Dr Stacy Clemes reveals how road transport firms can invest in driver health
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A study conducted by Dr Stacy Clemes and her colleagues at Loughborough University recently concluded that health education and Fitbits, along with cabin workouts, can all improve activity levels of lorry drivers and thus bring health benefits.
It is hoped that the findings of the study, particularly with regards to its health workshops, can be included in compulsory driver training in the future.
However, the process of lobbying for this change and having it implemented is likely to take time, if it is to happen. Taking this into account, we reached out to Dr Clemes herself to learn about what positive changes can be made now by road transport companies who value the health and wellbeing of their drivers.
Read on to find out why Dr Clemes believes road transport companies can boost driver health via the use of fitness trackers and health education, as well as the creation of green spaces among other things.
Thanks for taking the time to talk to us Dr Clemes. Does your experience with the program make you feel that any incorporation of health modules into compulsory training would be received well? On one hand, many drivers find such training unnecessarily time consuming. On the other hand, you could argue that this type of training is something new that drivers may not have already gone through when becoming qualified.
Based on our sample, we had really good feedback on the training workshops. The kind of training was similar in some way to the CPC modules that drivers undertake. The main difference was that our workshop was six hours, whereas the CPC training I think is seven hours.
The training was conducted in designated rooms within transport sites, it was group-based and run by trained facilitators in a slightly different way to traditional driver training. At the same time, it also mirrored in some ways what they would undertake in a CPC module. Within the session, drivers were encouraged to problem solve together and discuss the challenges they face – particularly with regards to being active, sitting less, and having a healthy diet. The facilitator also helped them to come up with solutions.
So it wasn’t a traditional classroom-based training session where there was a facilitator there just teaching them. It was very much interactive, with group discussion and lots of props including plastic mock-ups of different foods. The drivers would work together to arrange them according to calorie content, for example. There were lots of little interactive games involved.
Other exercises helped with understanding about sugar content in different foods and drinks that drivers might encounter on the road. Participants also got hints and tips on how they can make healthier choices. It’s designed as well for participants to learn from fellow drivers who have good eating and exercising habits and can share them with colleagues.
We have really positive feedback from all the drivers who completed the education session. We asked them about a month afterwards in a questionnaire how they found the experience, the feedback was all very positive.
We then interviewed them about 12-18 months after completing the whole study, drivers still spoke about the training session. We also asked them about our long term goal to implement this and other aspects of our intervention into a Driver CPC module.
I think the drivers welcomed that, because they said it was different to what they do already. This is understandable I guess, as a lot of the training is on safety. In our module, we’re very much focused on how drivers can improve their health and make personal health choices.
We also asked transport managers about their opinions of it, and they were very supportive too. So this is definitely something that we want to take forward.
Our next steps following the intervention and our discussions with drivers and managers, is to better understand what works and what we need to improve. This is what we’re planning to do next.
Hopefully over the next few years, we will have some more funding to translate our program into a CPC module. We definitely want to do this in collaboration with drivers and training providers.
We want to say to people: “This is what we’ve got already. These are our ideas. What do you think?” We really wish to create this module with drivers to make sure it is of absolute relevance to them and it’s something that they want to learn about. So this is the next area we have to work on.
In the findings of the study, I noticed that the program observed no differences between the groups for other health outcomes such as fruit and vegetable intake, sleep duration or efficiency, or mental wellbeing. What do you think are the reasons for this and is there anything that could be done about it or investigated via another study?
I think we were quite surprised initially that there weren’t any changes in diet between the two groups, because our education program focused quite a lot on diet.
After the study, we interviewed drivers to find what they liked and disliked about the intervention, as well as what we can improve. Actually, a lot of them said they really liked the education session – that was one of their most favourite bits along with the Fitbit. The main thing they recalled from the education session was all the dietary information we gave them.
So when we actually saw that there were no changes between the two groups, we were quite surprised. The possible explanation we have is that maybe our measurement tool wasn’t sensitive enough to detect change. We relied on a self-reported food frequency questionnaire, which perhaps didn’t completely pick up any dietary changes that drivers may have made.
Certainly in the future, we really want to do a lot more work on the dietary side. There are very high levels of obesity across the driving population that we studied. As we only saw a small change in weight in the intervention group, we feel that actually a lot more needs to be done on the dietary side. We are already planning further work in this area.
One thing that we’re hoping to do is a large survey of HGV drivers to understand a bit more about their diet. We would like to know where they are actually stopping for food, what they are eating and how they prepare their food. If they do prepare their meals, what food items do they bring with them and who prepares it? Is it themselves or a partner?
We’re hoping that from such a survey we can learn a lot about lorry drivers’ diet, this will give us more information and help us to come up with interventions to improve dietary intake. We are currently preparing our survey as part of this work.
In terms of the other markers such as mental well being, our intervention didn’t really specifically target this and thus we weren’t too surprised to see little changes in this area. We’d hope that increases in physical activity would be associated with improved mental well being.
In our particular sample of drivers, the levels of depression and anxiety reported from our tools were not really high. In other research, there’s some evidence suggesting a number of drivers have a poor mental health profile. However, actually we didn’t observe that in our sample, which is a good thing.
It could be that these individuals were lucky in a way that they’re employed by a logistics company who already do a lot to promote their mental well being.
Lobbying for changes in legislation takes some time, as does implementing the legislation itself. Taking this into account, do you feel road transport companies could get a return on investment by implementing some or all of the recommendations of the report internally?
We are obviously keen to work with as many employers as possible. If there are any employers that are interested in working with us, I would really encourage them to do so. The more companies we can work with going forwards the better.
Employers do face real challenges in terms of promoting the health of their drivers. We noticed in our study that most drivers who made positive health changes tended to do so on non-workdays as opposed to workdays. So I think there’s still a lot more that needs to be done to help drivers during their workdays.
Some things that employers could do is provide drivers with tips on little changes they can make in order to improve their health. This includes the standard kind of advice out there already from the NHS in this country. There’s lots of resources available on small changes that people can make to improve their health.
Even just making drivers aware that this type of information exists is one of the small things they could do. It could be in the form of some posters at sites or company level communication to drivers.
Drivers could be encouraged to go for a walk, if possible, during the unloading process. Or at least get out of their vehicle and walk around it to break their sitting time. People should be encouraged to sit less and move more as much as they can. It’s a really simple message that people can adopt both at work and at home. Although, I appreciate that regularly breaking up sitting whilst driving is not possible.
Another big thing is on the dietary side. I think raising awareness of healthier food choices is important. Again, this could be in the form of educational posters or resources that companies can provide their drivers. They could contain simple messages about the sugar content of popular food and drinks, for example.
Sleep, of course, is a big issue as well in this industry. One of the concerning findings in our study was the fact that drivers have very short sleep durations and this applied to both of our groups.
Our intervention didn’t really focus on sleep. Nevertheless, from looking at the sleep data, we need to do a lot more to support drivers’ sleep. I guess this is very much linked to the shifts that drivers do with long working hours.
Companies obviously have a say over that, although I appreciate the demands businesses are facing with customer delivery expectations. It’s a really difficult situation, because in an ideal world, I would say to companies to limit shift work and reduce driving hours. However, at the end of the day, they’ve obviously got businesses to run. So I’d say that, wherever possible, trying to ensure drivers get maximum rest opportunities is really important.
We’ve got more funding now to do a specific sleep behaviour study for drivers. We’re also in the process of working with drivers and managers to create a very specific sleep management behaviour intervention delivered via an app.
Do you feel more facilities need to be brought to lorry parks and rest areas in order to make it easier for lorry drivers to be more active? Would it also be advisable for road transport companies to have some fitness/leisure facilities at their base to help drivers too?
I think that’s really important and another area we definitely want to do a lot more work into. The survey we’re about to launch will feed into this, certainly as part of the dietary side of things, as we want to understand more about where drivers are going for their rest stops.
In the UK, we have designated truckstops which I think are popular with drivers, but we also have standard motorway service stations. Some initial insight we received from drivers is that they don’t tend to stop at a motorway service station if they can help it, as the food is more expensive among other things.
The next step in this program of work is to actually go and do an audit of these places. We can look into the kind of the foods available to drivers and the facilities. How much room have they got to exercise? Are there green spaces or nice walking areas? What’s the level of security like? These are questions we plan to answer in an audit of truckstops.
Once we know what’s available, we would like to try and lobby the government to make improvements. I know at the moment, there is talk that the government is investing in stops, and that they’re hoping to make them perhaps more conducive to healthier foods. This would be great, we’re hoping to work with policymakers in this area if possible.
Another area we’re keen on looking at is access to green spaces and natural environments. In a survey of our participants, which was conducted during the first initial lockdown, we asked drivers about time spent in nature and green spaces.
This could be anything from public parks and gardens to woods and fields. We found from some analyses of the data that the drivers who reported spending time in green space had lower levels of fatigue, and actually had improved aspects of mental well being than those who didn’t spend time in green space.
So another area we want to look at is provision of green space, and we would love to create some kind of green space intervention for drivers as well. If we can impact the environments of rest stops to ensure there is green space where drivers walk around or exercise in, I think it could make a big difference to driver fatigue levels and wellbeing.
The other thing we would recommend to any companies as well is to utilise any green space around them, or to create some green spaces. If it is possible, I would urge companies to do that now.
When drivers are at their depot, they could be signposted to just have a little walk in this green space before they start, or after they’ve driven. There’s lots of evidence, not just relating to drivers, that spending time in nature can really do wonders for your mental wellbeing. I think this could be a relatively simple intervention that some companies could implement. Even just putting plants in waiting rooms can make a difference.
I guess the other aspect that drivers have informed us of is security at truckstops. Drivers told us that when they stop, they feel like they can’t leave the vehicle for security reasons. They talked about the fact they transport high value loads and that there have been cases of theft. So I think what’s really important for boosting driver health long term is to ensure our truckstops are better secured.
The study also found the use of fitness tracker wristbands to be beneficial for driver health. Given that some of these devices are relatively inexpensive, do you feel road transport companies would get a return on investment by providing their drivers with such devices?
I think that would have a huge impact definitely on driver health. The Fitbit was the favourite part of the intervention. When we were advertising and recruiting drivers for the study, a lot of them later told us a reason they took part was the draw of potentially having a Fitbit.
When we recruited drivers for the study, we told them they had a 50/50 chance of being in the intervention or control groups, so they knew it wasn’t guaranteed. It was nonetheless a big motivator for them to take part. Of all the intervention components, the Fitbit and the health workshop were the most favoured.
What was really interesting was even though our intervention had a six month duration, when we interviewed drivers, 16-18 months later, a lot of them were still wearing and using the Fitbit.
That was one intervention component that they really stuck with and used. The drivers found it really motivating to be able to see their step counts, and set goals to improve their step count.
Obviously there’s lots of other wearables, not just Fitbits, and they all function in the same way. They all incorporate a host of psychological behaviour change techniques within the device and within their apps. These are aimed at motivating people to track their activity and set goals.
Most devices now have a reminder built in for you to move. Drivers reported to us that they found that quite effective. Obviously they couldn’t do anything when they were driving, but a lot said this function was helpful on their non-work days. When the device would buzz to remind them to move each hour, they would actually do so.
I would say that if companies were willing to invest in these types of trackers and provide good practice for their drivers, it could make quite a big difference to driver health and provide a really good return on investment.