Abstract

Amy C. Dennis, Nichole Bosson, Jose Elias Collado Peralta, Cesar Castillo, Mark Foran and Stephen P. Wall*

Motorcycle-related traumatic brain injuries are a leading cause of morbidity and mortality in the Dominican Republic. Although rates of helmet use by motorcycle riders are low, little is known regarding the specific factors that drive this behavior. In this study, 26 adults in an urban Dominican hospital who self-reported riding motorcycles often without wearing a helmet participated in semistructured qualitative interviews about their motorcycle use, collision history, and beliefs regarding helmets. A theoretical construct was created based on iterative coding of the resulting interview transcripts. Most participants understood helmets protect against head injury, yet stated that helmets are not needed for short distances, in rural areas, or when riding as the passenger. Perceived barriers to helmet use include cost, lack of access for passengers, and unattractiveness. Participants revealed that the national law mandating driver helmet use did not apply to passengers and was not effectively enforced. Findings are discussed in relation to the Health Belief Model. Specific policy recommendations are proposed, including changes in national legislation to apply to motorcycle passengers, increased law enforcement in rural areas and with less predictability in urban areas, financial interventions to reduce the consumer cost of helmets, and cultural interventions to popularize motorcycle helmet use.