Dec 10, 2025
Assessment of Helmet Usage Among Secondary School Students: Study Protocol
- Mazhar Iqbal1,
- Kashif Shafique2,
- Mariam Ashraf3
- 1PhD Scholar, School of Public Health, Dow University of Health Sciences, Karachi, Ojha Campus, Suparco Road, Karachi, Pakistan;
- 2Professor (Public Health) & Principal, Director, Office of Research, Innovation & Commercialization, School of Public Health, Dow University of Health Sciences, Karachi, Ojha Campus, Suparco Road, Karachi, Pakistan.;
- 3Associate Professor (Public Health), Manager, Office of Research, Innovation & Commercialisation, School of Public Health, Health Services Academy, Islamabad, Pakistan.
- Mazhar Iqbal: First Author;
- Kashif Shafique: Second Author;
- Mariam Ashraf: Third Author; Corresponding Author
Protocol Citation: Mazhar Iqbal, Kashif Shafique, Mariam Ashraf 2025. Assessment of Helmet Usage Among Secondary School Students: Study Protocol. protocols.io https://dx.doi.org/10.17504/protocols.io.ewov11ey7vr2/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: December 08, 2025
Last Modified: December 10, 2025
Protocol Integer ID: 234469
Keywords: practices of adolescent motorbike rider, helmet use in karachi, assessment of helmet usage, adolescent motorbike rider, regarding helmet use, helmet usage, using motorcycle, motorcycles for transport, using health belief model, health belief model, theory of planned behaviour, sector secondary schools in karachi, planned behaviour, study protocol objective, secondary school student, attitude, validated structured questionnaire
Abstract
Objective: Assess knowledge, attitudes, and practices of adolescent motorbike riders (ages 15-19) regarding helmet use in Karachi, Pakistan.
Design: Descriptive-analytical cross-sectional study using Health Belief Model (HBM) and Theory of Planned Behaviour (TPB).
Setting: Public-sector secondary schools in Karachi, Pakistan.
Participants: 502 male students aged 15-19 years using motorcycles for transport.
Data Collection: October-December 2022 using validated structured questionnaire.
Guidelines
Quality Control:
- Same-day submission to principal investigator
- Locked storage before and after data entry
- Restricted access to data files
- Daily verification of completeness
Materials
Required Materials
- Validated questionnaire (Urdu translation)
- Informed consent forms (Urdu)
- Parental consent forms for participants 3c18 years
- Secure storage files for data
- IBM SPSS version 27 for analysis
Equipment Specifications
- Computer-generated random number generator for sampling
- STATA software for cluster size calculation
- Locked storage facilities for questionnaires
Troubleshooting
Problem
Low consent rate
Solution
Conduct parent information sessions; provide detailed study benefits
Problem
Incomplete questionnaires
Solution
Implement on-site completion verification; train interviewers thoroughly
Problem
Language barriers
Solution
Use Urdu-validated questionnaire; employ bilingual interviewers
Problem
Access to schools
Solution
Obtain formal education department approval letters; coordinate with principals
Problem
Data quality concerns
Solution
Implement same-day PI review; conduct periodic inter-rater reliability checks
Before start
1. Guarantee anonymity and confidentiality.
1. ETHICAL APPROVAL
Duration: 2-4 weeks before study commencement
Obtain IRB approval (Reference: IRB-2510/DUHS/Approval/2022/856)
Request approval from Sindh Education Department
Obtain school enrollment lists from education department
2. SAMPLING STRATEGY
Duration: 1 week
Sample Size Calculation:
Formula: Two means comparison (Openepi.com)
Based on: Mean±SD knowledge scores 7.16±1.55 (intervention) vs 6.84±1.68 (control)
Confidence interval: 95%
Study power: 80%
Initial calculated: 416 students
Final adjusted: 500 students (20% non-response buffer)
Actual enrolled: 502 students (100% response rate)
Cluster Sampling:
Software: STATA
Intra-cluster correlation: 0.05
Power: 80%, CI: 95%
Result: 10 schools total (5 per arm)
Students per school: 50
Selection method: Computer-generated random numbers
Sampling frame: Student identifiers from grades 8-10, ages 15-19, using motorcycles
Stratification:
Seven districts in Karachi
Public-sector secondary schools
Higher and lower socioeconomic communities
3. PARTICIPANT RECRUITMENT
Duration: 3 months (October-December 2022)
Inclusion Criteria:
Male students aged 15-19 years
Attending public secondary schools
Using motorbike for transportation (rider, pillion rider, or passenger)
Provided informed consent
Parental consent obtained (for age 3c18 years)
Exclusion Criteria:
Students not using motorcycles
Declined participation
Incomplete parental consent
Consent Process:
Distribute information sheets in Urdu
Obtain written parental consent (students 3c18 years)
Obtain written student assent/consent
Ensure voluntary participation
Guarantee anonymity and confidentiality
4. QUESTIONNAIRE DEVELOPMENT
Duration: 4-6 weeks (completed before data collection)
Phase 1 - Item Generation:
Adapted HBM scales from Champion 6 Skinner (2008)
Adapted TPB measures following Ajzen (2006)
Knowledge items from Pakistan's National Highway and Motorway Police curriculum
Initial items: 65
Expert review panel: 3 road safety researchers + 2 behavioral psychologists
Phase 2 - Content Validation:
Expert panel: 5 specialists (2 road safety, 2 health behavior, 1 adolescent psychologist)
Content validity index: 0.89
Forward-backward translation to Urdu
Discrepancy resolution through expert consensus
Phase 3 - Pilot Testing:
Sample: 50 students (non-study schools)
Factor analysis: KMO=0.83, Bartlett's test pc0.001
Principal component analysis: 11 factors, 64% variance explained
Factor loadings: All e0.40
Reliability Assessment:
Knowledge scale: α=0.76
HBM subscales: α=0.77-0.84
TPB subscales: α=0.80-0.88
Test-retest (n=30, 2-week interval): ICC=0.76-0.89
5. DATA COLLECTION
Duration: 3 months (October-December 2022)
Procedure:
Schedule data collection sessions with schools
Assemble trained data collection team
Conduct interviews during school hours
Use structured questionnaire (Urdu)
Complete one session per school per day
Submit questionnaires to PI same day
Store in locked filing system
Quality Control:
Same-day submission to principal investigator
Locked storage before and after data entry
Restricted access to data files
Daily verification of completeness
Variables Assessed:
Demographics (age, socioeconomic status)
Transport characteristics (motorcycle type, riding frequency, user type)
Accident history (past 12 months)
Helmet usage patterns (as rider and passenger)
Knowledge scores (range: 3-16)
HBM scores (range: 12-33)
TPB scores (range: 8-22)
6. OPERATIONAL DEFINITIONS
Socioeconomic Status:
Tool: Modified Kuppuswamy scale (Pakistan adaptation)
Components: Education (1-7), Occupation (1-10), Income (1-12)
Total range: 3-29 points
Categories: Middle class (16-25), Lower-middle (11-15), Lower (≤10)
Accident History:
Timeframe: Past 12 months
Definition: Collision/crash requiring medical attention or causing property damage
Assessment: Self-reported via questionnaire
Helmet Use Frequency:
Scale: 5-point (Always, Often, Sometimes, Rarely, Never)
Assessed separately: As rider and as passenger
Collapsed for analysis: Always / Often-Sometimes-Rarely / Never
Score Classifications (Median Split):
Knowledge: Adequate (≥11) vs Inadequate (c11)
HBM: High (≥23) vs Low (c23)
TPB: High (≥11) vs Low (c11)
7. DATA MANAGEMENT
Duration: 2-4 weeks post-collection
Data Entry:
Software: IBM SPSS version 27
Secure data entry workstation
Double-entry verification for accuracy
Data cleaning and validation
Data Storage:
Locked physical storage for questionnaires
Password-protected digital files
Restricted access (PI and designated staff only)
Backup copies maintained
8. STATISTICAL ANALYSIS
Duration: 2-3 weeks
Descriptive Statistics:
Frequencies and percentages (categorical variables)
Means and standard deviations (continuous variables)
Median and IQR (score distributions)
Inferential Statistics:
Pearson chi-square tests for categorical associations
Significance level: pc0.05
Analysis of associations between:
Socioeconomic status and scores
Transport characteristics and scores
Helmet usage patterns and scores
Social influence patterns (peer and family effects)
Intention-behavior gaps
Risk perception patterns
Software:
IBM SPSS version 27
EXPECTED OUTCOMES
Primary Outcomes:
Knowledge, attitude, and practice scores regarding helmet use
Associations between socioeconomic factors and safety behaviors
Identification of barriers to helmet adoption
Secondary Outcomes:
Social influence patterns (peer and family effects)
Intention-behavior gaps
Risk perception patterns
SAFETY 6 QUALITY ASSURANCE
Ethical Safeguards:
IRB-approved protocol
Voluntary participation
Written informed consent
Parental consent for minors
Anonymity and confidentiality maintained
Right to withdraw anytime
Data Quality:
Validated questionnaire with high reliability
Trained data collectors
Same-day supervision and verification
Secure storage protocols
Systematic data management
TIMELINE SUMMARY
Protocol references
1. Champion V, Skinner CS. The Health Belief Model. In: Health behavior and health education. 4th ed. 2008.
2. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179-211.
3. Sharma R. Revised Kuppuswamy's socioeconomic status scale. Indian Pediatrics. 2017;54(10):867-870.
4. Pakistan Education Statistics 2021-22. Pakistan Institute of Education. https://pie.gov.pk
Acknowledgements
Ethics approval: IRB-2510/DUHS/Approval/2022/856
Funding: No funding was used for this research
Conflicts of Interest: None declared
Troubleshooting:
- Low consent rate: Conduct parent information sessions; provide detailed study benefits
- Incomplete questionnaires: Implement on-site completion verification; train interviewers thoroughly
- Language barriers: Use Urdu-validated questionnaire; employ bilingual interviewers
- Access to schools: Obtain formal education department approval letters; coordinate with principals
- Data quality concerns: Implement same-day PI review; conduct periodic inter-rater reliability checks