P096: Non-legislative interventions to promote helmet use in adult cyclists: a scoping review

Abstract

Introduction: Helmets are effective in preventing brain injury and fatality in cyclists. Methods to promote their use include legislation and non-legislative interventions (NLIs) such as education, social interventions, and subsidies. These have been systematically reviewed and proven effective in pediatric populations. We conducted a scoping review regarding NLIs to promote helmet use amongst adult cyclists. Methods: We conducted a scoping review of NLIs to promote helmet use amongst cyclists age 18 or older. PRISMA guidelines were followed. Databases searched included MEDLINE, EMBASE, CINAHL, PsycINFO, and SportDiscus, in addition to grey literature. Articles were excluded if non-English, focused on age <18, on legislative interventions, or did not report on outcomes related to helmet use or ownership. Study inclusion and data extraction were conducted in duplicate. Data were extracted regarding participant demographics, setting, intervention details and effects, and were reported using descriptive statistics with a narrative synthesis. A limited quality assessment was conducted. Results: A total of 16 papers were included, stratified as 4 randomized-controlled trials and 12 pre-post studies. Only 4 were specific to adults. Community cyclists (5/16, 31%) and community members were most commonly targeted, with most interventions taking place in the community (8/16, 50%) or in a healthcare setting (4/16, 25%). Most interventions were multi-faceted, involving components of community awareness programs, education, information distribution, helmet giveaways and monetary incentives, use of mass media, motivational interviewing, and social marketing. The studies were heterogeneous in quality. Changes in helmet rate use varied between -6% and 26%, with half the studies (8/16, 50%) noting a statistically significant increase. Duration of follow-up of helmet use rates following the intervention varied between 4.5 weeks and 11 years (median 1.38 years, mean 3.0 years.) Conclusion: NLIs to encourage bicycle helmet use were frequently multi-faceted and generally associated with an increase in use amongst adults. Studies were heterogenous in quality, varied in their targeted audiences and often not focused on adults. Further evidence is needed to better characterize the efficacy of non-legislative interventions to achieve sustained helmet use in adult cyclists.