In small islands of low and middle-income countries, schoolchildren rely on canoe transport to access education. Although this is associated with rampant drowning and barriers to access schooling, there is little empirical evidence in the drowning prevention and rural transport literature. Consequently, there are high school dropouts among children in rural islands. This study investigates inland water transport barriers and the factors influencing the adoption of canoes in rural areas. A household survey of 350 parents/caregivers was conducted in 17 small islands of Ukerewe District, Tanzania. Based on the Health Belief Model, structural equation modeling was performed to measure how perceived susceptibility, severity/risk, self-efficacy, and barriers can affect intentions to use inland water transport using perceived benefits as a moderator. Overall, schoolchildren ride canoes without the aid of adults, exposing them to negative health effects such as injury, tiredness, and drowning. Notably, only perceived severity had statistically significant effects on the adoption of water transport to school when mediated by the perceived benefits. These findings imply that the provision of safer transport modes and policies aimed at reducing the perceived risks can enhance inland water transport adoption and reduce the rate of child drowning and school dropouts in rural islands.