat belt behavior, we discovered that the Health Belief Model explained more of the variance in seat belt behavior among perinatal people (57.6%) than the Theory of Planned Behavior (47.1%). Perceived benefits and perceived barriers were the two constructs from the Health Belief Model that were most strongly associated with favorable seat belt behavior, while attitude and personal agency were the two constructs from the Theory of Planned Behavior that were the most strongly associated with favorable seat belt behavior.

Our study revealed that specific behavioral constructs best predict seat belt behavior in the perinatal population. These constructs should be incorporated into current prevention and intervention techniques promoting proper seat belt use to reduce maternal death from motor-vehicle crashes.

Public messaging and patient education about seat belt use in the perinatal population should draw from the constructs of the Health Belief Model for the greatest positive impact on behavior.