Predictors of Seat-Belt Use among Bus Passengers in Ghana: An Application of the Theory of Planned Behaviour and Health Belief Model.

BACKGROUND: Seat-belt use is effective in preventing traffic fatalities and injuries yet its use is not universal. This study sought to determine the predictors of self-reported seat-belt use among bus passengers in Ghana based on the theory of planned behaviour and health belief model. METHODS: A quantitative cross-sectional study design with 633 randomly selected intercity bus passengers was conducted using a structured questionnaire in Kumasi, Ghana. The resulting data were analysed using SPSS version 23.0. Ordinal regression was employed to determine the predictors of self-reported seat-belt use. RESULTS: Majority of the respondents were male (61.5%) with a mean age of 32.2 (SD = 11.6). A third (33.0%) reported that they always wear their seat-belt as bus passengers. The results indicated that intention (OR = 1.49, 95% CI = 1.21-1.84, p = 0.001), subjective norm (OR = 1.57, 95% CI = 1.15-2.13, p = 0.004) and perceived behavioural control (OR = 1.53; 95% CI = 1.21-1.92, p = 0.001) variables from the theory of planned behaviour were significant independent predictors of seat-belt use. Among the health belief model variables, perceived severity (OR = 1.57, 95% CI = 1.15-2.16, p = 0.005) and perceived barriers (OR = 0.52, 95% CI = 0.39-0.67, p = 0.001) were the only significant independent predictors of self-reported seat-belt use. CONCLUSION: The findings suggest that intention, subjective norm, perceived behavioural control, perceived severity and perceived barriers play an important role in determining bus passengers' seat-belt use behaviour. Road safety programmes to increase seat-belt use will gain from giving serious attention to these factors in the design and implementation of such programmes.

Barriers to the enforcement of mandatory seat belt laws in Ghana: an exploratory study.

Road traffic accidents claim millions of lives every year across the world. Fortunately, effective safety and preventive measures such as routine maintenance of vehicles and roads and the use of seat belts exist. Yet, authorities in some countries fail to enforce laws on these measures. One of the barriers to compliance with traffic laws is poor enforcement. Using a cross-sectional study design, we explored the barriers to the enforcement of mandatory seat belt laws in Ghana. We employed an open-ended key informant interview guide to interview 26 staff of the Motor Traffic and Transport Department of the Ghana Police Service, National Road Safety Authority and the Driver and Vehicle Licensing Authority. The interviews which lasted between 30 and 45 min per session were analysed through a thematic approach facilitated by ATLAS.ti. The findings showed that the barriers to the enforcement of seat belt laws mentioned by the participants were institutional factors (inadequate resources and logistics and inability to enforce vehicle safety standards) political factors (external interference and lack of consensus on seat belt law implementation) and human factors (poor public attitudes and non- recognition of road safety as both individual and collective responsibility). The enforcement of road safety laws could be enhanced by adequately resourcing officers, addressing external interference of police duties and empowering officers to perform their duties without fear or favour. These findings are also useful in continuous public education and enhanced enforcement of the seat belt laws.