Predictors of Road Safety behaviors among Boda-Boda Operators and their passengers in Kampala: A Mixed-Methods Study

1. Abstract Background Despite road safety regulations, “Boda Boda” riders in Uganda continue experiencing frequent road traffic injuries due to unsafe riding behaviours, increasing morbidity and mortality among riders and passengers. Evidence on safe riding practices and associated factors remains limited. This study assessed factors associated with safe riding behaviours among boda-boda riders and passengers in Kampala Central Division. Methods A cross-sectional survey using a convergent parallel mixed-methods design guided by Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation Model was conducted. Quantitative data were collected from 424 riders using structured questionnaires and analyzed using descriptive statistics and binary logistic regression to determine predictors of safe riding behaviours, with adjusted odds ratios (AORs) reported at p<0.05. Qualitative data were collected simultaneously through in-depth semi-structured interviews with 10 passengers. Thematic analysis and triangulation were used to identify convergences and divergences, providing a comprehensive understanding of safety determinants among riders and passengers. Results Among 424 riders (mean age 29.56 ± 5.71), 65.1% exhibited unsafe riding behaviors. Bivariate analysis identified education, marital status, religion, willingness to obey traffic regulations, and family encouragement as significant factors. In the adjusted model, secondary (AOR=0.50; 95% CI:0.30–0.85) and post-secondary education (AOR=0.57; 95% CI:0.33–0.98), being married (AOR=0.56; 95% CI:0.34–0.91), Christian religion (AOR=2.98; 95% CI:1.63–5.47), willingness to obey traffic regulations (AOR=0.41; 95% CI:0.24–0.70), union advocacy (AOR=1.76; 95% CI:1.03–3.01), and well-maintained roads (AOR=1.65; 95% CI:1.07–2.55) were significant predictors. Qualitative findings highlighted barriers including helmet lack, over-speeding, traffic regulation disregard, and poor road infrastructure Conclusions Rider and passenger safety is still low, interdependent, and influenced by multiple factors. Integrated interventions focusing on education, stronger families, religious affiliations, union safety advocacy, and stricter enforcement of traffic regulations are vital for enhancing safety for both riders and passengers. Clinical trial number: not applicable