Background and rationale
Truck driving is essential to the economy. Approximately 75% of all goods delivered in the UK are transported via road freight, with the road freight transport sector contributing over £13B to the UK economy.1 The UK logistics sector currently employs just under 300,000 heavy goods vehicle (HGV) drivers, with a HGV being defined as having a gross vehicle weight between 3.5 and 44 tonnes.1 Owing to the nature of their occupation, long-distance HGV drivers are exposed to a multitude of health-related risk factors and have been identified as working within one of the most hazardous professions.2,3 The working environment of long-distance HGV drivers and their job demands (i.e. long irregular hours, enforced sedentarism, poor dietary options, high stress) constrain the enactment of healthy behaviours, leaving drivers vulnerable to a myriad of physical and mental health conditions.4
Our own systematic review-level evidence has shown that HGV drivers globally exhibit high levels of physical inactivity and accumulate large amounts of sedentary (sitting) behaviour. HGV drivers also tend to make poor dietary choices, have high alcohol intakes and have a high prevalence of smoking.4 Furthermore, long and variable working hours, including shift work, contributes to sleep deprivation,5,6 and this can lead to metabolic disturbances and further promote the uptake of unhealthy behavioural choices.3,5–8 The isolated nature of driving a HGV can result in a lack of peer social support and poor mental health.9,10 Within this occupational group, adverse mental health conditions can be exacerbated by intense job demands and low levels of perceived job control, as a result of chronic time pressures, compounded by tight delivery schedules and traffic conditions.11 Indeed, our systematic review identified high levels of mental ill-health within HGV drivers.4
As a result of HGV drivers’ working environment and poor health behaviours, review-level evidence has demonstrated that they nationally and internationally exhibit high rates of obesity and cardiometabolic risk factors.4,12–14 In addition to elevating their risk of cardiovascular disease (CVD) and type 2 diabetes, the incidence of obesity-related comorbidities in HGV drivers is increasing, suggesting that the trajectory of HGV driver health is declining.2,3,15–18 These factors likely culminate in HGV drivers having an increased risk of accidents, higher rates of chronic diseases and reduced life expectancies in comparison with other occupational groups.2,19–24 Despite this, HGV drivers are currently underserved in terms of health promotion efforts.25
To compound the high-risk health profile observed in HGV drivers nationally and internationally,4,12–14 within the UK’s logistics sector, HGV drivers are an ageing workforce, with an average age of 48 years.26 A report prepared by an All Party Parliamentary Group for Freight Transport has highlighted the challenges that the industry is facing with an ageing workforce, and the health impact of this ageing, at-risk workforce driving such large and potentially dangerous vehicles.27
The UK’s logistics sector is also experiencing a serious shortfall in HGV drivers, which has recently been described as reaching a ‘crisis point’, with this shortage rising from 60,000 drivers in 201528 to an estimated 100,000 drivers in 2021.29 Factors responsible for the sharp decrease in driver numbers include the uncertainties around Brexit, with a number of European drivers returning home; the COVID-19 pandemic, with the resulting national lockdowns further encouraging international drivers to return to their home countries and seeing HGV licence testing suspended; and a large number of drivers retiring.29 Barriers to driver recruitment have been reported to include a lack of roadside facilities, medical concerns and long working hours.27 Recommendations on how to address this shortfall and attract younger employees to the sector made by the All Party Parliamentary Group for Freight Transport include increasing awareness within the industry of the need to address driver health risks and health behaviours.27 Indeed, now more than ever, the government and sector urgently need to address working conditions and the poor health profile of this ageing workforce to attract employees to the role. Driver recruitment and a prioritisation of driver health is essential to combat the current challenges seen in maintaining critical supply chains.
A systematic review25 of health promotion interventions in HGV drivers, including only eight studies, observed that the interventions generally led to improvements in health and health-related behaviours. However, the review25 concluded that the strength of the evidence was limited because of poor study designs, no control groups, small samples and no or limited follow-up periods.25 Since the publication of the systematic review,25 studies have examined the impact of a weight loss intervention in US HGV drivers30 and a smartphone application (app) on physical activity and diet in Australian HGV drivers.31 Although positive findings were observed, the studies were limited by having relatively small samples and no comparison groups. It has been suggested that health and well-being programmes that focus on health education and improvements in health literacy should be implemented and prioritised across the logistics industry.4 For example, international research has shown that HGV drivers with higher educational levels are more likely to have higher levels of physical activity32 and lower body mass index (BMI)33 than HGV drivers with lower levels of education. Where they exist, health and well-being programmes within the logistics industry have been considered to have the potential to have a positive impact on employee health4,25 and, in turn, potentially benefit employers through increased employee retention and reductions in health-care costs.4 Furthermore, health promotion initiatives targeting HGV drivers will likely have a broader public health impact through improving road safety for all users.25 Research in the USA, for example, has shown that HGV drivers with obesity were 55% more likely to have an accident than normal-weight drivers.34 In the UK, although only accounting for 12% of all vehicle traffic on motorways, 41% of accident-related fatalities involved HGVs in 2017,35 highlighting the wider public safety impact of health improvement programmes in this at-risk occupational group.
Development of the SHIFT programme
We developed the Structured Health Intervention For Truckers (SHIFT) programme, which is a multicomponent theory-driven health behaviour intervention designed to promote positive lifestyle changes in relation to physical activity, diet and sitting in HGV drivers. This SHIFT intervention has been informed by extensive public and patient involvement (PPI), which has included drivers and relevant stakeholders, a qualitative study exploring the perceived barriers to healthy lifestyle behaviours in drivers,7 an observational study (n = 157) exploring lifestyle health-related behaviours in HGV drivers and markers of health,36 and a pre–post pilot intervention (n = 57)37 with a full process evaluation.38 Initial pilot testing of our intervention delivery, over a 3-month period, revealed potentially favourable increases in physical activity, with 81% of the sample increasing their daily step counts by an average of 1646 [standard deviation (SD) 2156] steps per day. Significant increases in fruit and vegetable intake were also observed (4.5 vs. 5.4 portions/day), along with favourable changes in markers of cardiometabolic health.37
The current study extends this work by evaluating the multicomponent SHIFT programme within a cluster randomised controlled trial (RCT), with the inclusion of full process and cost-effectiveness evaluations. As the intervention was administered within the worksite setting, a cluster RCT design was employed with delivery sites/depots (i.e. individual worksites) as the unit of allocation to minimise any potential contamination occurring between intervention and control participants.
Aim and objectives
The aim of this study was to evaluate the effectiveness and cost-effectiveness of the multicomponent SHIFT programme, compared with usual care, in a sample of long-distance HGV drivers at both 6 months and 16–18 months.
Primary objective
- To investigate the impact of the 6-month SHIFT programme, compared with usual care, on device-measured physical activity (expressed as steps/day) at 6 months’ follow-up.
Secondary objectives
- To investigate the impact of the SHIFT programme, compared with usual care, at 6 months’ follow-up on:
- time spent in light physical activity and moderate or vigorous physical activity (MVPA)
- sitting time
- measures of adiposity (i.e. BMI, per cent body fat, waist–hip ratio, neck circumference)
- cardiometabolic risk markers [i.e. glycated haemoglobin (HbA1c), total cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C)]
- fruit and vegetable intake and dietary quality
- blood pressure
- psychophysiological reactivity
- sleep duration and quality
- functional fitness (i.e. grip strength)
- cognitive function
- mental well-being (i.e. anxiety and depression symptoms, and social isolation)
- work-related psychosocial variables (i.e. work engagement, job performance and satisfaction, occupational fatigue, presenteeism, sickness absence and driving-related safety behaviour)
- health-related quality of life (HRQoL)
- health-related resource use [i.e. general practitioner (GP) visits].
- To investigate the longer-term impact of the SHIFT programme, compared with usual care, at 16–18 months’ follow-up on:
- steps per day
- time spent in light physical activity and in MVPA
- sitting time
- fruit and vegetable intake and dietary quality
- sleep
- mental well-being (i.e. anxiety and depression symptoms, and social isolation)
- work-related psychosocial variables (i.e. work engagement, job performance and satisfaction, occupational fatigue, presenteeism, sickness absence and driving-related safety behaviour)
- HRQoL.
- To conduct a mixed-methods process evaluation throughout the implementation of the intervention (using qualitative and quantitative measures) with participating drivers and site managers.
- To undertake a full economic analysis of the SHIFT programme.