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.