Operational Management of Truck Driver Fatigue: A Systematic Review

Abstract

Effectively managing truck driver fatigue is essential for ensuring driver safety, as fatigue negatively impacts health and performance. Since fatigue is a complex, multidimensional issue with various cause–effect relationships, it requires a comprehensive management approach. This systematic review investigates truck driver fatigue management strategies currently available in the road freight industry. The review analyses and synthesises fatigue management recommendations from 32 resources, leading to the identification of overarching themes and the development of suitable frameworks. The findings highlight that fatigue management focuses on operational systems and processes, safety culture and practices, and driver health and well-being. Effective fatigue management should encompass each of these themes, whereby the specific proactive, real-time, and reactive practices are interlinked to support feedback loops, emphasising the application of a change management model. Further research that develops and empirically tests an actionable toolkit integrating the proposed frameworks in a developing country will enhance our understanding of the unique operating environment. This review acts as a foundational tool for management and researchers, highlighting available strategies for managing truck driver fatigue while emphasising that fatigue risk cannot be addressed by a singular approach, but rather that a combination of interconnected systems is required.

1. Introduction

The operating environment for truck drivers in South Africa presents numerous challenges, compounded by demanding work conditions and inadequate opportunities for restorative rest at home. These factors arise from the competitive business landscape where supply chains manage processes and flows, from raw material extraction to the final delivery to consumers, acting as the crucial link connecting all stakeholders [1,2]. The overarching objective is to enhance competitiveness and provide customer service [3], which in turn intensifies pressure on human resources. Logistics management plays a critical role in orchestrating the flow of goods, information, and services across the supply chain [4]. Freight transportation is crucial for improving both place and time utilities within supply chains, ensuring timely and efficient product delivery [5]. In South Africa, road transportation is the backbone of freight movement [6], placing significant demands on truck drivers navigating the extensive road network.

1.1. Review of the Existing Systematic Literature

Several systematic reviews have examined truck driver fatigue, but significant gaps remain in providing operational management frameworks suitable for practical implementation, particularly in developing country contexts. The most comprehensive recent review examining the effectiveness of fatigue risk management systems (FRMSs) found that these systems are data-driven management practices for identifying and managing fatigue-related safety risks [7]. However, their review concluded that the effectiveness of FRMSs depends heavily on organisational safety culture maturity and resource availability. This finding is particularly relevant to developing countries where resource constraints and varying safety culture maturity levels present implementation challenges.

A literature review examining the effects of fatigue on truck drivers in cargo transportation identified three main factors influencing fatigue manifestation: sleep, work, and health [8]. While this review offers valuable insights into fatigue causation, it does not address operational management strategies or provide frameworks for systematic fatigue risk management implementation. While existing reviews have focused on fatigue causation, detection technologies, or regulatory approaches, this study examines how diverse management strategies can be integrated into practical operational frameworks.

The management of driver fatigue extends beyond the road transport sector, with similar challenges observed across various transportation modes and operational contexts. Recent research has highlighted the importance of integrated management approaches that consider both technological solutions and human factors. Digital transformation in logistics and supply chain management increasingly incorporates fatigue monitoring systems as part of broader operational efficiency frameworks [9]. Furthermore, the intersection of occupational health, safety management systems, and environmental sustainability creates a complex operational landscape where fatigue management must be balanced against productivity demands [10]. These contemporary developments underscore the need for comprehensive, context-specific frameworks that can accommodate the unique challenges faced by truck drivers in developing countries.

1.2. The Operational Management Context in Developing Countries

This study adopted an operational management perspective, defined as the systematic design, management, and improvement of operational processes to achieve organisational objectives efficiently and effectively. In the context of truck driver fatigue, operational management encompasses the integration of scheduling systems, safety protocols, health interventions, and risk management processes into cohesive frameworks that can be implemented by transport operators regardless of their resource constraints.

South Africa presents a particularly compelling case for operational fatigue management research due to its unique combination of challenges. The country experiences poor health outcomes relative to its economic development level, characterised by what researchers term the “quadruple burden of disease”: hyperendemic HIV/AIDS and tuberculosis, high rates of violence and injuries, consistently high levels of maternal and child mortality, and the continued rise of noncommunicable diseases [11]. Further research confirms the prevalence of these health risks among truck drivers in South Africa, noting the prevalence of manageable cardiovascular risk factors, mental health issues, and sexual risk behaviours [12].

The operational management challenges in developing countries extend beyond individual health factors. Infrastructure limitations significantly impact fatigue management effectiveness. In many developing regions, inadequate road infrastructure leads to longer journey times, increased vehicle vibration and stress, and the limited availability of safe stopping points. The quality and availability of truck stop facilities represent a critical operational challenge: many developing countries lack sufficient numbers of secure, well-maintained rest facilities with adequate sleeping accommodations. Where facilities do exist, they often fail to provide the basic amenities necessary for restorative rest including secure parking, clean sanitation facilities, access to nutritious food, and protection from environmental stressors such as extreme temperatures or noise [13].

Economic pressures in developing countries create additional constraints on fatigue management implementation. Transport operators often operate on narrow profit margins, limiting their ability to invest in advanced fatigue monitoring technologies, vehicle ergonomics improvements, or comprehensive driver wellness programmes. The informal nature of many transport operations in developing countries further complicates regulatory enforcement and the implementation of systematic fatigue management approaches. These economic realities necessitate fatigue management frameworks that are cost-effective and scalable, capable of delivering meaningful safety improvements without requiring substantial capital investment.

Regulatory enforcement variability, limited access to advanced fatigue monitoring technologies, and insufficient driver training infrastructure create a complex operational environment requiring adapted management frameworks. Unlike developed countries where FRMS implementation can assume mature safety cultures and adequate resources, developing country contexts require operational frameworks that can function effectively under resource constraints while gradually building safety culture maturity. The intersection of poor infrastructure, economic constraints, limited regulatory capacity, and challenging working conditions creates a unique operational environment where traditional fatigue management approaches developed for high-resource settings may prove inadequate without substantial adaptation.

1.3. Study Rationale and Objectives

Central to fatigue risk is the multidimensional nature of its causation and manifestation. Fatigue is defined as “reduced mental and physical functioning caused by sleep deprivation and/or being awake during normal sleep hours” [14]. Research notes how fatigue negatively impacts drivers’ attention, reaction time, and vigilance, leading to increased safety risk [15]. Given fatigue’s pervasive nature and safety implications, effective management requires an interconnected system of proactive, real-time, and reactive measures.

Government regulations have established hours-of-service limitations for driver safety, but research shows that a purely prescriptive approach overlooks critical aspects of fatigue management [16]. While various truck driver fatigue management strategies exist that transcend prescriptive management, there is a lack of comprehensive synthesis that integrates these approaches specifically for the operational realities of developing countries’ road freight transportation industry.

This systematic review aims to investigate available truck driver fatigue management strategies and propose applicable operational management frameworks to guide future research and facilitate the implementation of effective fatigue management systems within developing countries’ road freight transport industry, with specific focus on the South African context.

2. Materials and Methods

This systematic review aimed to explore the literature on the management of truck driver fatigue in the road freight transport industry using the PRISMA methodology (Supplementary Materials). The purpose of this review is twofold:

(i)

To ascertain the extent of truck driver fatigue management studies conducted specifically in South Africa, considering the country’s unique complexities.

(ii)

To identify and analyse existing global practices and tools available to management in addressing truck driver fatigue within the South African context.

The systematic review followed the nine-step procedure outlined by [17]. Each step served as a guide; however, a methodological quality assessment was omitted due to the inclusion of grey literature and industry reports.

2.1. Identifying the Research Question

The systematic review addressed the research question, “What international practices and fatigue frameworks can be implemented to mitigate truck driver fatigue in developing countries, with a specific focus on South Africa?”

2.2. Literature Search

The literature search strategy focused on utilising keywords relevant to the primary concepts of the research question: truck drivers, fatigue, and management strategies. These core concepts were broadened with synonyms and related terms to encompass a comprehensive scope of the relevant literature. The complete list of the 42 keywords utilised is provided in

Table A1. Search terms and Boolean operators.

Concept	#1 Truck Drivers	#2 Fatigue	#3 Strategies
Boolean operators	AND	AND	AND
OR	“road transportation”	fatigue	“risk management”
OR	“road transport”	sleepiness	“risk mitigation”
OR	“truck transportation”	exhaustion	mitigation
OR	“truck transport”	tiredness	management
OR	“road freight”	alertness	framework
OR	“truck driver”	drowsiness	structure
OR	“freight driver”		toolkit
OR	“professional driver”		guideline
OR	“lorry driver”		guidelines
OR	“commercial driver”		model
OR	“heavy vehicle driver”		scheme
OR			countermeasure
OR			countermeasures
OR			measure
OR			measures
OR			system
OR			systems
OR			practice
OR			practices
OR			“best practices”
OR			“best practice”
OR			“best in class practices”
OR			“best-in-class practices”
OR			strategy
OR			strategies

Source: Researchers’ own construct (2024).

(in Appendix A). Scientific databases were queried using the specified search terms, specifically Web of Science, Scopus, EBSCOHost, PubMed, and PsycINFO. These databases were chosen to provide a holistic perspective into the systematic search of truck driver fatigue management, recognising fatigue as both a human issue and a critical concern in business management. Furthermore, the search strategy incorporated grey literature sources, namely Google Scholar and CORE, with CORE specifically targeting theses and dissertations. Due to string limitations, the search strategy for grey literature was adapted, as outlined in

Table A2. Grey literature search strategy.

Database	Search Terms	Concept & Search Operator
Google Scholar	(“truck driver” OR “heavy vehicle driver” OR “lorry driver” OR “commercial driver” OR “professional driver”) AND fatigue AND (management OR mitigation OR prevention OR combat OR avoidance OR toolkit OR guideline)	Concept #1: intitle Concept #2: intitle Concept #3: intitle
CORE (Theses)	(“truck driver” OR “freight driver” OR “lorry driver” OR “commercial driver” OR “professional driver” OR “heavy vehicle driver”) AND (sleepiness OR fatigue OR drowsiness OR exhaustion OR alertness OR tiredness) AND (mitigation OR management OR prevention OR framework OR structure OR toolkit OR guideline OR model OR scheme OR countermeasure OR measure OR system OR practice OR strategy)	Concept #1: all fields Concept #2: title Concept #3: all fields

Source: Researchers’ own construct (2024).

(in Appendix A). Including grey literature ensured the incorporation of unpublished resources, particularly those within industry, broadening the scope of the literature examined.

Search operators were employed to refine the search strategy to facilitate manageable analysis and eliminate irrelevant findings. Each database presented unique rules and limitations regarding the utilisation of search operators, necessitating the use of multiple search strings. The specific search operators utilised for each concept in every database are detailed in

Table A3. Database search operators for concepts.

Database	Concept and Field
Scopus	Concept #1: TITLE-ABS-KEY Concept #2: TITLE Concept #3: TITLE-ABS-KEY
PsycINFO	Concept #1: Abstract Concept #2: Abstract Concept #3: Abstract
PubMed	Concept #1: Title/Abstract Concept #2: Title/Abstract Concept #3: Title/Abstract
Web of Science	Concept #1: Abstract Concept #2: Abstract Concept #3: Abstract
EBSCOHost	Concept #1: AB Concept #2: AB Concept #3: AB

Source: Researchers’ own construct (2024).

(in Appendix A). Following refinement, the search yielded a total of 798 resources, as shown in Figure 1.

As part of the systematic review’s objective to assess truck driver fatigue management research within the context of developing countries, particularly focussing on South Africa, the search strategy included “South Africa” as a search term. This refinement yielded a total of five resources (nine including duplicates), of which only two were directly related to truck drivers. These resources encompassed an investigation into the health of Southern African truck drivers [12] and a comprehensive examination of the Road Transport Management System self-regulation initiative in South Africa [18]. However, none of these resources met the inclusion criteria for providing actionable management strategies to mitigate truck driver fatigue. This scarcity necessitated a global approach to identify international best practices that could potentially be adapted for developing country contexts. Successful road safety strategies utilised in developed countries can be implemented within developing country contexts despite contrasting social and economic environments, provided appropriate adaptation occurs [19]. Subsequently, these inclusion and exclusion criteria were applied to the 798 returned resources.

2.3. Screening of the Literature

To streamline the screening process and address potential duplicates, the search outputs from the various databases were collated using Zotero version 6.0, a reference management software, and duplicates were identified and removed. Theses and dissertations sourced from CORE were managed separately using Microsoft Excel. The remaining 578 unique studies were transferred to Rayyan, a collaborative software designed to facilitate the initial screening process through semi-automation [20]. Within Rayyan, the unique resources underwent screening based on the predefined inclusion and exclusion criteria. The 28 unique resources obtained from CORE were subjected to separate screening using Microsoft Excel.

The inclusion and exclusion criteria were applied manually, with each resource undergoing screening based on the title, abstract, and, if necessary, full text to determine its relevance. Resources were required to be in English and were restricted up to 2023 publications. To be included, resources needed to propose actionable operational systems, strategies, tools, frameworks, or practices that business management could implement to address truck driver fatigue. Government regulations and interventions beyond minimum HOS compliance were included, although most government resources were excluded from this review. The use of incentive and payment schemes as a mitigation strategy was excluded due to scope limitations.

Five hundred and eighty-one (581) resources failed to meet the screening criteria and were excluded; further details on the reasoning for exclusion can be found in Figure A1 (in Appendix B). Five additional duplicates were identified during the screening process, and full texts were unavailable for three resources via inter-library loans. As such, 32 resources remained after the initial screening, which was followed by a rigorous application of the exclusion criteria within a full-text review. No theses or dissertations were included from the CORE database. Finally, 25 resources were included before the researchers conducted backward citation searching. The reference lists of each of the 25 included resources were scanned to ensure no relevant resources were excluded from the systematic review. As a result, seven resources were deemed appropriate and included. Thus, 32 resources were considered pertinent for inclusion.

2.4. Data Extraction and Synthesis

The research question served as a guide in determining the data to be extracted. However, research highlights the challenge of delineating what constitutes data and findings, especially when synthesising qualitative studies [21]. Moreover, the review yielded various studies, each differing in reporting methodology. As such, it was decided that the ‘Discussion’, ‘Results’, and ‘Conclusions’ sections of the resources would be thoroughly examined for text related to the operational management of truck driver fatigue. In addition, the Table of Contents was reviewed to prevent overlooking other important sections. Before commencing data coding and theming, supplementary information was extracted including year of publication, country of research, and document type.

Atlas.ti version 24.2.0, computer-assisted qualitative data analysis software used for coding and analysing text, was used to examine each document and code the relevant text, which began the process of thematic synthesis. The effectiveness of Atlas.ti in grouping and coding articles and categorising the code by creating code groups has been analysed [22]. Initially, the identified truck driver fatigue management methods were categorised into code groups representing distinct management tools or strategies. The initial categorisation resulted in 23 groups and 191 individual codes. These 23 groups were integral for the subsequent theming process, while the 191 codes provided the necessary detail to inform subsequent discussions. Eleven (11) subthemes emerged based on comparability between codes and a thorough review of the resources, as delineated in

Table 1. Identified themes and occurrences.

Management Theme	Subtheme	Occurrences	References
Operational Systems and Processes	Scheduling	12	[23,24,25,26,27,28,29,30,31,32,33,34]
	Fatigue Risk Management System	3	[35,36,37]
	Fatigue Measurement	2	[27,38]
	Risk Classification System	2	[39,40]
	Accident Investigation	1	[41]
	Real-Time Fatigue Monitoring	3	[42]
Safety Culture and Practices	Safety Culture	5	[24,27,29,43]
	Fatigue Management Programme	2	[43,44]
	Driver Training and Education	6	[27,28,45,46,47,48]
Health and Wellness Initiatives	Fatigue, Health, and Wellness Intervention	2	[48,49]
	Emotional Fatigue Management	1	[50]

Source: Researchers’ own construct (2023).

, representing the array of strategies available to management in mitigating or preventing truck driver fatigue. These 11 subthemes were further consolidated into three overarching management themes that allowed for the development of fatigue management frameworks. Details of the strategies within each management theme and subtheme are discussed in

Table A4. Details on subthemes and practices.

Subthemes	Practices	Reference
Driver Training and Education	Trucking apprenticeship training	[44]
	SHIFT education	[46]
	Fatigue training objectives	[45]
	Fatigue outreach topics	[43]
	Fatigue training lecture components	[45]
	Safety and training meetings	[25]
	FMP driver fatigue education	[42]
Accident Investigation	Fatigue assessment in crashes	[39]
	Fatigue contribution in crashes	[39]
Fatigue Measurement	N/A	[26,37]
Fatigue Management Programme	FMP components	[41,42]
	FMP implementation	[42]
	FMP instructional modules	[42]
Fatigue Risk Management System	FMS activities	[35]
	FMS audit	[33]
	FRMS activities	[34]
Fatigue, Health, and Wellness Intervention	Fatigue, health, and wellness program	[47]
	SHIFT intervention	[46,50,51,52]
Real-Time Fatigue Monitoring	Monitoring device guidelines	[40]
	Real-time fatigue monitoring goal	[40,49]
Risk Classification System	Risk classification dimensions	[27,38]
	Risk classification principles	[27,38]
Emotional Fatigue Management	Managing emotional fatigue	[48]
Scheduling	Rest breaks	[30]
	Recovery time	[24,26,32]
	Restart breaks	[31]
	Brief nap into nightwork	[21]
	Holistic scheduling	[22,23]
	Minimise night-time schedules	[21,26,27,36]
	Route and schedule regularity	[21,24,26,29]
	Two-up driving	[22,23]
	Loading and unloading assistance/minimisation	[26,27,36]
	Electronic logbook	[28,29]
	Customer collaboration	[24,26]
Safety Culture	Safety budget	[29]
	Safety culture/climate	[26,27,36]
	Dispatcher pressure	[27]
	Sleep disorder screening	[41]
	Driver autonomy	[23,26]
	Fatigue management collaboration with external customers	[36]

Source: Researchers’ own construct (2023).

(in Appendix C).

2.5. Reporting of Results

The final step involved reporting on the review’s findings. The 11 identified subthemes were consolidated into three overarching management themes, which are discussed in the subsequent sections. In addition, fatigue management frameworks are proposed and evaluated from a broader fatigue risk management perspective.

2.6. Limitations

The dataset was extracted using predefined inclusion and exclusion criteria, which ensured relevance and methodological rigor but may have excluded studies that did not meet these parameters. Furthermore, reliance on the published and accessible grey literature introduces the possibility of publication bias, as some industry reports or regional studies may not have been available through the selected databases. A formal methodological quality appraisal was also not conducted. This was an intentional decision due to the inclusion of heterogeneous sources such as grey literature and industry reports, which do not conform to academic reporting standards. Applying a single adapted tool across these diverse materials would have been inconsistent and risked excluding practical insights essential for understanding fatigue management practices.

The review was limited to English-language sources, which may have excluded relevant studies published in other languages, particularly from non-English-speaking developing countries. In addition, the scope of analysis focused exclusively on fatigue management within the road transport sector and did not include strategies from other transport industries, such as aviation or rail, which may offer transferable insights.

An additional limitation of this review is its focus on synthesising available management strategies through thematic analysis rather than conducting a quantitative meta-analysis of intervention effectiveness. While this approach was appropriate given the heterogeneity of included sources and the focus on management practices rather than controlled intervention trials, it limits the ability to make definitive statements about which specific strategies demonstrate the strongest empirical evidence of fatigue reduction or safety improvement. Future systematic reviews incorporating meta-analytic techniques could address this limitation by quantitatively synthesising outcome data from controlled studies evaluating specific fatigue management interventions.

Furthermore, while the review identifies that socioeconomic and infrastructure factors in developing countries necessitate adapted fatigue management approaches, the included literature provided limited empirical data directly comparing framework effectiveness between developed and developing country contexts. Most included resources were generated in developed countries (particularly the United States, Australia, and United Kingdom), and the review’s conclusions about developing country applications necessarily involve extrapolation from this evidence base. Direct empirical validation of the proposed frameworks in developing country settings, as discussed in Section 5.4, remains an important research priority.

3. Results

The discussion of the results of the systematic review is separated into two main sections: an investigation into the characteristics of the various resources analysed (Section 4.1), followed by an examination of the identified themes and management strategies (Section 4.2).

3.1. Overall Review of Resources

This section reviews the types of resources, dates of publication, and countries of research and provides an overview of the systematic review’s results.

3.1.1. Resource Type

The results of the systematic review returned resources from numerous resource types. This included articles, reports, conference proceedings, theses, dissertations, pilot studies, book chapters, and commentary articles. Articles (19) represented the most research on truck driver fatigue management, representing approximately 59% of the overall resources. However, the prevalence of industry and government-sponsored studies (56%) also highlights a commitment from these parties to solve this industry problem. In addition to the 19 articles, this systematic review analysed six reports, three conference proceedings, one thesis, one pilot study, one book chapter, and one commentary article.

3.1.2. Time Range

Figure 2 visualises the distribution of the included resources examining truck driver fatigue management over the 30-year period from 1993 to 2023. The data revealed sustained research attention without a clear increasing trend in publication frequency. Notable research activity occurred in the early 2000s with foundational work on scheduling practices and operational systems [23,24,25,26,28], followed by the development of fatigue management programmes and FRMS frameworks in the mid-2000s [41,43]. The 2010s saw continued focus on diverse strategies including risk classification systems [39], real-time monitoring [42,51], and comprehensive health interventions culminating in the SHIFT program [48,52]. The most recent included resources [53,54] continued this health intervention focus, analysing cardiovascular reactivity as a predictor of fatigue symptoms. The relatively consistent publication rate across three decades suggests that truck driver fatigue has maintained steady research attention as a persistent operational challenge rather than emerging as a recent concern, though the lack of marked increase in recent years may indicate that comprehensive operational management frameworks integrating these diverse strategies remain underdeveloped in the literature.

3.1.3. Country of Research

Research on the management of truck driver fatigue predominantly focused on the United States, Australia, and the United Kingdom, as illustrated in Figure 3. Examining the country of research was important for the systematic review, which aimed to identify whether truck driver fatigue management practices or frameworks exist within developing countries, specifically focussing on the South African context. The socioeconomic and demographic characteristics of developing countries need to be incorporated into effective truck driver fatigue management, especially for developing an industry toolkit.

The results, shown in

Table 2. Categorisation of countries where research was conducted.

Developed Countries (Number of Articles)	Developing Countries (Number of Articles)
United States (12)	Serbia (1)
Australia (7)	South Africa (1)
United Kingdom (5)	Indonesia (1)
North America (2)
Canada (2)
Greece (1)
New Zealand (1)

, depict a shortage of research conducted on truck driver fatigue management within developing countries. Only three of the resources from the systematic review addressed truck driver fatigue management in developing countries, while the majority were conducted in North America, Australia, and the United Kingdom—highlighting a potential link between robust fatigue management policy and research output. Of note is that research was conducted in South Africa, which was not isolated initially when “South Africa” was included in the search strategy. This article proposed how real-time fatigue feedback can be implemented within a broader safety management plan [51]. While this is relevant to the systematic review and meets the inclusion criteria, it does not account for the uniqueness of fatigue management within South Africa. This also applies to the research conducted in Indonesia [37] and Serbia [38]. The findings revealed that while individual developing country studies exist, none provided comprehensive operational management frameworks adapted to developing country constraints.

3.2. Results of Thematic Analysis

Managing truck driver fatigue takes numerous approaches, with each reviewed resource recommending unique strategies ranging from separate practices to comprehensive program contents. Through a thorough review, similarities emerged, allowing for the grouping of these strategies into distinct management subthemes. The identified subthemes included driver training and education, accident investigation, fatigue measurement, fatigue management plan, fatigue risk management system, fatigue, health and wellness intervention, real-time fatigue monitoring, risk classification systems, emotional fatigue management, scheduling, and safety culture. These subthemes were further organised into three overarching management themes: operational systems and processes, safety culture and practices, and health and wellness initiatives. Moreover, each subtheme was classified based on its proactive, real-time, or reactive management style, providing a broad overview (highlighted in Figure 4) of the available management strategies.

It is important to distinguish certain concepts before discussing the themes. Each management theme and subtheme was categorised into proactive, real-time, or reactive management styles that utilise feedback loops to inform effective fatigue management. In this review, proactive management refers to developing and using systems to prevent fatigue risks before they occur. Real-time management focuses on providing immediate intervention to signs of fatigue, and reactive management refers to responding to fatigue incidents after they have occurred.

3.2.1. Operational Systems and Processes

Operational systems and processes outline the different activities, practices, and systems related to the overall management and operation of truck driver fatigue including recruitment processes, monitoring systems, training programmes, scheduling, accident investigation, and an overarching fatigue risk management system. This section outlines the resources within each subtheme and culminates in the development of an operational fatigue management framework.

Scheduling

Of prominence was the effectiveness of scheduling practices to reduce fatigue among truck drivers. Twelve (37.5%) resources advised certain practices regarding fatigue management using scheduling. These scheduling practices referred to the timing and duration of rest breaks, recovery durations, restart breaks, a holistic approach to scheduling, minimising night-time driving and loading and unloading activities, schedule and route regularity, two-up driving, brief naps prior to night shifts, utilisation of electronic logbooks to reduce HOS as well as customer collaboration to improve scheduling performance. For further clarification, details on authorship for each recommendation can be found in Table A4 (in Appendix C).

Fatigue Measurement

Fatigue measurement refers to the collection and analysis of data related to fatigue to understand and assess the likelihood of fatigue risk. Two (6%) resources discussed the effective measurement of truck driver fatigue. One developed commercial motor vehicle driver fatigue model included two measures that allowed managers to quantify the prevalence of fatigue [28]. Further research added more depth, where road safety performance indicators were expanded to include fatigue-related ones [38]. Ten indicators were highlighted, alongside the measurement method and variable descriptions, which were categorised into four groups: sleep-related indicators, operation-related indicators, rest-related indicators, and indicators of undertaken activities. Thus, the effective measurement of truck driver fatigue must encompass both subjective and objective measures such as using conversations to assess driver sleep characteristics and tachograph monitoring to track driving hours [28,38].

Risk Classification System

Traditional fatigue management focused on strict working hour regulations and rest break durations, potentially limiting flexibility. Two (6%) resources advocated for a more flexible approach: one reporting a risk classification system [39], while the other provided commentary [40]. In Australia, there are three tiers of regulation, from traditional prescriptive rules to a performance-based approach [40]. Employed alongside Advanced Fatigue Management in Australia, the risk classification system allows operators to justify deviations from traditional limits and semi-quantitatively assess fatigue likelihood through a scorecard. It is based on three dimensions: work-related rest breaks, recovery breaks, and reset breaks—further defined by seven principles.

Real-Time Fatigue Monitoring

Real-time fatigue monitoring has garnered significant academic attention [7]. However, the majority of these resources primarily focused on scientific and technological design and were excluded due to scope limitations (see Figure A1). Two (6%) resources, refs. [42,51] offered insights into implementation considerations, providing guidelines for informed implementation and outlining the goals of real-time monitoring as long-term support for supplemental strategies.

Accident Investigation

Investigating fatigue’s role in road accidents is crucial for effective long-term management. One (3%) resource discussed accident investigation procedures. Another study proposed four questions to enhance accident reports, focussing on sleep obtained before the accident, duration of wakefulness, recent rest periods, and sleep patterns [41]. In addition, four risk factors related to acute sleep loss, extended wakefulness, cumulative sleep debt, and circadian timing have been suggested to aid investigation. The presence of two or more of these risk factors indicates potential fatigue involvement [41].

Fatigue Management System (FMS)

Systematically managing truck driver fatigue is critical to ensuring a holistic management approach. This is separated into two distinct but similar approaches, namely FRMS and FMS. An FRMS is a data-driven approach to flexibly manage fatigue, focussing on identifying, assessing, and mitigating fatigue risks [36]. On the other hand, a fatigue management system (FMS) encompasses the policies, procedures, and practices implemented to prevent or mitigate fatigue risk. Three (9%) resources outlined management systems. Components often included fatigue monitoring, education programmes, and pre-employment health, physical, and cognitive checks [37]. One study emphasised the need for tailored FRMS implementation, supported by a robust safety culture [36]. The Northern Territory Department of Transport [35] in Australia provides auditing guidelines for fatigue management systems, ensuring adherence to effective practices across all operational roles. The use of an FRMS is advocated in this review due to its focus on continuous improvement through data collection and risk identification.

3.2.2. Safety Culture and Practices

The primary focus of the ‘Safety Culture and Practices’ management theme is to cultivate safety awareness, prevent fatigue incidents, and ensure effective personal fatigue management among truck drivers. A just safety culture is paramount within an FRMS [36] and is a core objective of an FMP [43,44]. Central to achieving this culture is comprehensive fatigue management training for all stakeholders involved in the truck industry, including drivers, dispatchers, managers, external customers, trainers, and drivers’ families. Ensuring alignment across the entire organisation, regarding the necessary measures to manage truck driver fatigue effectively, is essential.

Safety Culture

While not entirely a practice management can implement, fostering a safe driving culture is fundamental to mitigating truck driver fatigue. Recommendations from five (15%) resources highlight strategies to enhance safety culture, including reducing pressure on drivers [29], promoting driver autonomy regarding tiredness [24,28], allocating more budget to safety [31], developing sleep disorder screening, assessment and treatment policies [43], and collaborating on fatigue management with external customers [27]. Truck drivers should perceive a safe working culture where their safety and health are cared for [27,28,29].

Driver Training and Education

Extensive coverage was dedicated to educating and training truck drivers on fatigue management and provided various lecture topics and objectives. Six (18%) resources detail the necessity of educating and training truck drivers to manage fatigue. Educational lecture topics for a Structured Health Intervention for Truckers (SHIFT) were developed [48]. This educational lecture aims to involve the drivers’ experience, revolving around managing the health and wellness challenges associated with truck driving [48], aiming to manage cardiovascular reactivity, which was proven to be a predictor of fatigue symptoms [54]. Research identified fatigue topics unknown to truck drivers and urged its inclusion in fatigue outreach campaigns—this primarily concentrated on the elements of sleep [45]. Research also highlighted various fatigue training lecture components and the subsequent objectives, guiding truck drivers in effectively managing fatigue and improving their understanding of the risk factors and consequences [47]. Regarding these safety training sessions, research highlights the need for both voluntary attendance and compensation for attendance to enhance results [27,28].

Fatigue Management Program

A fatigue management program (FMP) is a purely educational initiative that, in this case, attempts to address the issue of truck driver fatigue by ensuring a safety culture of fatigue management and educating all truck driver stakeholders [44]. Two (6%) resources presented a case for using an FMP, each offering different details. One [43] outlined the components necessary in an FMP, specifically emphasising sleep disorder screening and treatment. The other [44] delineated the ten instructional modules included in the North American FMP, highlighting the importance of driver, operator, manager, and driver-family education. A ten-step process for implementing the North American FMP was also proposed, discussed in detail, and required document templates suggested.

3.2.3. Health and Well-Being Initiatives

The risk of truck driver fatigue cannot be solely attributed to operational conditions at the workplace—a truck driver’s lifestyle and health choices are also of utmost importance such as their diet [55] and physical activity [56]. This management theme focuses on health and well-being initiatives tailored to the unique needs of truck drivers. It outlines the requirements of a driver-orientated health and wellness program [49], a structured health intervention for truckers (SHIFT) [48], and mitigation strategies for emotional fatigue [49]. These initiatives recognise the relationship between health, fatigue, and safety performance, aiming to improve truck driver well-being and reduce fatigue risk. The two subthemes included under this management theme were fatigue, health, and wellness intervention, and emotional fatigue management.

Fatigue, Health and Wellness Intervention

Five (15%) resources explored various proactive approaches to fatigue, health, and wellness interventions for truck drivers. Research has outlined several components of the SHIFT intervention, advocating for the provision of resources and activities such as education sessions, exercise equipment, free fruit, health coach support, local champion recruitment, physical trackers with goal setting, and step count challenges [48]. Similarly, the need for policy changes to improve access to healthier foods at truck stops, alongside interventions targeting sleep, diet, and opportunities for physical activity during workdays, has been emphasised [53]. Research also highlights the challenge of ensuring that healthy food options are perceived as satisfying and sustainable for truck drivers during long shifts [52]. In addition, a link between cardiovascular reactivity and future fatigue symptoms has been identified [54], underscoring the importance of interventions like SHIFT in reducing the risk of truck driver fatigue by addressing cardiovascular health.

While the aforementioned resources focused on managing truck driver fatigue through the SHIFT intervention, another proposed a comprehensive driver-orientated fatigue and health and wellness program [49]. This program encompasses seven critical features to promote driver well-being and mitigate fatigue-related risks. These features include:

• Pre-employment physicals to assess the drivers’ health status prior to employment.
• Health coaches to provide personalised guidance and support for the drivers’ health goals.
• Education sessions to increase the drivers’ awareness of fatigue management and healthy lifestyle practices.
• Sleep disorder screening and treatment to address sleep-related issues that may contribute to fatigue.
• Participatory health activities to engage drivers in proactive health-promoting behaviours.
• Incentive-based health and wellness schemes to motivate drivers to prioritise their health.
• Encouragement of support from the driver’s family to foster a supportive home environment for healthy behaviours.

This program underscores the importance of a holistic approach to addressing driver health and well-being. It incorporates elements such as education, screening, support, and incentivisation to effectively promote sustainable behaviour change and mitigate fatigue-related risks. SHIFT and the comprehensive driver-orientated fatigue and health and wellness program operate under a behaviour change model such as ADKAR. Emphasis is placed on educating truck drivers on healthy living while also providing resources to apply learnt knowledge, using systems to monitor and reward healthy behaviour progress, and intervene if further behaviour change is necessary. The aim is to ensure long-term healthy behaviour change.

Emotional Fatigue Management

While the concept of fatigue in the context of truck drivers often focuses on physical exhaustion, it is crucial not to overlook the emotional toll that can also contribute to driver fatigue. One (3%) resource investigated the management of emotional fatigue. Another highlighted the vulnerability of truck drivers to emotional fatigue and proposed five key proactive mitigation strategies to address this aspect [50]. These strategies included:

• Ensuring truck drivers have sufficient time at home to rest and recover.
• Providing opportunities for drivers to build supportive relationships with their co-workers.
• Consulting with drivers regarding delivery and pickup schedules to minimise stress and frustration.
• Allocating adequate parking spaces at truck stop terminals to reduce the stress associated with finding parking.
• Implementing stress management programmes to help drivers cope with the emotional demands of their work.

By addressing the emotional well-being of truck drivers through these strategies, organisations can help mitigate the risk of emotional fatigue and promote a healthier and more resilient workforce.

4. Overview of Truck Driver Fatigue Management

Truck drivers play a pivotal role in the supply chain, driving the transportation of goods between supply chain partners. However, the occupation is prone to detrimental physical and emotional health challenges. Its prevalence is well-researched in numerous countries through cross-sectional studies such as in South Africa [12], Australia [57], and the United States [58]. Organisations must manage their exposure to various risks of road freight transportation, limiting their likelihood and impact through a risk management process.

4.1. Supply Chain Risk Management

From a broader supply chain perspective, risk management is essential as globalisation has led to constant uncertainties and increased risk vulnerability [6,59,60]. Research defines risk as the possibility of any undesired consequence occurring, expressed as the loss’s probability and severity [61]. There are countless hazards in the business environment. However, not all risks deserve significant attention due to low likelihood and negligible consequences. Managing these supply chain risks requires a heterogeneous approach, developing prevention and mitigation strategies and recovery plans that account for the uniqueness of each risk [62]. This is because each risk will have varying levels of predictability and impact on an organisation. As such, supply chain risk management is the process of risk identification and the development of control measures to avoid, prevent, or mitigate disruptions in the supply chain [63].

Fatigue is an internal business risk that impacts organisational performance, public safety, and individual health and safety. Fatigue is not solely a concern and challenge for truck drivers, but an aspect of daily life, with occupational fatigue occurring in a number of sectors [64,65,66,67,68,69]. Another study identified that fatigue risk management has three levels: regulatory responsibility, industry/organisation responsibility, and individual responsibility [70]. This systematic review focused on how organisations can develop effective risk management systems and empower truck drivers to manage their personal fatigue. However, before a comprehensive investigation into the management of truck driver fatigue risk can be conducted, an overview of fatigue is necessary.

4.2. Fatigue

The challenge and prevalence of occupational fatigue are often symptoms of misalignment between an individual’s work schedule, circadian rhythms, and their need to sleep [71]. Further research builds on this by stating that sleep requirements are only one factor of fatigue, and that work (hours of work and recovery breaks) and health (medical and lifestyle) factors also play an essential role in its causation and management [72]. Fatigue results from exertion experienced at work and home, which is intensified by sleep loss, circadian effects, and individual health characteristics. However, the issue of fatigue primarily stems from insufficient sleep and disruptions in an individual’s normal sleep cycle [73]. As such, sleep duration and quality are essential components to effectively manage fatigue and healthy living.

This urge to sleep is embedded in humans with two functions working in tandem: sleep homeostasis (an individual’s pressure to sleep that decreases with sleep) and the circadian rhythm, which regulates alertness and sleepiness, fluctuating within a 24 h cycle [74]. An individual experiences sleepiness through the interaction of these two factors, as sleep homeostasis increases while awake and the circadian drive for wakefulness decreases [74,75]. Thus, fatigue management revolves around ensuring sufficient sleep at optimal hours of the day and that work schedules do not violate these requirements.

More specifically, if these requirements are not managed accordingly within the truck driving environment, a driver’s attention, reaction time, and vigilance will deteriorate, resulting in reduced vehicle control [15]. Safety risks attributed to fatigue arise from decrements in performance and the subsequent increased crash risk [76,77]. One study [78] described this practically, when it was found that the mean duration of a drowsiness event was 2.51 s. At a mean speed of 80 km/h, vehicles travel approximately 55 metres while the driver is unalert and inattentive—increasing the risk of an accident during this period. The extreme size difference between heavy and passenger vehicles amplifies the danger of this risk and demands effective truck driver fatigue management.

However, distinguishing fatigue-related accidents is challenging due to its multifaceted nature. Between 41% and 71% of fatigue-related truck accidents are incorrectly recorded, mainly due to crash investigations consisting of a singular fatigue check box [41]. Thus, fatigue’s prevalence in truck crashes is undoubtedly more costly than is reported. The nature of truck driving is conducive to fatigue, with its environment aiding a variety of health challenges. Long, monotonous working hours, inconsistent sleep patterns, tight delivery schedules, irregular nightshifts, loading and unloading activities, queuing and waiting, and limits of the ability for adequate rest all contribute to the prevalence of truck driver fatigue [8,79,80]. Governments and businesses must recognise the multifaceted nature of truck driver fatigue and implement systems that effectively address its root causes.

4.3. Regulatory Environment

The regulatory environment of managing truck driver fatigue is focused on HOS regulations, structuring work and rest requirements around the 24 h day [81]. HOS regulations were initially developed with the assumption that limiting a driver’s working hours and ensuring sufficient recovery periods would be adequate in managing fatigue, however, critical elements of fatigue were not considered [16]. These regulations are often considered prescriptive rulesets, forming the foundation of truck driver fatigue risk management but not the sole approach [70,82].

Table 3. Truck driving regulatory environment across countries.

Maximum	South Africa	United States	European Union	Australia (Standard)	New Zealand
Driving time between long rests	12 h	11 h	9 h (10 h × 2/wk)	12 h	13 h
Total work time between long rests	15 h (including overtime)	14 h	12.5 h	12 h	13 h
Time between long rests	Not specified	14 h	13 h	Not specified	Not specified
Duty time	45 h (ordinary) 30 h (overtime) 15 h (Sunday)	60 h/7 days 70 h/8 days	56 h/7 days 90 h/14 days Mean 48 h/wk	72 h in 7 days 144 h in 14 days	70 h in total
Duration long rest period (continuous)	9 h	10 h	11 h or 3 + 9 = 12 h or 9 h (3/14 days)	7 h	10 h
Night rest required	No	No	No	2 nights + 2 consecutive nights in 14 days	No
Maximum driving before short rest	Not specified 5 h before meal interval	<8	4.5	5.15 h, 7.30 h, 10 h	5.5 h
Period of short rest break	Not applicable to drivers 1 h meal interval	30 min	45 min (15 + 30)	15 min, 60 min in 11 h	30 min
Reset/restart break continuous break	Not specified	34 h (2 × 1 a.m.–5 a.m.) in 7 days	45 h at end of 6 days 24 h at end of 6 days once in 14 days	24 h in 7 days	24 h

Adapted from [38,81].

outlines the various prescriptive regulations for managing truck driver fatigue across countries. Developed nations have more comprehensive regulations including restart breaks and short rest breaks. However, in South Africa, relying solely on externally imposed regulations to manage truck driver fatigue is insufficient.

The challenge of prescriptive fatigue management stems from an inflexibility in managing fatigue effectively. HOS rules meant to manage fatigue result in new fatiguing work scenarios such as forcing drivers to stop when fatigue has not set in and forcing them to drive when fatigued [81]. A truck driver directly expresses this sentiment: “A lot of times you’re low on sleep and sometimes when you’re tired you got to drive, sometimes when you’re wide awake you got to sleep…” [83]. HOS rules focus on managing the truck drivers’ energy using clock time; however, this is disconnected from the operational requirements of freight delivery, creating desynchronisation rather than order [81]. It is becoming increasingly apparent that management must move away from a sole reliance on prescriptive fatigue management [70,84,85], and instead, develop a flexible risk-based management approach that is tailored to the specific organisation and truck drivers themselves [70].

4.4. Fatigue Risk Management Systems

Fatigue risk management systems (FRMSs) focus on the systematic identification of occupational hazards attributed to fatigue, going beyond regulatory compliance by identifying risk and developing necessary control measures [7]. The inadequacy of only managing fatigue using prescriptive HOS rules is demonstrated in Figure 5 [82], where within an FRMS, HOS rules are only an initial control mechanism. It is proposed that a fatigue-related incident is the result of a sequence of events, suggesting that there are four error levels that exist prior to an incident [82]. By understanding each level and the possible risks, an organisation can develop appropriate control mechanisms at each level and mitigate the root causes of fatigue.

The idea of multiple layers of defence against fatigue originates from the Swiss cheese model of human error [86], which proposes two approaches to view human error: the person approach and the system approach. The person approach places the blame for the error on the individual, while the system approach understands that individuals are error-prone, where consequences are primarily due to system failures [73]. Thus, it is essential to develop multiple barriers and control mechanisms, as under the Swiss cheese model, one hole (error) will not necessarily result in a fatigue-related incident, however, multiple holes (errors) that line up will end up having dire consequences [86]. This concept forms the backbone for the appropriate management of truck driver fatigue. Other research [16] has expanded on the Swiss cheese model and stressed the importance of an FRMS consisting of multiple defence layers, each attempting to mitigate the root cause of fatigue:

• Workload-staffing balance;
• Shift scheduling;
• Employee fatigue training and sleep disorder management;
• Workplace environment design;
• Fatigue monitoring and alertness for duty.

The combined goals of both [16,82] for FRMSs are sixfold. First, to ensure that HOS rules are complied with; second, that there are sufficient staffing levels to limit excessive overtime; third, drivers are provided with sufficient opportunities for sleep; fourth, transport operators support a workplace environment that is conducive to alertness; fifth, fatigue is monitored during work opportunities, and finally, that appropriate incident investigation is conducted. There are many strategies available to management to accomplish these goals, using each level of defence to guide what strategies to implement to manage truck driver fatigue effectively.

There are countless approaches to managing the risk of fatigue; however, each must be utilised in an integrated system that addresses each identified hazard presented by fatigue. The focus should be on developing a behaviour change model where stakeholders are educated on fatigue management, and strategies are implemented, monitored, and continuously improved through appropriate data collection. The systematic identification of management practices and strategies applicable in the road freight industry will prove valuable in building a toolkit for such a system for industry use. However, changing operational practices or behaviours will require a structured change management process.

4.5. Change Management

Change involves the occurrence of something different from the norm. Improving truck driver health and safety requires individual and organisational change, necessitating effective change management. The tactics or guidelines for implementing interventions and ensuring adoption is described as micro change management [87]. This approach focuses on driving change at the individual level, managing employee resistance, maintaining motivation, and coordinating activities for successful implementation. Adhering to a structured change management procedure will facilitate systematic implementation and sustained adoption. However, change is context-specific and requires change management models that are suitable to the organisational context and needs to ensure success [88,89]. Using change management models as a guiding framework to understand and approach change is beneficial, but a tailored implementation is necessary.

Change management models, such as the ADKAR model, are designed to facilitate change at the individual level, enhancing the likelihood of successful organisational change [90]. The model comprises five sequential and essential building blocks for effective change management: awareness of the risk and need for change; desire to support and participate in the change; knowledge of how to change; ability to implement the required skills and behaviours; and reinforcement to sustain the change [91]. Applying this model to truck driver behaviour involves several steps: raising awareness of the importance of healthier behaviours, fostering individual commitment, providing actional knowledge, demonstrating recommended practices to ensure understanding, and implementing reinforcement strategies such as incentives and optimal scheduling to sustain the change. While this review identified and proposes frameworks for effective truck driver fatigue management, change management at an individual and organisational level is critical.

5. Discussion

The findings of this systematic review reveal that effective fatigue management is not a singular intervention but a multi-layered system encompassing operational processes, safety culture, and driver wellness. The key implication for management is the necessity of moving beyond simple hours-of-service (HOS) compliance towards an integrated fatigue risk management system (FRMS). This system must be data-driven, using feedback from reactive measures (like accident investigations) and real-time monitoring to continuously improve proactive strategies (such as scheduling and training). Furthermore, the pronounced lack of research in developing nations underscores that strategies cannot be simply transferred from developed contexts; they must be adapted to address fundamental health and socio-economic challenges unique to the region. The following subsections detail the proposed frameworks derived from these findings.

5.1. Fatigue Management Frameworks

Identifying and analysing the overarching management themes allowed for the development of corresponding fatigue management frameworks for truck drivers. This included an operational fatigue management framework, a fatigue management framework for safety culture, and a fatigue management framework for well-being.

5.1.1. Operational Fatigue Management Framework for Truck Drivers

The operational fatigue management framework for truck drivers, shown in Figure 6, was built on the premise that effective fatigue management requires a comprehensive FRMS [36]. Central to this framework is the implementation of routine audits across all fatigue management systems to ensure their efficacy [35]. This framework advocates for a multi-faceted approach, encompassing various actionable items such as scheduling and operational policies, low fatigue risk scheduling requirements, fatigue measurement metrics, accident investigation procedures, and real-time monitoring technology guidelines. The practices outlined in the FMSs are included in operational policies and do not constitute a separate management category. Critically, it emphasises the establishment of a feedback loop, where real-time fatigue monitoring and reactive accident investigation inform proactive measures, fostering an integrated, data-driven management system.

The scheduling of truck drivers requires careful consideration of their circadian alignment [25], minimising night-time driving [23,27,28], and ensuring sufficient recovery time between shifts [26,28]. Other research indicated improvements in objective sleep duration, subjective sleepiness, ocular-based alertness, and some aspects of driver performance when increasing off-duty recovery time from seven hours to eleven hours [34]. The risk classification system [39] proposes that a recovery duration of nine hours is of low risk for fatigue. While the scheduling requirements stipulated in the framework follow the low-risk recommendations of the risk classification system, extending this period to eleven hours is necessary to increase opportunities for restorative rest. Alongside this is the recommendation to decrease the maximum truck driver shift durations to thirteen hours or less [39], where in South Africa, fifteen hours is the legal limit (including overtime).

Effective timing and duration of rest breaks during truck driver shifts are crucial for reducing crash risk and ensuring driver well-being. A recommended one or two 30 min rest breaks during a ten-hour trip has been shown to decrease the crash risk significantly [32]. However, this systematic review and the developed framework advocate for more frequent, shorter rest breaks, aligning with the risk classification system [39]. Truck driver scheduling must aim to reduce the time spent continuously driving, provide sufficient opportunities for night sleep, and provide regularity for truck drivers, both in terms of the timing of their schedules [23,26,31] and routes driven [28]. An effective strategy for reducing continuous driving time and enabling extended rests during long-haul deliveries is the utilisation of dual-driving [24,25]. While not included in this review, further insights into the benefits and practical application of dual driving are available [92]. By implementing these scheduling practices, management can prioritise driver safety and well-being and mitigate fatigue.

Proper measurement of truck driver fatigue is also essential for ensuring safety and well-being. This involves monitoring the drivers’ workload on a daily and weekly basis, ensuring adequate sleep quantity and quality, and minimising night-time driving [38]. Tachographs, used to record driving and rest periods, should be supplemented by the drivers’ subjective feedback regarding their sleep patterns and quality. Analysis of fatigue-related metrics can then inform adjustments to scheduling arrangements. Real-time fatigue monitoring serves a dual purpose: immediate safety intervention and informing long-term fatigue management strategies [42]. The framework also encourages fatigue monitoring prior to driving tasks [37], which can be completed through fitness-for-duty tests or proactively using the discussed fatigue-related metrics. It is crucial to view reactive and real-time monitoring not as a means of disciplinary action against drivers, but rather as tools for identifying scheduling policy issues [38] and implementing proactive management strategies. Only in cases of repeated issues should a driver root cause analysis be considered [42].

The operational fatigue management framework for truck driver fatigue relies on using FRMSs to pinpoint fatigue risk factors and assess the efficacy of implemented mitigation strategies [44]. It is imperative that each element outlined in the framework is integrated into the FRMS, creating a feedback loop, facilitating ongoing enhancements in fatigue management practices, and identifying areas requiring improvement. Each element should act as reinforcement for the next; changes to scheduling policies should be monitored with the outlined fatigue-related indicators, and truck driver fatigue instances should be examined against the specified risk factors and those fatigue-related indicators. An interlinked system of feedback loops and reinforcing relationships will create a robust fatigue management system.

5.1.2. Fatigue Management Framework for Truck Driver Safety Culture

The development of the fatigue management framework for truck driver safety culture relies on the implementation of an FMP, as depicted in Figure 7. This framework emphasises the establishment of organisational functions equipped with adequate resources to manage the fatigue management process, focussing on continuous improvement. There should be clear roles and responsibilities, policies, and ongoing communication and support to ensure fatigue management success. A critical aspect of building a safe driving culture is educating all stakeholders within the truck driving environment. For example, policies should be developed and dispatchers educated to reduce pressure on truck drivers to continue driving while fatigued [29] and provide autonomy to drivers in scheduling flexible rest breaks [24,28]. Trusting truck drivers to recognise and manage their own fatigue is crucial for ensuring that they rest at appropriate times and are not pressured to continue driving when fatigued. Each party involved must be trained and educated accordingly to effectively maintain the correct use of established operational FRMSs. This includes collaboration with external customers who may be responsible for schedules and loading and unloading procedures.

The aim of the FMP is to empower truck drivers to become responsible managers of their own fatigue by providing them with the necessary knowledge. In addition, it seeks to educate the drivers’ families to enhance home support for driver well-being, ensure a thorough understanding of sleeping disorders, and impart knowledge on the principles required to manage truck driver fatigue effectively [44]. Figure 8 provides a synthesised overview of the suggested topics included in truck driver fatigue education. Fatigue education is premised on building a foundational knowledge of the physiology of fatigue, understanding the regulatory and organisational environment of fatigue management, its impact on driving performance and safety, and providing recommendations for personal fatigue management. Fatigue training sessions should be voluntary, and truck drivers should be compensated for attending fatigue training sessions [28]. However, this review argues that education alone is insufficient, and tools and resources must be made available to facilitate the application of knowledge learnt. The organisation’s operational systems and processes must also uphold the information taught to stakeholders.

5.1.3. Fatigue Management Framework for Truck Driver Well-Being

The development of a fatigue management framework for truck driver well-being stemmed from an in-depth analysis of the various strategies proposed within the health and well-being management theme, as depicted in Figure 9. This framework is guided by principles [48] that aimed to achieve several key goals. First, it seeks to equip truck drivers with essential knowledge concerning health and well-being behavioural choices. Second, the framework seeks to ensure that the influences within the physical environments in which truck drivers operate support sustainable living practices. Third, it aims to foster a supportive work and social environment conducive to well-being. Finally, the framework emphasises the importance of self-efficacy and ongoing monitoring to facilitate lasting positive changes in truck drivers’ health and well-being.

The SHIFT intervention [48,52,53,54], driver-oriented fatigue, health, and wellness program [49], and emotional fatigue mitigation strategies [50] are each central to the idea of broadening the scope beyond mere health educational initiatives for truck drivers. While educational programmes are valuable and fundamental to the outlined initiatives, they must be complemented by a supportive work environment that facilitates and encourages the application of knowledge learnt. The construction of a fatigue management framework for truck driver well-being recognises that simply imparting the knowledge of healthy living practices may be insufficient; instead, there is a need to provide tangible tools and support systems that empower truck drivers to incorporate these practices into their daily routines, both at work and at home.

A comprehensive health education program is essential for equipping truck drivers with the knowledge and skills necessary to improve their well-being. This program should provide ongoing education and guidance on various aspects of health including healthy diets, weight management, sleep hygiene, fatigue management, stress reduction, and lifestyle improvement [49]. Moreover, the program should incorporate tailored and interactive instructional sessions encouraging active participation and driver-led discussions to develop personalised self-management plans [48]. These sessions should include practical demonstrations of exercise activities to ensure comprehension and follow-through implementation. This correlates with the employment of truck driver health coaches who can provide continuous health counselling during work, offering personalised support and guidance to drivers. It is crucial that the educational content has a theoretical basis [48] and that behaviour change techniques are incorporated to promote sustainable lifestyle changes.

Behaviour change techniques are foundational to physical health promotion in the fatigue management framework for truck driver well-being. These techniques include monitoring, incentives, health and physical activity competitions, goal setting, and support systems at work through complimentary portable exercise equipment and health coaches [48,49]. Physical health promotion is focused on developing a work environment that facilitates, incentivises, and sustains healthy behaviour changes. For example, this can be achieved through workplace gym and shower facilities, subsidised gym memberships, healthy and affordable canteen meal options, and physical health included in rewards programmes.

Truck driver health interventions should prioritise improvements in diet, sleep hygiene, and provide opportunities for physical activities during workdays [53]. Among the strategies focused on truck driver health and well-being, sleep disorder screening and treatment are critical practices advocated within the safety culture and practices management theme. Management must ensure that truck drivers are educated on sleep disorder risks, provided with screening opportunities, and offered follow-up treatments as needed [49]. To further support effective screening and treatment, accommodating initial and follow-up treatment visits is recommended [43]. This proactive approach not only fosters a safety culture, but also enhances driver well-being, aligning with the broader goals of the integrated management framework for truck driver well-being, which aims to provide comprehensive support systems for healthy living.

A critical aspect of the fatigue management framework for truck driver well-being is the active involvement of the drivers’ family members in educational and health activities [49]. As the truck drivers’ home environments may not always support restorative rest and healthy behaviours [93], fostering a supportive home environment becomes crucial. Research also stresses the importance of family involvement in fatigue management [44], as seen in the North American Fatigue Management Program; however, its focus remains primarily on educating families about fatigue management and not including them in initiatives.

In line with these recommendations, the fatigue management framework for truck driver well-being seeks to create a supportive work and home environment conducive to improved physical activity levels, dietary choices, and mitigated emotional fatigue among truck drivers. This framework places increased responsibility on management to actively support healthy behaviour changes, extending beyond traditional educational initiatives. Management cannot control the build-up of fatigue outside of working hours; however, truck drivers can be educated and provided with resources to ensure that they start their shift well-rested and energised.

5.1.4. Integration with International Fatigue Management Standards

The operational fatigue management framework proposed in this review aligns with and extends several established international approaches to occupational fatigue risk management. The International Organisation for Standardisation’s ISO 45003:2021 [94] standard provides guidelines for managing psychosocial risks at work, including fatigue, offering a complementary framework that emphasises organisational responsibility for worker well-being. While ISO 45003 provides broader guidance applicable across industries, our framework offers specific, actionable strategies tailored to the unique operational realities of truck driving in road freight transport.

The European Union’s “Smart Tachograph” regulation (EU 165/2014, amended by EU 2020/1054) [95] represents a technology-focused regulatory approach to fatigue management, mandating the digital recording of driving times, rest periods, and vehicle location data. This regulatory technology facilitates the objective monitoring of compliance with hours-of-service regulations and provides data for fatigue risk analysis. Our proposed framework incorporates similar real-time monitoring principles (Section Real-Time Fatigue Monitoring) while recognising that in developing country contexts, such advanced technological solutions may need to be implemented incrementally alongside lower-cost monitoring approaches such as logbook analysis and subjective driver fatigue reporting.

The framework’s emphasis on fatigue risk management systems (FRMSs) as the overarching management structure reflects international best practice established in the aviation, maritime, and rail transport sectors. However, this review identified specific implementation considerations for road freight transport in resource-constrained environments: the need for scalable implementation that can begin with basic scheduling improvements and systematic data collection before progressing to more sophisticated risk modelling and real-time monitoring technologies; the importance of integrating informal stakeholder collaboration (particularly with customers and clients who influence scheduling demands) into formal FRMS structures; and the requirement for culturally adapted training and communication approaches that account for varying literacy levels and prior safety culture exposure among drivers.

A key distinction of the proposed framework is its explicit integration of three interrelated management themes (operational systems, safety culture, and health/well-being) under a unified change management approach. While international standards often address these domains separately, the evidence synthesised in this review demonstrates that sustainable fatigue risk reduction requires simultaneous attention to scheduling practices, organisational safety culture, and individual driver health. This integrated approach is particularly crucial in developing countries where competing operational pressures may otherwise prevent holistic implementation.

Future research should empirically validate the proposed framework’s effectiveness compared with prescriptive regulatory approaches and evaluate the optimal sequencing of implementation components under different resource availability scenarios. Additionally, comparative studies examining how existing international frameworks perform when adapted to developing country contexts would provide valuable implementation guidance.

5.2. Comparative Analysis of Fatigue Management Strategies

A key finding of this review is the significant divergence in the focus of fatigue management research between developed and developing nations. Strategies originating from developed countries—such as the United States, Australia, and the United Kingdom—predominantly centre on technologically advanced, systematic, and regulatory-focused solutions. These include the implementation of comprehensive fatigue risk management systems (FRMSs), the use of real-time monitoring technologies, and the application of flexible, risk-based scheduling systems that supplement traditional hours-of-service (HOS) rules. Such approaches inherently assume the availability of capital for technology and the presence of a mature organisational safety culture.

In contrast, while specific research from developing countries is limited, the analysis suggests that effective interventions in these contexts must address more foundational challenges. The unique socio-economic pressures, such as inadequate housing, and severe health burdens, like South Africa’s “quadruple burden of disease”, mean that fatigue is often a symptom of broader systemic issues. Consequently, holistic interventions like the SHIFT programme—which integrates health education, nutrition, and accessible physical activity—are particularly relevant. These strategies focus on improving the driver’s overall well-being as a prerequisite for managing workplace fatigue, representing a significant departure from the operational and technological focus prevalent in developed nations. This review concludes that a direct transfer of strategies without adaptation to the local health and socio-economic context is unlikely to be successful.

5.3. Truck Driver Fatigue Management in Developing Countries

The systematic review identified a shortage of literature on managing truck driver fatigue in developing countries. Only 9% of the analysed resources were conducted in developing countries (see Table 3). While not specific to fatigue, increases in road users have outpaced the necessary improvements in road infrastructure, regulations, and the enforcement of driving laws in developing countries [96]. The differences in risks between countries result in a layer of complexity when managing driving safety, as organisations cannot simply implement a global standard solution. However, successful road safety strategies utilised in developed countries can be implemented within a developing country context despite the contrasting social and economic environments [19]. These conflicting remarks result in ambiguity in the argument of whether focused truck driver fatigue management strategies are required in a developing country. This review takes the perspective that customised strategies are necessary to effectively manage truck driver fatigue in a developing country.

Shift workers in developing countries are exposed to low levels of education, inadequate housing, insufficient social and public health services, low wages, and long and irregular working hours [97]. Truck drivers in developing countries, such as South Africa, are also exposed to the “quadruple burden of disease” [11] and stressful working environments [13]. Fatigue management strategies in developing countries must consider that truck drivers may have inadequate housing, resulting in suboptimal sleeping conditions, insufficient earnings to support a healthy lifestyle, and no access to ideal health services to aid health maintenance and improvement. Strategies solely focused on mitigating fatigue in the working environment and disregard the truck driver’s home environment may result in unsuccessful initiatives.

The SHIFT programme [48] may be an ideal fatigue management tool in developing countries. Although tested in the United Kingdom, it provides comprehensive health education, free healthy meal options, health monitoring, and flexible exercise equipment to promote active living for truck drivers. However, the recommended practices related to operational systems and processes, specifically scheduling (recovery, rest breaks, and reset breaks) and the use of real-time fatigue detection technologies, are universal to the effective management of truck driver fatigue. All truck drivers require sufficient sleep between shifts and optimally timed rest breaks during the shift to manage fatigue effectively.

Regulation in South Africa, however, does not adhere to these requirements [98]. The National Heavy Regulator [39] in Australia recommends that truck drivers be allowed recovery breaks of more than or equal to 12 h between shifts, 15 min rest breaks after every two hours of driving, no more than 12 h work shifts, and 30 h reset breaks (including two night periods) every two days to eliminate the accumulation of fatigue for a baseline fatigue safety risk after intensive research. It may be impossible to obtain a baseline fatigue score from the proposed [39] and discussed [40] risk classification. However, it allows organisations to ‘risk trade’ across the outlined dimensions and principles, allowing for flexibility unavailable from pure prescriptive HOS approaches. The management of truck drivers, specifically within South Africa, is based on unidimensional HOS rules, and if management does not seek flexible alternatives, such as those addressed internationally, the risk and prevalence of fatigue will continue.

5.4. Recommendations for Management

Management is recommended to manage truck driver fatigue holistically, ensuring that risk-based systems, educational programmes, effective measurement systems, health interventions, and optimal workload-resting schedules are followed. While not a finding of the systematic review and not specific to truck drivers, the FRMS guidelines presented in [16,82] are essential tools for management to build the foundation of truck driver fatigue management. This systematic review identified that a variety of strategies are available to management in this area; however, other research [73] concluded that a comprehensive FRMS incorporating engagement from all stakeholders was the most effective strategy for effectively minimising fatigue.

Thus, management can utilise the findings of this systematic review to build a comprehensive fatigue management system that incorporates the highlighted practices. Management attention must be placed on the root causes of fatigue: sleep requirements, work schedules, and truck driver physical and emotional health [72] as well as an understanding from management that fatigue also results from activities outside the workplace [84]. Implementation of an FRMS must be supported by a culture of safety, appropriate training and education regarding fatigue risk factors, routine audits to review compliance and continuous improvement, and ensure a shared responsibility between drivers and management [7]—providing truck drivers with the knowledge, skills, and resources to manage fatigue and building a work environment that promotes sufficient quality rest and reduced driving periods. Each of the proposed frameworks should holistically focus on preventing, mitigating, and monitoring fatigue before driving commences, while on-duty driving, and after the shift has ended. There must be an emphasis on feedback loops, whereby data obtained from real-time and reactive strategies are used to inform the proactive management of truck driver fatigue.

5.5. Future Research

The systematic review aimed to identify a comprehensive truck driver fatigue management toolkit or framework. However, the feasibility of this requirement may be in question, as Gander et al. [70] argue that the most effective FRMS should be internally imposed and developed by the organisation. Nonetheless, a template toolkit could still provide significant value as a basis for more comprehensive systems. The review consolidated fatigue management strategies into three frameworks; however, it did not address specific challenges in developing countries with the depth required for direct implementation.

Further research is needed to develop and empirically validate an actionable toolkit that integrates the proposed frameworks within the context of developing countries. Such validation should follow a structured research framework incorporating multiple methodological approaches:

• Pilot implementation studies: Controlled pilot studies should be conducted with transport operators in developing countries to test framework implementation feasibility, costs, and preliminary effectiveness. These studies should employ quasi-experimental designs comparing matched operator groups implementing the framework against control groups using standard practices with the measurement of objective outcomes (accident rates, fatigue-related incidents, hours-of-service compliance) and subjective measures (driver-reported fatigue, sleep quality, job satisfaction). Pilot studies should specifically examine which framework components are most readily implemented under resource constraints and which require external support or regulatory facilitation.
• Adaptation and contextualisation studies: Qualitative research should examine how the proposed frameworks require modification for specific developing country contexts, considering factors such as variations in regulatory enforcement capacity; cultural attitudes towards authority, rest, and health; infrastructure availability and quality; economic constraints on operators and drivers; and prevalence of informal versus formal employment relationships. These studies should employ mixed methods including interviews with drivers, managers, and regulators; observational studies of operational practices; and participatory action research approaches that engage stakeholders in framework adaptation.
• Component effectiveness analysis: Given the multifaceted nature of the proposed frameworks, research should systematically evaluate which specific components deliver the greatest fatigue reduction and safety improvement under different operational and resource availability scenarios. This analysis would guide prioritised implementation sequences, identifying “high-impact, low-cost” interventions that can be implemented immediately versus components requiring longer-term capacity building or investment.
• Longitudinal implementation studies: Extended longitudinal studies (12–24 months minimum) should track the evolution of fatigue management practices, safety culture development, and driver health outcomes as organisations progress through framework implementation. These studies should explicitly examine the change management processes that facilitate or hinder adoption; the time-course of observable benefits (recognising that some interventions may show immediate effects while others require sustained implementation); the sustainability of implemented practices beyond initial research support; and the organisational characteristics (size, ownership structure, market position) that predict successful implementation.

While this review focused primarily on management strategies rather than outcome meta-analysis, future systematic reviews could usefully conduct a meta-analytic synthesis of quantitative data regarding the relationship between specific hours-of-service parameters (maximum shift duration, minimum rest period, restart break requirements) and fatigue outcomes or accident rates; the effectiveness of different rest break schedules (duration, frequency, timing) in maintaining alertness; the comparative effectiveness of various fatigue monitoring technologies in predicting safety-critical events; and dose–response relationships between health intervention components (exercise frequency, dietary modifications, sleep education) and fatigue levels.

The scarcity of research from developing countries identified in this review highlights the need for deliberate efforts to conduct comparative studies examining how fatigue manifestation, causation, and management effectiveness differ between developed and developing country contexts. Such research should move beyond simply identifying differences to understanding the underlying mechanisms—whether differences reflect fundamental variations in human fatigue processes under different stressors, or whether they primarily reflect variations in operational and socioeconomic environments.

Finally, research should explicitly adopt implementation science frameworks to examine not just whether the interventions work, but how to successfully scale them across diverse organisational contexts. This includes economic evaluations assessing the cost-effectiveness of different management approaches, barrier analysis identifying systematic obstacles to implementation, and research on regulatory and policy mechanisms that can facilitate the widespread adoption of evidence-based fatigue management practices.

Such comprehensive research will reveal unique variables and improve fatigue management implementation in developing country settings, ultimately enhancing both driver well-being and road safety outcomes.

5.6. Practical Applications

Fatigue is an ever-changing conundrum with severe safety and health risks. The management of this risk, especially in the operating environment of truck drivers, presents a variety of solutions, each with its own applicability. This systematic review compiled literature on strategies appropriate to managing truck driver fatigue and serves as a guide for further research to identify insufficient areas of fatigue safety management research, and for business management to understand what is available to manage truck driver fatigue effectively.

For organisations in developing countries facing significant resource constraints, a phased implementation approach is recommended:

• Phase 1—Foundation (Months 0–6): Establish basic scheduling policies aligned with low-risk fatigue principles (adequate recovery breaks, restart breaks, minimised night driving), implement driver fatigue education programmes, develop simple fatigue measurement systems using logbooks and driver self-reporting, and create clear policies regarding driver autonomy to refuse driving when fatigued.
• Phase 2—Systematisation (Months 6–18): Formalise a basic fatigue risk management System structure with designated responsibility for fatigue management, establish the routine collection and analysis of fatigue-related data, implement formal accident investigation procedures that assess fatigue contribution, develop partnerships with health services to provide driver screening and basic health support, and expand educational programmes to include dispatchers, managers, and the drivers’ families.
• Phase 3—Optimisation (Months 18+): Introduce real-time fatigue monitoring technologies where feasible, implement comprehensive health and wellness programmes, develop sophisticated fatigue risk modelling capabilities, establish external partnerships (with customers, infrastructure providers) to support fatigue management objectives, and conduct systematic audits and continuous improvement processes.

This phased approach allows organisations to demonstrate early benefits from low-cost interventions, building organisational commitment and safety culture maturity that supports later investments in more resource-intensive components.

6. Conclusions

The systematic review identified three overarching themes for managing truck driver fatigue: operational systems and processes, safety culture and practices, and health and well-being initiatives. Fatigue is a multidimensional construct and a symptom of unhealthy practices; therefore, it requires a comprehensive approach that combines operational flexibility, education, and health support. Management must move beyond prescriptive hours-of-service (HOS) rules and adopt strategies tailored to the organisation’s operational context. Fatigue management is a shared responsibility between the employers and drivers, as activities outside the workplace also contribute to fatigue. Programmes such as SHIFT illustrate the value of holistic interventions that integrate education, health resources, and operational adjustments under a change management framework.

To ensure practical application, managers should implement flexible scheduling practices, adopt real-time fatigue detection technologies, and conduct routine audits to monitor compliance and risk. Fatigue education must be embedded into daily operations and supported by feedback loops for continuous improvement. Providing health and wellness resources, such as nutrition support and exercise programmes, is essential to address fatigue beyond the workplace. Policymakers should develop adaptable regulatory frameworks that allow risk-based approaches rather than rigid HOS rules and incentivise the adoption of fatigue monitoring technologies and wellness programmes. Supporting partnerships to improve infrastructure and driver health services will further strengthen fatigue management efforts. These recommendations aim to guide both managers and policymakers in creating integrated systems that proactively identify and mitigate fatigue risks before, during, and after driving.

7. Declaration of Generative AI and AI-Assisted Technologies in the Writing Process

During the preparation of this work, the authors used ChatGPT (GTP-4o) in order to ensure readability and language. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.