P044: HEADSTRONG: helmet education, advocacy, distribution & social media trial to reduce obstacles & nudge group behaviour

Abstract

Introduction: Head injury is a major cause of bicycling-related disability and death, and more likely to occur in unhelmeted riders. Legislation regarding helmet use varies by province. In Ontario, helmet use is not mandatory for cyclists >= age 18, and approximately 50 % of adult cyclists do not routinely wear helmets. Non-legislative approaches to increase helmet use have included education, public health campaigns, and helmet giveaways, but sustained effect is typically limited. The goal of the HEADSTRONG Behaviour Study is to identify injured adult cyclists who do not regularly wear helmets, and effect sustained helmet use. The strategy incorporates evidence-based elements of health behaviour change, including: reducing barriers, education and modelling, providing necessary materials, and social support. Methods: Prospective cohort study in downtown Toronto teaching hospital, launched Nov 2015. ED clinician (EP or NP) will recruit injured cyclists (consecutive, convenience sample) who report not regularly wearing a helmet nor owning a suitable one. Study endpoint: 100 enrolled (to estimate prevalence of usage of +/- 10%, alpha 0.05, power >90%, assuming 80% study completion and 50 % helmet wearing at 12 months). Exclusion criteria: unable to consent, admitted to hospital, age <18. Each element of the HEADSTRONG Behaviour Strategy is intended to facilitate patient adoption and maintenance of the desired behaviour, including: 1) enrolment/education by research associate while still in the ED; 2) provision and fitting of a free bicycle helmet; 3) social contract commitment and tailored reminders to document ongoing helmet use: participant agrees to respond to brief electronic survey follow-ups at two weeks, two months, six months, and twelve months; 4) social media engagement with participation in the HEADSTRONG Twitter group, which engages other enrolees and cycling advocacy groups; 5) peer nomination: the participant who is complying with the social contract is encouraged to nominate an uninjured non helmet-wearing colleague to enrol in the study. Results: Primary outcomes include: recruitment rate, enrolment, and sustained participation through follow-up period. Secondary outcomes include age, gender and social demographics of helmet recipients, and participation of peers. Conclusion: Discussion of strategy and interim results at six month interval will be presented at CAEP.