From Safety Knowledge to Everyday Practice: A Qualitative Exploration of Factors Influencing Personal Protective Equipment Use and Motorcycle Safety Practices Among Commercial Motorcycle Riders in Cameroon

Background: Commercial motorcycle riders are at substantial risk of road traffic injuries, yet the use of personal protective equipment (PPE) remains inconsistent in many low- and middle-income settings. Quantitative evidence from the Limbe and Tiko Health Districts of Cameroon has documented gaps in PPE uptake, knowledge, and attitudes, but provides limited insight into the contextual factors underlying everyday safety practices. This study explored individual, interpersonal, organizational, and structural factors influencing PPE use and broader motorcycle safety practices among commercial motorcycle riders in Limbe Health District, Cameroon. Methods: A qualitative descriptive study was conducted as part of a formative needs assessment for a theory-driven health education intervention. Data were collected through four focus group discussions (FGDs) involving 46 commercial motorcycle riders and seven in-depth interviews (IDIs) with key informants, including experienced riders, motorcycle union leaders, a Ministry of Transport representative, a healthcare worker, and a road safety police officer. Participants were purposively selected based on their experience or involvement in motorcycle transport, regulation, healthcare, or road safety. FGDs and IDIs were conducted using semi-structured guides, audio-recorded with permission, transcribed verbatim, and translated into standard English where necessary. Data were analyzed thematically through repeated reading, coding, categorization, and development and refinement of themes. Results: Five interrelated themes emerged. First, participants generally recognized the protective value of PPE, with personal experiences of motorcycle crashes reinforcing perceptions of its benefits. Second, practical barriers—including cost, discomfort, damaged equipment, work-related pressures, and forgetfulness—could prevent consistent PPE use despite this recognition. Third, gaps in formal training, licensing, regulation, and enforcement were perceived to constrain safety practices. Fourth, participants viewed motorcycle safety as extending beyond PPE to include motorcycle maintenance, functional lighting and signalling systems, speed, overloading, and passenger protection, with responsibility shared across riders, passengers, unions, authorities, law enforcement, healthcare workers, and the wider road environment. Fifth, participants emphasized the importance of repeated, accessible, and context-sensitive safety education delivered through complementary channels, including face-to-face engagement, union meetings, radio, SMS, WhatsApp, and other communication platforms. Conclusions: Commercial motorcycle riders' safety practices were shaped by interacting individual, practical, organizational, regulatory, and environmental factors. Recognizing the protective value of PPE was not sufficient to ensure consistent use. Interventions should therefore combine repeated and context-sensitive health education with measures addressing affordability, comfort, training, organizational coordination, motorcycle safety, passenger protection, and consistent enforcement of road safety regulations.