Perceived Factors Influencing Blue-Collar Workers' Participation in Worksite Health Promotion Programs in Freight Transport: A Qualitative Investigation Using the TDF and COM-B

Blue-collar workers in the freight transport industry report a high risk of developing chronic diseases, partly due to an unhealthy lifestyle. Worksite health promotion programs (WHPPs) may be able to promote a healthier lifestyle, but participation among blue-collar workers in these programs is generally lower than among other workers. The current study aimed to further examine factors that can explain participation of blue-collar workers in these programs. A pragmatic, qualitative study was conducted, and semi-structured interviews were held with 32 blue-collar workers in freight transport in the Netherlands (94% men, 81% driver, mean age 48 (SD = 11)). The interview guide was based on the Theoretical Domains Framework (TDF) and Capability-Opportunity-Motivation-Behavior (COM-B) model, and was used to assess perceived determinants that influence participation. A combination of framework analysis and thematic analysis was conducted, which yielded the following nine main themes: (i) not being aware of WHPPs on offer, (ii) no clear picture of what to expect, (iii) (not) giving priority to health, (iv) expecting feedback and practical support, (v) being open and ready to change, (vi) preferring to be self-dependent, (vii) being offered a practical, fun and joint WHPP, (viii) having an employer who cares, thinks along and facilitates participation, and (ix) working and living in an environment in which a healthy lifestyle is not the norm. With these insights we were able to formulate recommendations to enhance the participation of blue-collar workers in WHPPs.

The effects of a theory-informed intervention on physical activity behaviour, motivation and well-being of frontline aged care workers: A pilot study with 6-month follow-up

ISSUE ADDRESSED

Due to the nature of their jobs, frontline aged care workers may be a population at risk of poor health and lifestyle habits. Support of their well-being through the workplace is likely to be complex. The objective of this study was to assess the effectiveness of a need-supportive program for changing physical activity and psychological well-being via the motivational processes of behavioural regulations and perceived need satisfaction.

METHODS

Frontline aged care workers (n = 25) participated in a single cohort, pre-post pilot trial. The program included a Motivational Interviewing style appointment, education on goal setting and self-management, the use of affect, exertion and self-pacing for regulating physical activity intensity and practical support activities. Outcomes (7-day accelerometery, 6-min walk, K10 and AQoL-8D), and motivational processes (BREQ-3 and PNSE) were measured at baseline, 3 and 9 months, and analysed using linear mixed models for repeated measures.

RESULTS

There were significant increases in perceived autonomy at 3 months (Δ .43 ± SE: .20; p = .03) and 6-min walk distance at 9 months (Δ 29.11 m ± SE: 13.75; p = .04), which appeared to be driven by the relative autonomy index (behavioural regulations in exercise questionnaire [BREQ-3]). Amotivation increased at 3 months (Δ .23 ± SE:.12; p = .05); which may have been due to low scores at baseline. No other changes were demonstrated at any timepoint. SO WHAT?: Participants demonstrated positive changes in motivational processes and physical function, however, due to the low levels of participation in the program, the program had a negligible impact at the organisational level. Future researchers and aged care organisations should aim to address factors impacting participation in well-being initiatives.

Program Evaluation of Fit to Pass®, a Remotely Accessible Health Promotion Program for Commercial Motor Vehicle Truck Drivers

BACKGROUND

Chronic health conditions are highly prevalent among truck drivers due to many unique occupational and environmental stressors. Health promotion programs are shown to be effective in improving truck driver health outcomes; however, there is no research on whether such programs can increase the length of a driver's Department of Transportation (DOT) medical certificate. The purpose of this quality improvement project was to evaluate Fit to Pass (FTP), a remotely accessible health promotion program available for truck drivers on improved health outcomes and increased DOT medical certificate length.

METHOD

Program evaluation included an evaluation of the FTP coaching guide against evidence-based practice guidelines. An analysis of a limited dataset of 22 truck driver records examined the effectiveness of the program in achieving improved health outcomes and increased medical certification length.

FINDINGS

A review of the literature revealed three major themes: (a) motivational interviewing to increase driver intention and self-efficacy; (b) mobile health care technology to connect hard-to-reach truck drivers; and (c) effectiveness of structured multicomponent health promotion programs. After participation in FTP, truck drivers experienced a mean decrease in weight and body mass index (BMI) of 4.6 lbs and 1.3 kg/m2, respectively. The lengths of initial DOT medical certificates were compared with DOT medical certificates received at the time of recertification (post-FTP). Only eight participants had the potential for improvement in certificate length. Of those, three truck drivers achieved an increased DOT medical certificate length at the time of recertification.

CONCLUSION/APPLICATIONS TO PRACTICE

FTP offers tailored and comprehensive health coaching for truck drivers using current evidence-based practice guidelines to educate and reinforce healthy lifestyle habits. Analysis of a limited dataset revealed a mean decrease in BMI and a trend of increased DOT medical certification lengths after participation in FTP; however, further research with larger sample sizes is recommended.

Impact of work and coping factors on mental health: Australian truck drivers' perspective

INTRODUCTION

Truck driving is one of the most common male occupations worldwide. Drivers endure long working hours, isolation, separation from family, compromised sleep, and face rigid regulatory requirements. Studies have documented the work factors contributing to poor health outcomes, however these have not been explored in the Australian context. The aim of this grounded theory study was to explore the impact of work and coping factors on mental health of Australian truck drivers from their perspective.

METHODS

Recruitment used a purposive snowball sampling, through social media campaigns and direct email invites. Interview data were collected via phone/teleconference, audio recorded and typed verbatim. Inductive coding and thematic analysis were completed with triangulation of themes.

RESULTS

Seventeen interviews were completed (94% male). Six themes arose, two supporting (Connections; Coping methods), and four disrupting mental health (Compromised supports; Unrealistic demands; Financial pressures; Lack of respect). Drivers had concerns regarding the many things beyond their control and the interactions of themes impacting their health even further.

CONCLUSION

This study explored the impact of work and coping factors affecting truck driver mental health in Australia. Themes described the importance of connections and coping methods drivers had to support their health. Many factors that compromised their health were often outside their control. These results highlight the need for a multi-faceted collaboration between stakeholders; the driver, employing companies, policy makers/regulators and the public to address the negative impact of truck driving on mental health.

Dosing of Health and Wellness Coaching for Obesity and Type 2 Diabetes: Research Synthesis to Derive Recommendations

Health and wellness coaching (HWC) is an effective intervention for lifestyle disease such as obesity and type 2 diabetes. The evolving HWC profession needs recommendations to guide clinical practice, particularly the appropriate dose of coaching. The purpose of this paper was to systematically review and synthesize HWC literature to derive HWC programming recommendations. Of 102 papers retrieved, 88 were retained with data extracted determining HWC session number, frequency, duration, program length, and total coaching load. Differential analysis yielded no statistical difference in programming variables for randomized control trials and other designs, nor for studies with significant findings v. those not finding statistical significance, allowing these data to be pooled. The HWC intervention for obesity was slightly more intense (15 sessions over 7-8 mo) than the diabetes programming (12 sessions over 9-10 mo). On average, HWC programming applied in the peer-reviewed literature was 12-15 sessions of 35-40 min duration over 7-9 months. These recommendations for HWC programming variables are put forth as initial practice guidelines and should be examined with comparative effectiveness study for optimization. HWC best practice guidelines for other patient groups (e.g., heart disease, cancer, and chronic pain) should also be studied once an adequate literature data base is available.

Unravelling the Complexity of Irregular Shiftwork, Fatigue and Sleep Health for Commercial Drivers and the Associated Implications for Roadway Safety

Fatigue can be a significant problem for commercial motor vehicle (CMV) drivers. The lifestyle of a long-haul CMV driver may include long and irregular work hours, inconsistent sleep schedules, poor eating and exercise habits, and mental and physical stress, all contributors to fatigue. Shiftwork is associated with lacking, restricted, and poor-quality sleep and variations in circadian rhythms, all shown to negatively affect driving performance through impaired in judgment and coordination, longer reaction times, and cognitive impairment. Overweight and obesity may be as high as 90% in CMV drivers, and are associated with prevalent comorbidities, including obstructive sleep apnea, hypertension, and cardiovascular and metabolic disorders. As cognitive and motor processing declines with fatigue, driver performance decreases, and the risk of errors, near crashes, and crashes increases. Tools and assessments to determine and quantify the nature, severity, and impact of fatigue and sleep disorders across a variety of environments and populations have been developed and should be critically examined before being employed with CMV drivers. Strategies to mitigate fatigue in CMV operations include addressing the numerous personal, health, and work factors contributing to fatigue and sleepiness. Further research is needed across these areas to better understand implications for roadway safety.

Factors Associated with Colorectal Cancer Prevalence Among Long-Haul Truck Drivers in the United States

PURPOSE

To determine the age-adjusted association between colorectal cancer (CRC) risk factors and CRC prevalence among long-haul truck drivers (aged 21-85), after adjustment for age.

DESIGN

Pooled cross-sectional analysis using Commercial Driver Medical Exam (CDME) data. Setting. National survey data from January 1, 2005, to October 31, 2012.

PARTICIPANTS

47,786 commercial motor vehicle drivers in 48 states.

MEASURES

CRC prevalence was the primary outcome; independent variables included demographics, body mass index (BMI), and concomitant medical conditions.

ANALYSIS

Kruskal-Wallis tests to analyze continuous variables; Fischer's exact tests to analyze categorical variables; univariate and multivariable logistic regression for rare events (Firth method) to quantify the association between the independent variables of interest and CRC prevalence. Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for age, gender, years with current employer, year of exam, and BMI in a multivariate logistic regression.

RESULTS

Many factors were statistically significant. Obesity (OR = 3.14; 95% CI = 1.03-9.61) and increasing age (OR = 1.10 per year; 95% CI = 1.07-1.13) were significantly associated with CRC prevalence. Truckers with 4 or more concomitant medical conditions were significantly more likely to have CRC (OR = 7.03; 95% CI = 1.83-27.03).

CONCLUSIONS

Our findings highlight mutable risk factors and represent an opportunity for intervention that may decrease CRC morbidity and mortality among truck drivers, a unique population in the United States estimated to live up to 16 years less than the general population.

Physical Activity Assessment and Promotion in Clinical Settings in the United States: A Scoping Review

OBJECTIVE

The purpose of this scoping review was to systematically examine interventions that focused on physical activity assessment and promotion in clinical settings in the United States.

DATA SOURCES

A literature search was performed in 6 major databases to extract published peer-reviewed studies from 2008 to 2019.

INCLUSION AND EXCLUSION CRITERIA

Interventions with practicing health professionals in the United States who performed physical activity assessment and promotion with adult patients 18 years of age and older. Studies were excluded if they were published in non-English, observational or case study designs, or gray literature.

DATA EXTRACTION

Studies were screened and coded based on the population, intervention, comparison, outcomes and study setting for scoping reviews (PRISMA-ScR) framework. Of 654 studies that were identified and screened for eligibility, 78 met eligibility criteria and were independently coded by two coders.

DATA SYNTHESIS

Data were synthesized using qualitative and descriptive methods.

RESULTS

Forty-three of the included studies were randomized controlled trials with a majority being delivered by physicians and nurses in primary care settings. Fifty-six studies reported statistically significant findings in outcome measures such as anthropometrics and chronic disease risk factors, with 17 demonstrating improvements in physical activity levels as a result of the interventions.

CONCLUSION

The assessment and promotion of physical activity in clinical settings appears to be effective but warrants continued research.

The effect of weight loss interventions in truck drivers: Systematic review

Introduction

Truck driving is the most common vocation among males internationally with a high proportion overweight/obese due to a combination of work and lifestyle factors leading to health complications. With limited studies in this area, this systematic review aimed to identify and describe interventions addressing weight reduction in truck drivers.

Methods

Five electronic databases were searched, January 2000 to June 2020 (CINAHL, Cochrane Library, Embase, Ovid MEDLINE, Scopus). Inclusion criteria: experimental primary studies, long-distance (≥500 kms) truck drivers, peer reviewed publications in English. Weight loss interventions included physical activity, diet, behavioral therapy, or health promotion/education programs. Exclusions: non-interventional studies, medications or surgical interventions. Two independent researchers completed screening, risk of bias (RoB) and data extraction with discrepancies managed by a third. Study descriptors, intervention details and outcomes were extracted.

Results

Seven studies (two RCTs, five non-RCTs,) from three countries were included. Six provided either counselling/coaching or motivational interviewing in combination with other components e.g. written resources, online training, provision of exercise equipment. Four studies demonstrated significant effects with a combined approach, however, three had small sample sizes (<29). The effect sizes for 5/7 studies were medium to large size (5/7 studies), indicating likely clinical significance. RoB assessment revealed some concerns (RCTs), and for non-RCTs; one moderate, two serious and two with critical concerns. Based on the small number of RCTs and the biases they contain, the overall level of evidence in this topic is weak.

Conclusion

Interventions that include a combination of coaching and other resources may provide successful weight reduction for truck drivers and holds clinical significance in guiding the development of future interventions in this industry. However, additional trials across varied contexts with larger sample populations are needed.

Prevalence of Diagnosed Diabetes Among Employed US Adults by Demographic Characteristics and Occupation, 36 States, 2014 to 2018

OBJECTIVE

To assess the prevalence of diagnosed diabetes among employed US adults from 36 states by occupation group using data from 2014 to 2018 Behavioral Risk Factor Surveillance System.

METHODS

Prevalence of diabetes was calculated by 22 broad and 93 detailed occupation groups among a sample of 366,633 employed respondents. Wald chi-square values were used to determine the significance of associations between diabetes and occupation groups after adjusting for sex, age, and race/ethnicity.

RESULTS

The prevalence of diabetes was 6.4% among employed US adults. The three broad occupation groups with the highest adjusted prevalence of diabetes were protective services (8.9%), farming, fishing, and forestry (8.8%), and community and social services (8.4%).

CONCLUSIONS

Prevalence of diabetes differed by occupation. Work-related factors (eg, shift work, job stress) should be further examined in relation to risk of developing diabetes.

Cardiometabolic risk factors and mental health status among truck drivers: a systematic review

OBJECTIVE

This study aimed to systematically review and summarise the literature on cardiometabolic risk factors, lifestyle health behaviours and mental health status of truck drivers globally to ascertain the scale of these health concerns.

DESIGN

Systematic review reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

PubMed, Scopus, PsycINFO and Web of Science were searched in January 2019 and updated in January 2020, from the date of inception to 16 January 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Papers were included if they (1) reported independent data on truck drivers, (2) included quantitative data on outcomes related to cardiometabolic markers of health, mental health and/or health behaviours, (3) were written in English and (4) were published in a peer-reviewed journal. Grey literature was ineligible for this review.

DATA EXTRACTION AND SYNTHESIS

One reviewer independently extracted data and assessed methodological quality using a checklist based on the National Heart, Lung and Blood Institute Quality Assessment tool. 20% were independently assessed for eligibility and quality by a second reviewer. Due to heterogeneity of the outcomes, results were narratively presented.

RESULTS

3601 titles and abstracts were screened. Seventy-three studies met the inclusion criteria. Truck driving is associated with enforced sedentarism, long and irregular working hours, lack of healthy foods, social isolation and chronic time pressures. Strong evidence was observed for truck drivers to generally exhibit poor cardiometabolic risk profiles including overweight and obesity, hypertension, hypercholesterolaemia, high blood glucose, poor mental health and cigarette smoking.

CONCLUSIONS

Improving truck driver health is vital for the longevity of the trucking industry, and for the safety of all road users. The workplace plays a vital role in truck driver health; policies, regulations and procedures are required to address this health crisis.

PROSPERO REGISTRATION NUMBER

CRD42019124499.