Development of a Perception Scale of Motorcycle Helmet Use for University Students Using the Health Belief Model

Abstract

Motorcycle accidents causing life-threatening violence and head injuries are the leading cause of death and disability among motorcyclists who do not wear helmets. Although Thailand has had established laws governing helmet wearing since 1979, most motorcyclists do not wear a helmet. A survey of wearing a helmet among motorcyclists in Thailand in 2018 found that among teenagers only 22% of them wear a helmet. In understanding the behavior of motorcyclists, a behavioral theory is needed to provide a better explanation and comprehensive insight into the phenomena. In particular, the Health Belief Model (HBM) is one of the most widely used behavior models that has been applied extensively to evaluate and explain individual differences in preventive health behavior. There are some research studies on the behavior of wearing a helmet among motorcyclists using the HBM, but not using the complete HBM structure in the research tool. Consequently, the results of the study are not clear due to a lack of psychological properties of measurement, especially in terms of content and construct validity. In Thailand, there are no research reports on the perception scale of motorcycle helmet use that was created with the complete constructs of the HBM. The aims of this research were: 1) to develop a perception scale of motorcycle helmet use (PSMHU) for university students based on the Health Belief Model (HBM) and 2) to examine the content and construct validity of the PSMHU.

A cross-sectional survey of 600 undergraduate students of Thailand National Sports University, Chon Buri campus, Thailand, was conducted in August 2020. The students were randomly selected from three faculties: Education, Arts, and Sport Science and Health. The instrument was designed to collect data regarding demographics, brief motorcycle riding information, and six HBM construct measures. The content validity of the HBM constructs was assessed by five experts. A pilot study was conducted among 50 students to ensure the validity and reliability of a preliminary total of 60 questions of HBM components. Some items were revised and refined based on the results of the pilot study. Also, all items were screened to pass an alpha reliability criterion of ≥0.70. Finally, the 24 questions that passed the reliability criterion represented the PSMHU and were used to collect the data. Statistical analyses were carried out using descriptive, alpha reliability, and Second Order of Confirmatory Factor Analysis (SOCFA).

The mean age of the students was 20.77 ± 8.01 years. Overall 67.3% (n = 404) of the students were male. Most of the students studied in the Faculty of Education (46.8%) followed by the Faculty of Arts (32.3%), and Sport Science and Health (20.8%). On average, students had driven motorcycles for 6.84 years. About 69.3% of the students did not wear a helmet. The PSMHU had a scale reliability of 0.87 and each item had reliability between 0.71- 0.82. The alpha reliabilities of six components were in the range of 0.81-0.85. The results of SOCFA indicated that the model fit to the empirical data. All six constructs of PSMHU were statistical significant at p <0.001. The perceived susceptibility (β_PSUS = 0.95,  = 0.90) and severity (β_PSEV = 0.81,  = 0.66) were the most influential components, followed by perceived benefit (β_PBEN = 0.75,  = 0.56), barrier perception (β_PBAR = - 0.73,  = 0.53) and self-efficacy (β_PSEL = 0.70,  = 0.49). Finally, cues to action (β_CTAC = 0.63,  = 0.40) played the least influence in the PSMHU.

The primary aims of the present study were met. A psychometrically-sound scale containing six components relevant to the HBM was developed and preliminary support regarding the reliability and construct validity of the PSMHU was established. This PSMHU can be used as a research tool for predicting helmet wearing behavior in motorcycling using the HBM. The results that were obtained from testing construct validity of the PSMHU provided important information, especially regarding susceptibility and severity perceptions of head injuries due to non-helmet use. These outcomes are useful for instructors who teach health education and safety, should they develop a preventive-health behavior program that encourages students to habitually wear a helmet when driving a motorcycle.