Document Type : Original Article


1 Department of Community Medicine, East Point College of Medical Sciences and Research Centre

2 Intern, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India


CONTEXT: Wearing helmet during road traffic accidents among motorcycle riders decreases the
likelihood of death by 39%. The theory of planned behavior (TPB), a psychological model helps to
explain the failure in helmet usage, by assuming a causal chain. The current study was taken up
as no studies have elicited the determinants of helmet usage in terms of TPB among health‑care
providers, the role models for healthful behavior by virtue of their profession in the current urban
Indian context.
AIMS: The aims of the study were (1) to determine the proportion of proper use of helmets
and (2) to identify TPB‑related factors and other factors influencing the use of helmets.
MATERIALS AND METHODS: A cross‑sectional study was conducted among 147 students and
staff of a tertiary health‑care center, Bengaluru, using a pretested, validated, semi‑structured,
self‑administered questionnaire. Convenience sampling was used. Hierarchical regression model
was used to explain variation in the scores of helmet‑use behavior on the basis of TPB variables.
P < 0.05 was considered as statistically significant.
RESULTS: About 65% of respondents practiced “proper use” of helmets. Intention, perceived
behavioral control (direct), and attitude (indirect) were significant predictors of helmet use (P < 0.05).
Mean scores of knowledge on helmet use and behavior showed positive correlation (P > 0.05).
CONCLUSIONS: Application of TPB in urban Indian context was successful in identifying precursors
of helmet use. This study throws a light on the strong influencers of helmet use which can assist policy
developers in developing effective programs to successfully promote the “proper use” of helmets.


1. Global Status Report on Road Safety 2013: supporting a Decade
of Action. World Health Organization; 2013. Available from:
status/2013/en/. [Last accessed on 2015 Oct 03].
2. Global Health Observatory Data Repository. Road Traffic Deaths
Data by Country. World Health Organization. Available from: [Last
accessed on 2016 Sep 03].
3. Accidental Deaths and Suicides in India 2014. National Crime
Records Bureau Ministry of Home Affairs Government of India;
2014. Available from:
ADSI/ADSI2014/adsi‑2014%20full%20report.pdf.[Last accessed
on 2016 Sep 03].
4. Kharola PS, Tiwari G, Mohan D. Traffic Safety and City Public
Transport System‑ Case Study of Bengaluru, India. J Public Transp
5. Shruthi P, Venkatesh VT, Viswakanth B, Ramesh C, Sujatha PL,
Dominic IR. Analysis of fatal road traffic accidents in a
metropolitan city of South India. J Indian Acad Forensic Med
6. NIMHANS Public‑Health Alerts: Helmets. NIMHANS. Available
pha1.pdf. [Last accessed on 2016 Sep 12].
7. World Health Organization. How to Design and Implement
a Helmet Programme? World Health Organization. Available
helmet_manual/3‑How%20to.pdf.[Last accessed on 2016 Sep 12].
8. Olakulehin OA, Adeomi AA, Oakanbi O, Itie CJ, Olanipekun OO,
Silori O. Perception and practice of helmet use among motorcycle
riders in a semi‑urban community in South‑Western Nigeria.
J Dent Med Sci 2015;14:120‑4.
9. Peltzer K, Pengpid S. Helmet use and associated factors among
motorcyclists in the Association of Southeast Asian Nations:
Prevalence and effect of interventions: Review. Afr Saf Promot J
10. Kulanthayan S, Umar RS, Hariza HA, Nasir MT, Harwant S.
Compliance of proper safety helmet usage in motorcyclists. Med
J Malaysia 2000;55:40‑4.
11. Conrad P, Bradshaw YS, Lamsudin R, Kasniyah N, Costello C.
Helmets, injuries and cultural definitions: Motorcycle injury in
urban Indonesia. Accid Anal Prev 1996;28:193‑200.
12. Kalantharakath T, Iyer R. Helmet attitudes and practices among
university students of dental and medical professional courses
in Vadodara, India. J Interdiscip Med Dent Sci 2015;3:1‑5.
13. Haqverdi MQ, Seyedabrishami S, Groeger JA. Identifying
psychological and socio‑economic factors affecting motorcycle
helmet use. Accid Anal Prev 2015;85:102‑10.
14. Glanz K, Rimer Bk, Viswanath K. Health Behavior and Health
Education Theory, Research and Practice. 4th ed. California:
Jossey‑Bass; 2008. Available from: http://www.fhc.sums. [Last accessed on
2016 Sep 12].
15. Tavakol M, Dennick R. Making sense of cronbach’s alpha. Int J
Med Educ 2011;2:53‑5.
16. Ali M, Saeed MM, Ali MM, Haidar N. Determinants of helmet
use behaviour among employed motorcycle riders in Yazd, Iran
based on theory of planned behaviour. Injury 2011;42:864‑9.17. Gibbons FX. Behavioral Intentions, Expectations, and Willingness.
Health Behavior Constructs: Theory, Measurement, and Research.
Bethesda, MD: National Cancer Institute; 2006. Available from:
html. [Last Accessed on 2018 Aug 20].
18. Sharma R. Revision of Prasad’s social classification and provision
of an online tool for real‑time updating. South Asian J Cancer
19. Sharma R. Online Interactive Calculator for Real‑Time Update of
the Prasad’s Social Classification. Available from: http://www. [Last accessed on 2016 Sep 12].
20. Government of India. Current Month Consumer Price Index;
2016. Available from:
htm. [Last accessed on 2016 Sep 12].
21. Gururaj G. Road Safety in India: A Framework for Action.
Bangalore, India: National Institute of Mental Health and Neuro
Sciences; 2011.
22. Wadhwaniya S, Gupta S, Tetali S, Josyula LK, Gururaj G,
Hyder AA, et al. The validity of self‑reported helmet use among
motorcyclists in India. WHO South East Asia J Public Health
23. Yadukul S, Devadass PK, Gururaj G. Role of helmet in preventing
head injury among two wheeler occupants in fatal road traffic
injuries. Indian J Forensic Med Toxicol 2016;10:6‑10.
24. Karuppanagounder K, Vijayan AV. Motorcycle helmet use in
Calicut, India: User behaviors, attitudes, and perceptions. Traffic
Inj Prev 2016;17:292‑6.
25. Bachani AM, Tran NT, Sann S, Ballesteros MF, Gnim C, Ou A,
et al. Helmet use among motorcyclists in Cambodia: A survey
of use, knowledge, attitudes, and practices. Traffic Inj Prev
2012;13 Suppl 1:31‑6.
26. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis
Processes 1991;50:179‑211.
27. Aghamolaei T, Tavafian SS, Madani A. Prediction of helmet use
among Iranian motorcycle drivers: An application of the health
belief model and the theory of planned behavior. Traffic Inj Prev
28. Lajunen T, Räsänen M. Can social psychological models be used
to promote bicycle helmet use among teenagers? A comparison
of the health belief model, theory of planned behavior and the
locus of control. J Safety Res 2004;35:115‑23.
29. Ahmed MB, Ambak K, Raqib A, Sukor NS. Helmet usage among
adolescents in rural road from the extended theory of planned
behavior. J Appl Sci 2013;13:161‑6.
30. Kalbandkeri LR, Boramma G, Ghooli S. A study to assess
the knowledge and practice of road safety measures among
undergraduate medical students of MR medical college,
Kalaburagi. Int J Community Med Public Health 2018;5:1596‑601.
31. Suwannaporn S, Hongsranagon P, Havanond P. Knowledge,
attitude and practice towards helmet use among motorcycle riders
and passengers in Ratchaburi Province, Thailand. J Health Res
32. Rezazadeh J, Rajabzadeh R, Jabbari S, Soliymani A, Emami O,
Hosseini SH. Knowledge, attitude, and practice of the
motorcyclists of Bojnourd regarding using helmets. Saf Promot
Inj Prev 2015;2:303‑12.
33. Pezeshki MZ, Shadman A, Alizadeh M, Hakimi S, Heidari F.
Validity and reliability of the questionnaire for assessing women’s
reproductive history in Azar cohort study. J Caring Sci 2017;6:183‑6.
34. McCambridge J, Witton J, Elbourne DR. Systematic review of the
Hawthorne effect: New concepts are needed to study research
participation effects. J Clin Epidemiol 2014;67:267‑77.
35. Kohli E, Ptak J, Smith R, Taylor E, Talbot EA, Kirkland KB, et al.
Variability in the hawthorne effect with regard to hand hygiene
performance in high – And low‑performing inpatient care units.
Infect Control Hosp Epidemiol 2009;30:222‑5.