JMIR Publications

ABSTRACT

Background:

Road traffic injury (RTI) is a pressing public health issue in Tanzania. Men are particularly at high risk of RTI because nearly all drivers of motorcycle taxis (“bodabodas,” in Kiswahili, or “bodas” for short), a major form of public transportation in the country, are men. Studies have shown that helmet use can significantly reduce disability and death resulting from road traffic injuries. Efforts have been made by the Tanzanian government to develop tighter helmet use laws. However, adherence to helmet use has remained dangerously low throughout the country. One promising intervention to promote helmet use is the introduction of persuasive short message service (SMS) reminders delivered to boda drivers.

Objective:

To evaluate the comparative impact of two different types text messages, also known as short message service (SMS) reminders, on motorcycle helmet use.

Methods:

Participants were 391 commercial motorcycle taxi drivers in Dar es Salaam, Tanzania. Participants were randomized into three groups, each receiving a different set of messages: 1) social-norming messages aimed at emphasizing society’s positive stance on helmet wearing, 2) fear appeal messages that emphasized the dangers of riding without a helmet, and 3) control group messages, which included basic road safety messages unrelated to helmet use. Every participant received the control messages. Adherence to helmet use was evaluated by self-report through surveys conducted at baseline, 3 weeks and 6 weeks.

Results:

At 6 weeks, the odds of self-reporting consistent helmet use was estimated to be 1.58 times higher in the social-norming group than in the control group (P=.043), though this difference is not significant after accounting for multiple testing. There was little difference between fear appeal and control group recipients (OR= 1.03, P=.466). Subgroup analysis suggests that both fear control and social-norming message types might have been associated with increased helmet use among participants who did not consistently wear helmets at baseline (OR= 1.66 & OR=1.84), but this was not significant (P=.109 & P=.071). Amongst those who were consistent wearers at baseline, the social-norming messages performed better than the fear appeal messages, and this difference reached traditional significance (P=.029), but is not significant after accounting for multiple testing.

Conclusions:

The use of SMS reminders may improve helmet use among motorcycle drivers when framed as social-norming messages. Given that nearly half of the drivers in our sample did not consistently wear their helmets on every trip, strategies to increase consistent usage could be an important benefit to public safety. Clinical Trial: clinicaltrials.gov Identifier: NCT02120742 https://clinicaltrials.gov/ct2/show/NCT02120742