When implemented properly, universal helmet law increases helmet use substantially, bringing along a reduction in mortality and morbidity due to head injuries. Kerala has seen tremendous success in regards to various indicators for health within India. But when it comes to wearing helmets, the state lags behind others with reported rates as less as 27%.

A cross-sectional survey of 300 two-wheel drivers in Thiruvananthapuram City was preformed, which looked into helmet wearing patterns, their determinants, and the risk perception among the respondents. Further, a content analysis of newspaper reports pertaining to helmet legislation from the Thiruvananthapuram edition of two leading newspapers was performed. The reports included were from the periods of July 2003 to June 2005 and July 2008 to June 2010. Lastly, in-depth interviews were conducted with informants from among the key stakeholders in helmet policy of the state.

The study found 36.8% of the respondents wear a helmet. A scale to measure risk perception was developed for the purpose of this study. The four-item scale has been found to have internal consistency with a Cronbach alpha value of 0.74. The risk perception measured by using this scale has significant relation with helmet-wearing behavior. The content analysis helped in deriving a historical perspective of the policy along with the themes of reporting. The informant interviews provided expert opinions, problem identification, and specific recommendations.

The practice of wearing a helmet is low, and people with lower risk perception have greater tendency not to wear helmets. Other findings also show that there are gaps in policy and lack of visionary leadership as far as the policy toward helmet legislation and its implementation.