Background Appropriate helmet use can reduce the number of fatalities that occur from serious head injuries sustained in motorcycle crashes. However, the accurate measurement of helmet use remains a challenge due to variations in self-reporting and observational studies, the most widely used techniques for studies on helmet use worldwide.

Objective This study determined the discrepancy between observed and self-reported helmet use among motorcyclists and the factors associated with over-reporting of helmet use.

Methods A cross-sectional survey was conducted among 381 motorcyclists (riders and pillion riders) at twelve randomly selected fuel stations in the Tamale Metropolitan Area between March and April, 2021. All motorcyclists who stopped to purchase fuel were recruited. The motorcyclists were first observed on actual helmet use (observed helmet use) as they entered the premise of the station and then interviewed face-to-face on helmet use practices.

Results Observed helmet use was 21.3% whiles self-reported helmet use was 37.8%. Of the motorcyclists who were observed wearing helmets, 63.0% reported they used helmets always whiles 37.0% did not use helmets always. On the other hand, 31.0% of those observed without helmets reported that they used helmets always, whiles the remaining 69.0% actually did not use helmets always. Over-reporting of helmet use was lower among motorcyclists who had secondary (18.9% over-reporting) and tertiary education (18.7%) compared to those with basic education (44.1%). Additionally, over-reporting rate of helmet use was lower among motorcyclists who had informal occupation (26.2%) or unemployed (13.6%) compared to those with formal/professional occupations (31.8%).

Conclusion The study reveals a significant disparity between observed and self-reported helmet use among motorcyclists in northern Ghana. Self-reported helmet use was notably higher than observed. A notable proportion of those observed not wearing helmets stated that they wore them always, highlighting an over-reporting tendency. Motorcyclists with higher educational attainment exhibited lower rates of over-reporting. The findings underscore the need for targeted interventions to bridge the gap between self-reported and observed helmet use among motorcyclists. When combined with enforcement actions, the implementation of extensive education programs stressing the value of constant helmet use can potentially align self-reported behaviors more closely with actual practices.