Article Text

Download PDFPDF
Effectiveness of a nationwide intervention to increase helmet use in Dutch skiers and snowboarders: an observational cohort study
  1. Ingrid Vriend1,2,
  2. Arlette Hesselink3,
  3. Ellen Kemler1,
  4. Vincent Gouttebarge1,4,
  5. Willem van Mechelen2,4,
  6. Evert Verhagen2,5
  1. 1 Consumer Safety Institute (VeiligheidNL), Amsterdam, The Netherlands
  2. 2 Amsterdam Collaboration on Health and Safety in Sports, Department of Public & Occupational Health and Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
  3. 3 ResCon, Research and Consultancy, Haarlem, The Netherlands
  4. 4 Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  5. 5 Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia
  1. Correspondence to Dr Evert Verhagen, Department of Public & Occupational Health, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands; e.verhagen{at}


Objective Helmet use in Dutch recreational skiers and snowboarders (DRSS) remains low. This study evaluated the effects of exposure to a nationwide intervention on relevant determinants of helmet use and helmet use in DRSS.

Methods The intervention mapping protocol was used to develop an in-season intervention programme targeted at adult DRSS. A prospective single-cohort study was conducted to evaluate the impact of intervention exposure on determinants of helmet use (ie, knowledge about head injury risk and preventive measures, risk perception, attitudes to head injury risk and helmet use and intention to helmet use) and self-reported helmet use. A random sample of 363 DRSS from an existing panel participated in this study. Data were collected using online questionnaires before and immediately after the 2010/2011 intervention season. In a separate sample of 363 DRSS, intervention reach was assessed after the 2010/2011 season.

Results Overall, no significant associations were found between intervention exposure and the determinants of helmet use. However, subgroup analyses revealed intervention effects on risk perception and knowledge in specific subpopulations. Intervention exposure had a significant, positive effect on helmet use in DRSS (β=0.23; 95% CI 0.017 to 0.44). Subgroup analyses revealed that this effect was found in: (1) skiers, (2) female DRSS, (3) young skiers and (4) intermediate skiers. Overall, intervention reach was 28.1%, with differences found between skiers and snowboarders.

Conclusions Exposure to a nationwide intervention programme was associated with increased self-reported helmet use in DRSS. Differences were found in intervention effectiveness and reach between subpopulations. These differences must be taken into account when developing and evaluating future interventions.

  • snow sports
  • intervention
  • helmet use
  • behaviour change

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors IV and AH conceived the research idea, developed the questionnaires and performed the data analyses. AH coordinated the data collection. EK and IV contributed to the intervention development. IV and EV interpreted the data and prepared the manuscript. All authors discussed the analyses, contributed to the manuscript and read and approved submission of the final manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.