2. Materials and Methods
2.1. Study Context
2.2. Focus Groups with Drivers
2.3. Key Informant Interviews
2.4. Data Analysis
3.1. Work Relationships
3.1.1. Driver Relationships with Supervisors
“The person (supervisors) does not even take his time to ask, for example, what happened to you, whether you are OK, to show concern, you’d better go home…you, see? Right away, the first thing, a grim face. …You (the driver) have to apologize, to say the least, because you are not in good condition, when it should be the other way around.” (Driver)
“We are supporting the drivers, helping them, we have even communicated to them that if it is necessary for a service to arrive late, we are going to arrive late, the important thing is not to have accidents, not to put the driver or the passengers at risk.” (Key Informant)
“Something is still lacking; we have to continue to work in building a climate of trust.” (Key Informant)
3.1.2. Relationships between Drivers
“What I enjoy the most is comradeship. Here we share with our mates, we get together with different workmates, different people… it is very pleasant.” (Driver)
“We are not considered at all. Not even when we’ve had meetings with them (supervisors), you can’t talk, you can’t say anything.” (Driver)
3.1.3. Drivers’ Relationships with Passengers
“(The passengers) show the driver bad manners… lack of respect, say, lack of judgement toward the driver… that’s stressful. Us drivers have a huge responsibility in the end.” (Driver)
3.2. Organization of Work
3.2.1. Breaks and Vacation Time
“My wife works, and we never have vacations together. When she is on vacation I am working. And she says hey ’get’” a sick leave so that we have some days off. That is where sick leaves come from.” (Driver)
“We have a severe problem that we’ve had a lot of demand for transport, and we’ve had to cut into the drivers’ vacation time, so we’re not giving them all the vacations that we ought to, so the vacation time starts to build up, the rest time that the drivers ought to have, and we’re postponing their vacations.” (Key Informant)
3.2.2. Distribution of Shifts
“You get home by midnight, and you are supposed to get up at 4:30 a.m.… Then, you come here [to work] already feeling sleepy since you have slept just four hours… Then repeat the process 5 days in a row.” (Driver)
3.2.3. Route Scheduling
“The drivers say to themselves ‘I’m going down that route again,’ Now I’m going down in a bad mood, I’m going to be late, I’m going to run into a traffic jam…(Key Informant)”
“At least they should be distributed in a more balanced way. If I have a busy day, the next day I should have a more relaxing day, and the one who got a less busy day, the next day should have a busier day. It can be compensated in that way.” (Driver)
3.2.4. Bus Design and Maintenance
“Yeah, the gearshift of the vehicles, the ones we drive, they are hell, shifting gears, and look, I’m not exaggerating, once I put the vehicle into reverse and ended up with my hand cut open.” (Driver)
3.3. Driver’s Health and Well-Being
“Fatigue … makes your health poor, you lack sleep, it’s quite powerful, as time goes by you simply start wearing away.” (Driver)
“You really feel under pressure as you know that you have to get somewhere and the guy is gonna be worried about this, about that, about the guy over here, about the vehicle over here, I think all that makes you… I think all that stuff has a negative impact on your health.” (Driver)
3.3.3. Health Behaviors
“You eat badly, you get used to eating badly or drinking lots of coffee. Some guys drink more, they start smoking a lot, drinking too much coffee to stay awake.” (Driver)
“Most of the sick leave is, some for stress, panic attacks, what else do we have…stomach aches, which are caused by the same (stress-related) eating disorders, excess sometimes of coffee, cigarettes. Basically, poor habits.” (Key Informant)
3.3.4. Chronic Health Conditions
“[Our] diet messes you up… diabetes and hypertension are quite common among colleagues and it must be a result of that (not having time to eat)… we eat in a rush and not in an organized way.” (Driver)
“We are constantly worrying about [the drivers], obesity is a common result of sedentary work, therefore we are always concerned about hypertension, high blood-pressure, obesity.” (Key Informant)
3.4. Informing a Total Worker Health® Intervention
4.1. Working Conditions Influencing Bus Drivers’ Safety, Health, and Well-Being
4.2. Safety, Health, and Well-Being of Professional Bus Drivers
4.3. Using Qualitative DATA to Inform Intervention Design
4.4. Strengths and Limitations
4.5. Implications for Future Research and Practice
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
- Rauser, E.; Foley, M.; Bonauto, D.; Edwards, S.; Spielholz, P.; Silverstein, B. Preventing Injuries in the Trucking Industry; Technical Report No. 90-17-2008; Washington State Department of Labor & Industries: Tumwater, WA, USA, 2008. [Google Scholar]
- Tse, J.L.; Flin, R.; Mearns, K. Bus driver well-being review: 50 years of research. Transp. Res. Part F Traffic Psychol. Behav. 2006, 9, 89–114. [Google Scholar] [CrossRef]
- Bigert, C.; Gustavsson, P.; Hallqvist, J.; Hogstedt, C.; Lewné, M.; Plato, N.; Reuterwall, C.; Schéele, P. Myocardial Infarction among Professional Drivers. Epidemiology 2003, 14, 333–339. [Google Scholar] [CrossRef]
- Gustavsson, P.; Alfredsson, L.; Brunnberg, H.; Hammar, N.; Jakobsson, R.; Reuterwall, C.; Ostlin, P. Myocardial infarction among male bus, taxi, and lorry drivers in middle Sweden. Occup. Environ. Med. 1996, 53, 235–240. [Google Scholar] [CrossRef] [PubMed]
- Rosso, G.L.; Perotto, M.; Feola, M.; Bruno, G.; Caramella, M. Investigating obesity among professional drivers: The high risk professional driver study. Am. J. Ind. Med. 2015, 58, 212–219. [Google Scholar] [CrossRef]
- Birdsey, J.; Sussell, A.L. Prevalence of Obesity, No Leisure-Time Physical Activity, and Short Sleep Duration Among Occupational Groups in 29 States. J. Occup. Environ. Med. 2017, 59, 1221–1228. [Google Scholar] [CrossRef] [PubMed]
- Pope, M.H.; Magnusson, M.; Wilder, D.G. Low Back Pain and Whole Body Vibration. Clin. Orthop. Relat. Res. 1998, 354, 241–248. [Google Scholar] [CrossRef] [PubMed]
- Pope, M.H.; Andersson, G.; Frymoyer, J.; Chaffin, D.B. Occupational Low Back Pain: Assessment, Treatment and Prevention; Mosby: St. Louis, MO, USA, 1990. [Google Scholar]
- NRC/IOM. Musculoskeletal Disorders and the Workplaces: Low Back and Upper Extremities; National Academy Press: Washington, DC, USA, 2001. [Google Scholar]
- Bernard, T. Musculoskeletal Disorders and Workplace Factors; DHHS Publication (NIOSH) 97-141; DHHS Publication (NIOSH): Washington, DC, USA, 1997. [Google Scholar]
- Useche, S.A.; Cendales, B.; Montoro, L.; Esteban, C. Work stress and health problems of professional drivers: A hazardous formula for their safety outcomes. PeerJ 2018, 6, e6249. [Google Scholar] [CrossRef]
- Garbarino, S.; Guglielmi, O.; Sannita, W.G.; Magnavita, N.; Lanteri, P. Sleep and Mental Health in Truck Drivers: Descriptive Review of the Current Evidence and Proposal of Strategies for Primary Prevention. Int. J. Environ. Res. Public Health 2018, 15, 1852. [Google Scholar] [CrossRef]
- Ba, A.J.S.; Doucette, J.T.; Garland, E.; McGinn, T. Healthcare and the long haul: Long distance truck drivers? A medically underserved population. Am. J. Ind. Med. 2004, 46, 463–471. [Google Scholar] [CrossRef]
- Apostolopoulos, Y.; Lemke, M.; Sönmez, S. Risks Endemic to Long-Haul Trucking in North America: Strategies to Protect and Promote Driver Well-Being. New Solut. J. Environ. Occup. Health Policy 2014, 24, 57–81. [Google Scholar] [CrossRef]
- Sabbagh-Ehrlich, S.; Friedman, L.; Richter, E.D. Working conditions and fatigue in professional truck drivers at Israeli ports. Inj. Prev. 2005, 11, 110–114. [Google Scholar] [CrossRef] [PubMed]
- Bradley, C.J.; Grossman, D.C.; Hubbard, R.A.; Ortega, A.; Curry, S.J. Integrated Interventions for Improving Total Worker Health: A Panel Report from the National Institutes of Health Pathways to Prevention Workshop: Total Worker Health—What’s Work Got to Do with It? Ann. Intern. Med. 2016, 165, 279–283. [Google Scholar] [CrossRef] [PubMed]
- Filho, A.G.; Rocha, M.S.; Oliveira, F.M.; Dos Santos, U.C.; Costa, J.V.R.; De Jesus, J.S. Working Conditions of Bus Drivers in a Large Brazilian Metropolis. Procedia Manuf. 2015, 3, 2505–2509. [Google Scholar] [CrossRef]
- Gómez-Ortiz, V.; Cendales, B.; Useche, S.; Bocarejo, J.P. Relationships of working conditions, health problems and vehicle accidents in bus rapid transit (BRT) drivers. Am. J. Ind. Med. 2018, 61, 336–343. [Google Scholar] [CrossRef]
- Kim, J.H.; Zigman, M.; Aulck, L.S.; Ibbotson, J.A.; Dennerlein, J.; Johnson, P. Whole Body Vibration Exposures and Health Status among Professional Truck Drivers: A Cross-sectional Analysis. Ann. Occup. Hyg. 2016, 60, 936–948. [Google Scholar] [CrossRef] [PubMed]
- Chen, J.-C.; Dennerlein, J.T.; Chang, C.-C.; Chang, W.-R.; Christiani, D.C. Seat inclination, use of lumbar support and low-back pain of taxi drivers. Scand. J. Work. Environ. Health 2005, 31, 258–265. [Google Scholar] [CrossRef] [PubMed]
- Silla, I.; Gamero, N. Psychological safety climate and professional drivers’ well-being: The mediating role of time pressure. Transp. Res. Part F Traffic Psychol. Behav. 2018, 53, 84–92. [Google Scholar] [CrossRef]
- Hege, A.; Lemke, M.K.; Apostolopoulos, Y.; Sönmez, S. Occupational health disparities among U.S. long-haul truck drivers: The influence of work organization and sleep on cardiovascular and metabolic disease risk. PLoS ONE 2018, 13, e0207322. [Google Scholar] [CrossRef] [PubMed]
- Guerra, E.B.S.; Suazo, S.V.V.; Campo, V.A.R. Working Conditions, Health and Quality of Life among Drivers. Rev. Cuid. 2020, 11. [Google Scholar] [CrossRef]
- de Croon, E.M.; Sluiter, J.K.; Frings-Dresen, M.H. Need for recovery after work predicts sickness absence: A 2-year prospective cohort study in truck drivers. J. Psychosom. Res. 2003, 55, 331–339. [Google Scholar] [CrossRef]
- Sorensen, G.; McLellan, D.L.; Sabbath, E.L.; Dennerlein, J.T.; Nagler, E.M.; Hurtado, D.A.; Pronk, N.P.; Wagner, G.R. Integrating worksite health protection and health promotion: A conceptual model for intervention and research. Prev. Med. 2016, 91, 188–196. [Google Scholar] [CrossRef]
- NIOSH. Total Worker Health. Available online: http://www.cdc.gov/niosh/twh/ (accessed on 19 September 2017).
- Nielsen, K.; Abildgaard, J.S.; Daniels, K. Putting context into organizational intervention design: Using tailored questionnaires to measure initiatives for worker well-being. Hum. Relat. 2014, 67, 1537–1560. [Google Scholar] [CrossRef]
- Peters, S.; Nielsen, K.M.; Nagler, E.M.; Revette, A.C.; Madden, J.; Sorensen, G. Ensuring Organization-Intervention Fit for a Participatory Organizational Intervention to Improve Food Service Workers’ Health and Wellbeing. J. Occup. Environ. Med. 2020, 62, e33–e45. [Google Scholar] [CrossRef] [PubMed]
- Peters, S.E.; Trieu, H.D.; Manjourides, J.; Katz, J.N.; Dennerlein, J.T. Designing a Participatory Total Worker Health® Organizational Intervention for Commercial Construction Subcontractors to Improve Worker Safety, Health, and Well-Being: The “ARM for Subs” Trial. Int. J. Environ. Res. Public Health 2020, 17, 5093. [Google Scholar] [CrossRef] [PubMed]
- Vignoli, M.; Nielsen, K.; Guglielmi, D.; Tabanelli, M.C.; Violante, F.S. The Importance of Context in Screening in Occupational Health Interventions in Organizations: A Mixed Methods Study. Front. Psychol. 2017, 8, 1347. [Google Scholar] [CrossRef] [PubMed]
- Sorensen, G.; Dennerlein, J.T.; Peters, S.E.; Sabbath, E.L.; Kelly, E.L.; Wagner, G.R. The future of research on work, safety, health and wellbeing: A guiding conceptual framework. Soc. Sci. Med. 2020, 269, 113593. [Google Scholar] [CrossRef] [PubMed]
- Anger, W.K.; Elliot, D.L.; Bodner, T.; Olson, R.; Rohlman, D.S.; Truxillo, D.M.; Kuehl, K.S.; Hammer, L.B.; Montgomery, D. Effectiveness of Total Worker Health interventions. J. Occup. Health Psychol. 2015, 20, 226–247. [Google Scholar] [CrossRef] [PubMed]
- Feltner, C.; Peterson, K.; Weber, R.; Cluff, L.; Coker-Schwimmer, E.; Viswanathan, M.; Lohr, K.N. The Effectiveness of Total Worker Health Interventions: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Ann. Intern. Med. 2016, 165, 262–269. [Google Scholar] [CrossRef]
- Corley, K.G.; Gioia, D.A. Building theory about theory building: What constitutes a theoretical contribution? Acad. Manag. Rev. 2011, 36, 12–32. [Google Scholar] [CrossRef]
- Gioia, D.A.; Corley, K.G.; Hamilton, A.L. Seeking qualitative rigor in inductive research: Notes on the Gioia methodology. Organ. Res. Methods 2013, 16, 15–31. [Google Scholar] [CrossRef]
- Krippendorff, K. Content Analysis: An Introduction to Its Methodology; Sage Publications: Thousand Oaks, CA, USA, 2018. [Google Scholar]
- Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef]
- NVivo. Relationship Nodes: About Relationships. Available online: https://help-nv11.qsrinternational.com/desktop/concepts/about_relationships.htm (accessed on 10 September 2021).
- Hege, A.; Lemke, M.K.; Apostolopoulos, Y.; Whitaker, B.; Sönmez, S. Work-Life Conflict among U.S. Long-Haul Truck Drivers: Influences of Work Organization, Perceived Job Stress, Sleep, and Organizational Support. Int. J. Environ. Res. Public Health 2019, 16, 984. [Google Scholar] [CrossRef]
- Hämmig, O. Health and well-being at work: The key role of supervisor support. SSM-Popul. Health 2017, 3, 393–402. [Google Scholar] [CrossRef]
- Yanar, B.; Lay, M.; Smith, P.M. The Interplay between Supervisor Safety Support and Occupational Health and Safety Vulnerability on Work Injury. Saf. Health Work. 2018, 10, 172–179. [Google Scholar] [CrossRef]
- Fournier, P.-S.; Lamontagne, S.; Gagnon, J. Interactions between Dispatchers and Truck Drivers in a High Turnover Context. Articles 2012, 67, 263–282. [Google Scholar] [CrossRef]
- Zhao, Y.; Richardson, A.; Poyser, C.; Butterworth, P.; Strazdins, L.; Leach, L.S. Shift work and mental health: A systematic review and meta-analysis. Int. Arch. Occup. Environ. Health 2019, 92, 763–793. [Google Scholar] [CrossRef]
- Liu, Q.; Shi, J.; Duan, P.; Liu, B.; Li, T.; Wang, C.; Li, H.; Yang, T.; Gan, Y.; Wang, X.; et al. Is shift work associated with a higher risk of overweight or obesity? A systematic review of observational studies with meta-analysis. Int. J. Epidemiol. 2018, 47, 1956–1971. [Google Scholar] [CrossRef]
- Winkler, M.R.; Mason, S.; Laska, M.N.; Christoph, M.J.; Neumark-Sztainer, D. Does non-standard work mean non-standard health? Exploring links between non-standard work schedules, health behavior, and well-being. SSM-Popul. Health 2017, 4, 135–143. [Google Scholar] [CrossRef]
- Brauner, C.; Wöhrmann, A.M.; Frank, K.; Michel, A. Health and work-life balance across types of work schedules: A latent class analysis. Appl. Ergon. 2019, 81, 102906. [Google Scholar] [CrossRef]
- Wong, K.; Chan, A.H.S.; Ngan, S.C. The Effect of Long Working Hours and Overtime on Occupational Health: A Meta-Analysis of Evidence from 1998 to 2018. Int. J. Environ. Res. Public Health 2019, 16, 2102. [Google Scholar] [CrossRef]
- Ihlström, J.; Kecklund, G.; Anund, A. Split-shift work in relation to stress, health and psychosocial work factors among bus drivers. Work 2017, 56, 531–538. [Google Scholar] [CrossRef]
- Mello, M.; Santana, M.; Souza, L.; Oliveira, P.; Ventura, M.; Stampi, C.; Tufik, S. Sleep patterns and sleep-related complaints of Brazilian interstate bus drivers. Braz. J. Med. Biol. Res. 2000, 33, 71–77. [Google Scholar] [CrossRef]
- Sekkay, F.; Imbeau, D.; Chinniah, Y.; Dubé, P.-A.; DE Marcellis-Warin, N.; Beauregard, N.; Trépanier, M. Risk factors associated with self-reported musculoskeletal pain among short and long distance industrial gas delivery truck drivers. Appl. Ergon. 2018, 72, 69–87. [Google Scholar] [CrossRef]
- Kim, J.H.; Zigman, M.; Dennerlein, J.T.; Johnson, P.W. A Randomized Controlled Trial of a Truck Seat Intervention: Part 2—Associations between Whole-Body Vibration Exposures and Health Outcomes. Ann. Work. Expo. Health 2018, 62, 1000–1011. [Google Scholar] [CrossRef]
- Crizzle, A.M.; Bigelow, P.; Adams, D.; Gooderham, S.; Myers, A.M.; Thiffault, P. Health and wellness of long-haul truck and bus drivers: A systematic literature review and directions for future research. J. Transp. Health 2017, 7, 90–109. [Google Scholar] [CrossRef]
|Topic Area||Focus Group Questions||Key Informant Questions|
|Workers’ perspectives of their work and key health, safety, and well-being outcomes||What do you enjoy most about your job?|
What do you enjoy least about your job?
What are the main health and safety considerations that impact you on your job?
What about your job contributes to your overall quality of life and well-being?
|What do think the key priorities for safety of drivers are at <company>?|
Beyond safety, what other health and well-being priorities are important at <company>?
What are the concerns for drivers with respect to their safety, health, and well-being?
|Focus on specific safety, health, and well-being outcomes (job satisfaction and happiness, general health, absenteeism from work, job stress, musculoskeletal pain and injuries at work, and fatigue)||What contributes to your overall happiness at work?|
Do you think your general health is impacted by your job? How?What are some of the main reasons that people miss days at work?
Are there things about your work that you find stressful? Do you think that stress affects your health and safety on the job?
Are there parts of your body that ache/are painful that you think are caused by or made worse by your work? What aspects of your job contribute to your symptoms?
How does your job affect how tired you get during the day?
|Can you tell me more about how <outcome> impacts on drivers’ safety, health, and well-being?|
|Working conditions influencing safety, health, and well-being||Thinking about your job, what are the working conditions that most impact your:||While there are various ways to promote safety, health, and well-being, we want you to think broadly about how work is organized and managed here at <company>-how does the work environment influence drivers’ safety, health, and well-being?|
We would like your unique perspective regarding systems already in place and how policies and practices support or promote drivers’ safety, health, and well-being.
Specific questions on working conditions were asked, e.g., what causes stress on the job? Are there aspects of the physical work environment that impact the drivers’ safety, health, and well-being?
|Perspectives on priority areas||From your perspective, what should be the top priority with respect to improving: ||What types of policies, programs and practices do you see as beneficial in improving drivers’ safety, health, and well-being?|
|Determine barriers and facilitators to intervention||What are the most important things to think about when trying to make positive changes in the workplace?|
What things could get in the way of making changes in your workplace?
|Are there initiatives in place that could be built upon that you think could really make a difference?|
What do you see as the main challenges we might face in developing a program?
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).