Education, incentive, and engineering‐based interventions to promote the use of seat belts

Interventions to encourage use of seat belts

Key messages

– We found some evidence to suggest education‐based (behavioural and health risk appraisal (HRA)) and engineering‐based interventions may promote seat belt use in early and late adolescents and adults; however, we are not confident in the current evidence.

– More research is needed to better understand the effectiveness of education‐ and engineering‐based interventions on seat belt use.

– High‐quality research is also needed to investigate the benefit of incentives (alone or combined with other interventions) as well as other types of interventions, different combinations of interventions, and different settings.

Why is wearing a seat belt important?

Many people, mostly children and young adults, die each year as a result of road traffic injuries suggesting it to be a leading cause of death with around 75% of traffic‐related deaths occurring among young males. Many others are permanently and seriously injured. Seat belts are designed to protect occupants from being thrown out of the vehicle by the force of impact, and spread the impact across less vulnerable parts of the body to lessen the damage. Passing laws mandating seat belt use is not sufficient to encourage seat belt use on its own.

What did we want to find out?

We investigated the effectiveness of education, incentive, or engineering‐based interventions, but not law enforcement, to encourage seat belt use and determine which types of interventions are most effective. Educational‐based interventions are structured programmes teaching drivers and passengers the importance of using seat belts. Engineering‐based interventions are design changes to the vehicle structure that promote the wearing of seat belts, such as seat belt alarms, while incentives include rewards schemes.

What did we do?

We searched for studies that randomly allocated people travelling in passenger or commercial vehicles to interventions aiming to improve seat belt use. We excluded people travelling in farming or agricultural vehicles since these are not deemed commercial vehicles. Two review authors independently evaluated studies to judge inclusion in the review. We recorded information about the study design, setting, participants, interventions, and outcomes. In terms of outcome, we looked at the frequency of wearing a seat belt as well as crash‐related injuries and deaths. Because of the differences between the included studies, we provided a written account and assessed how much each result could be trusted using the ratings, high, moderate, low, or very low quality, depending on our confidence in the reliability of the results. We summarised the findings and compared study results.

What did we find?

We found 15 studies enrolling 12,081 participants and four ongoing studies. Thirteen studies were conducted in the USA and enrolled participants from various sites (worksites, schools, emergency departments, a residential retirement community, and primary care settings) and of different age groups (adults, late and early adolescents, and dyads of child/adolescent and parent/legal guardian).

Twelve studies looked at educational interventions alone, one at education and incentives, and two at engineering‐based interventions. All included studies reported on the frequency of wearing a seat belt; however, most studies (12) reported this outcome through participant self‐reporting. The remaining studies reported the frequency of wearing a seat belt through in‐vehicle data monitoring systems (two studies) and observation (one study). None of the included studies reported crash‐related injuries and deaths.

Some evidence suggests that education‐based and engineering‐based interventions may promote seat belt use; however, we cannot be confident in the current evidence. For education‐based interventions, evidence suggests that behavioural‐based (motivational interviews, behavioural change counselling, and behavioural messages) and HRA (alone or with educational information plus incentive) interventions may improve seat belt use in early adolescents, late adolescents, and adults. The evidence suggests that engineering‐based interventions may promote seat belt use in early adolescents and adults.

More research is needed to better understand the effectiveness of education‐ and engineering‐based interventions on seat belt use. In addition, high‐quality research is needed to investigate the benefit of incentives alone or in combination with other interventions as well as research to investigate other types of interventions, different combinations of interventions, settings (such as low‐ and middle‐income countries), and populations.

What are the limitations of the evidence?

Only two studies looked at engineering‐based interventions to improve seat belt use and both studies enrolled a small number of participants making it challenging to conclude that these interventions are beneficial. Trials investigating educational interventions to improve seat belt use vary in terms of the type of intervention, quality, number and types of people in the study, etc. Studies included children, adolescents, and adults; however, the most effective intervention for each population group remains unclear. Our confidence in the evidence was low or moderate, mainly due to the outcome (wearing seat belts) being measured through participant self‐reporting. Self‐reported outcomes are open to being influenced by participants answering in a manner they believe to be desirable or by participants' limited recollection of the event being studied. None of the included studies was conducted in countries where deaths and injuries related to road traffic accidents are the highest.

How up to date is this evidence?

Up to date to August 2022.