Studies of helmet promotion programs were gathered from around the world using the World Wide Web and personal communication with authors and implementers which resulted in 31 programs for analysis of theory content. Unarticulated theories were made explicit. Legislation, educational programs, and combination programs of legislation and education were separated and then grouped by study design for analysis. Outcome measures and evaluation methods were also recorded.
This study found that there were five major implicit, or unarticulated, theories being used in the educational programs reviewed. Further, outcome measures were not standardized, which made answering the question of which theories most influence cyclists to wear helmets even more difficult to answer.
It was found that theories were being used in helmet promotion program development. The information learned in this study may encourage program developers to use a more systematic approach to program development in the future, using explicit theories and a standardized method of outcome evaluation. It was also discovered that peer pressure, a major barrier to helmet use, was not being effectively addressed in the programs and may need to be made a focus of future bicycle helmet promotion programs.
