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Applying the health action process approach to bicycle helmet use and evaluating a social marketing campaign
  1. Florian M Karl1,
  2. Jennifer Smith2,
  3. Shannon Piedt2,
  4. Kate Turcotte2,
  5. Ian Pike2,3
  1. 1 Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Neuherberg, Germany
  2. 2 BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
  3. 3 Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Florian M Karl, Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München (GmbH) – German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Florian.karl{at}


Background Bicycle injuries are of concern in Canada. Since helmet use was mandated in 1996 in the province of British Columbia, Canada, use has increased and head injuries have decreased. Despite the law, many cyclists do not wear a helmet. Health action process approach (HAPA) model explains intention and behaviour with self-efficacy, risk perception, outcome expectancies and planning constructs. The present study examines the impact of a social marketing campaign on HAPA constructs in the context of bicycle helmet use.

Method A questionnaire was administered to identify factors determining helmet use. Intention to obey the law, and perceived risk of being caught if not obeying the law were included as additional constructs. Path analysis was used to extract the strongest influences on intention and behaviour. The social marketing campaign was evaluated through t-test comparisons after propensity score matching and generalised linear modelling (GLM) were applied to adjust for the same covariates.

Results 400 cyclists aged 25–54 years completed the questionnaire. Self-efficacy and Intention were most predictive of intention to wear a helmet, which, moderated by planning, strongly predicted behaviour. Perceived risk and outcome expectancies had no significant impact on intention. GLM showed that exposure to the campaign was significantly associated with higher values in self-efficacy, intention and bicycle helmet use.

Conclusion Self-efficacy and planning are important points of action for promoting helmet use. Social marketing campaigns that remind people of appropriate preventive action have an impact on behaviour.

  • Traumatic Brain Injury
  • Bicycle Helmet
  • Social Marketing
  • Health Action Process Approach(HAPA)

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  • Contributors All authors contributed significantly to the paper and that the final version of the paper has also been seen and approved by all authors in an internal review process. FMK and IP have contributed substantially to the study design and acquisition and analysis/interpretation of the data. FMK drafted the article with assistance from KT and SP, and both IP and JS have extensively reviewed and revised the article critically for important intellectual content. Neither the article nor any of its essentials have been published or are submitted for publication elsewhere.

  • Competing interests IP is the coexecutive director and spokesperson for Preventable.

  • Ethics approval University of British Columbia Research Ethics Board (certificate #H15-03012).

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

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