Fostering mental health and chronic diseases self-management among professional truck drivers

 

Most passengers and goods in Canada travel by road. The trucking industry is the backbone of the tangible goods economy. However, the health and well-being of this aging workforce is in jeopardy. Recent data reveals that 86% of the truckers’ community are 50 years old and over, 4% are female and 5% are immigrants. Moreover, 75% of the male truckers self-reported one or more health condition (54% obesity, 19% hyperlipidemia, 18 % high blood pressure, 11 % type II diabetes). Despite, the high prevalence of risk factors (e.g. stress, depression/anxiety, lower level of education, social isolation and financial challenges) and preventable chronic diseases among truckers, in New Brunswick and elsewhere in Canada, there is a lack of on-the-road accessible lifestyle change programs. Therefore, tailored interventions are needed to appropriately support them adopt healthy behaviors. Using the Re-AIM Framework, we carried out 23 semi-structured interviews to inform the development of tailored educational material. The aims were: to describe the needs and challenges and to design a truckers-sensitive educational intervention. The theoretical foundation of this qualitative study is articulated around concepts extracted from cognitive and behavioural theories (transtheoretical model of behaviour change). Qualitative analysis of verbatims identified four major themes: Lifestyle challenges, Social and individual representation of healthy behaviors, Health education strategies and communication and Motivational and engagement strategies. Drawing upon these findings we developed tailored educational material and pre-validated them with a small group of professional truck drivers. Our findings informed the development of an educational intervention to support truckers manage and improve their mental health and self-management of chronic diseases. The next step is to implement a randomized clinical trial to test and assess acceptability, feasibility, and effectiveness of our intervention.

Key messages

Mental illness prevention in post-ACS men: A partcipatory action research

Background

The prevalence of social determinants of health (i.e. rurality, low education and poverty) among men put them at an elevated risk for comorbid cardiac disease and mental illness. While, men are particularly vulnerable to mental illnesses (i.e. depression, anxiety) after an acute coronary syndrome (ACS), they are typically averse to seeking medical care, especially for mental health issues. Targeting interventions to at-risk population groups is a well documented approach. However, little in the literature presents how to prevent mental illness in cardiac men. This study aims to develop, implement and pilot a psychoeducational program tailored for post-ACS men.

Methods

A mixed method including a scoping review, a qualitative study and a quasi-experimental pilot study.

Results

In total, 42 articles were retrieved to extract key components of cardiac men-sensitive psychoeducation programs. We led 22 focus groups and 14 semi-structured interviews (119 men in total). The mean age was 51.2 years [45-77]. We integrated the gathered data gathered from the scoping review and the qualitative study to develop a psychoeducational program (3 group sessions). The pilot study involved 48 men who completed the baseline, the 3-month and the 6-month data collections. We observed 80% of compliance. Findings show a significant improvement in PHQ-9, GAD-7, IES-R, CSI and EQ-5D scales. We also observed changes in the CMNI-22, a measure of attitudes, beliefs, and behaviors associated with both traditional and non-traditional masculine gender roles. Men appreciated the time flexibility (sessions were scheduled based on participants’ availability) and the responsiveness of the sessions (content was discussed based on their needs and interests). Life partners were invited and 65% attended to all sessions.

Conclusions

The program was a success and we expect to transform it into a peer-led intervention to improve its delivery in the community and its accessibility for rural and remote areas.

Key messages

At-risk population-sensitive approaches are key for compliance and effectiveness. Group sessions are effective approaches to improve men’s mental heatlh literacy.

Stratified cancer screening: the practicalities of implementation

BACKGROUND

Improving understanding of the genetic basis of disease susceptibility enables us to estimate individuals' risk of developing cancer and offer them disease prevention, including screening, stratified to reflect that risk. Little attention has so far been given to the implementation of stratified screening. This article reviews the issues that would arise in delivering such tailored approaches to prevention in practice.

RESULTS

Issues analysed include the organisational context within which implementation of stratified prevention would occur, how the offer of screening would be made, making sure consent is adequately informed, how individuals' risk would be assessed, the age at which risk estimation should occur, and the potential use of genetic data for other purposes. The review also considers how management might differ depending on individuals' risk, how their results would be communicated and their follow-up arranged, and the different issues raised by modification of an existing screening programme, such as that for breast cancer, and the establishment of a new one, for example for prostate cancer.

CONCLUSION

Stratified screening based on genetic testing is a radically new approach to prevention. Various organisational issues would need to be considered before it could be introduced, and a number of questions require further research.