Introduction

According to the World Health Organization (WHO), all workers are exposed to risks in their workplace, ranging from biological, chemical, physical, and ergonomic factors, as well as accidents and psychosocial risks. ¹⁾ These risks can be present in all Works, distributed in different measures, depending on, among other things, job characteristics, position, and work environment. In the case of workers who are dedicated to driving, problems associated to temperature, noise, and vibration, insufficient and inefficient ventilation, traffic jams and interpersonal relationships with passengers. ²

Other items that have been identified as risks in professional drivers are those of psychosocial type, ³⁾ which in turn seem to have a negative relationship with the quality of life of such group, preventing the efficient performance of their work, and even associating it to an increase of the likelihood of causing traffic accidents. In addition to the foregoing, it has been mentioned ⁴⁾ a constant fear on the part of professional drivers of being assaulted or involved in an accident; additionally, this group has been negatively associated to alcohol consumption and poor eating habits, culminating in chronic non-communicable diseases, for example, high blood pressure, which is present in more than one third of drivers worldwide, exceeding the general population. ⁵

In view of the above, this is particularly relevant when the International Labor Organization (ILO) states that the road transport sector is of fundamental strategic importance for social and economic development. In addition, it ensures the mobility of passengers and goods between territories and countries, thus contributing greatly to economic growth and job creation. ⁽⁶⁾ However, evidence indicates that public transport drivers present, in general and at a global level, unfavorable working conditions, with the presence of physical and psychological risks. ⁷⁾ In the case of truck drivers, not only do they face fatalities and injuries caused by vehicle collisions, but compared to other workers, they are exposed to greater risks of occupational illnesses and accidents. ⁽⁸

One health challenge is to support these workers by reinforcing healthier lifestyles and promoting their personal health through actions aimed at maintaining physical, mental, and social well-being in the workplace. In 2012, workplace health promotion was defined by the ILO as “the joint effort of employers, workers, and society to improve the health and well-being of people in the workplace.” ⁽⁹⁾ This has been considered as a strategy that not only involves providing education, but also counseling and motivation for behavioral change.

Currently, health promotion in the workplace is addressed only to a limited extent, since few attempts have been made to apply it, which would allow professional drivers, in this case, to increase their control over their health to improve it and positively influence their working conditions. ¹⁰ In view of the above, considering the importance of professional drivers, the risks to which they are exposed, and the need to promote the health of this population, the present research was developed with the objective of identifying interventions, in the available state of the art, that promote the health of professional drivers.

Materials and method

Systematic review type research, whose guiding question was: What interventions promote the health of professional drivers? To carry out the review, it was structured based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement updated in 2020. ¹¹⁾ Having circumscribed the research problem, the searches were then organized in Spanish, English and Portuguese, using the MeSH and Boolean descriptors shown in Table 1.

Table 1: Descriptors and Boolean used in the searches 

^Source: Own elaboration (2022)

The searches performed considered articles up to December 2021, including the following databases: PUBMED (United States National Library of Medicine), SCOPUS, SciELO (Scientific Electronic Library Online), and BVS (Biblioteca Virtual en Salud). The search strategies and filters used in each database are shown in Table 2.

Table 2:  Search strategy and filters applied 

^Source: Own elaboration (2022)

The inclusion criteria used considered articles in the three languages mentioned (Spanish, English, and Portuguese), documents published in the period ranging from 2000 to 2021 (up to December), and related to professional drivers; the exclusion criteria corresponded to reviews, letters to the editor and duplicity of manuscripts; first of all, the titles and abstracts of the articles located were reviewed, and those that met the exclusion criteria were read in full. Figure 1 shows the review flowchart.

Figure 1: Review Flowchart 

After the application of descriptors and search strategies, a total of 1303 articles were identified; after the application of filters, 234 articles were located; after the application of the inclusion criteria, 21 articles remained; and finally, after the application of the exclusion criteria, 11 articles remained.

Results

To complete the review process, the most relevant results of the selected articles will be presented and interpreted. Valuable contributions were highlighted, which can be grouped into 5 dimensions: technology, counseling and motivational interviewing, environmental control, sexual health, and strategic approach. Table 3 P1 summarizes these articles according to author, objective or question, sample, methodology and relevant results.

Table 3: Selected studies  

^Source: Own elaboration (2022)

Discussion

In terms of technology, portable devices were described as new possibilities for improving the health and well-being of drivers; ¹²⁾ consistent with what has been described associated with targeted mobile health messaging, ¹⁸ since these are useful tools for informing professional drivers about health conditions and plans, and have also been shown to contribute to primary care, especially for monitoring or reporting diagnosis results or treatment plans. This is of particular importance in the nutritional alterations due to excess in drivers, as described by the scientific community. ¹⁰

The above is consistent with the findings of Hafidy, et al, ²³ who identified 220 mobile applications that can help improve driving behavior; however, the findings of Barengo NC, et al, ²⁴ have reported inconsistent results on whether mobile health technologies are effective in reducing HbA1C levels or the incidence of type 2 diabetes in patients with prediabetes, but may hold promise for decreasing body weight.

In relation to motivational counseling and interviewing, the intervention associated with providing an interactive document with suggestions in the area of work-recovery-rest balance, food and beverage intake, and physical activity was positively assessed. ¹³⁾ In addition to the above, after 12 months of counseling with professional drivers, there was evidence of a reduction in weight and a decrease in significant cardiometabolic risk factors. ¹⁷ Additionally, it has been described that short-term motivational interviewing can be effective when implemented as a clinical standard for professional drivers. ¹⁹ It has been recommended to consider those approaches or formats that require less health literacy skills, ²¹ as well as an individual approach. ²²

This is consistent with another review, which notes that interventions that include a combination of training and other resources can provide successful weight reduction for truck drivers and are of clinical importance in guiding the development of future interventions in this industry. ⁽²⁵ This takes on particular importance, since noncommunicable diseases among drivers, for example, of buses, have been described as a growing threat, generating a substantial burden on the health system and services. ²⁶

In terms of environmental control, an exposure to environmental settings with nature can contribute to health and wellness promotion interventions. ¹⁴⁾ This is consistent with another study, where it is noted that sleep should be explicitly addressed in weight management interventions, where benefits can be obtained as maximum efficacy after establishing socially supportive work environments that reduce exposure to stress. ¹⁵

In the sexual health dimension, a study that is included describes that exposure to an intensive program in professional drivers who practice safe sexual behaviors was less likely to suffer sexually transmitted infections and HIV. ¹⁶⁾ This is particularly important because HIV-positive drivers with associated neurocognitive impairment have been reported to be at increased risk of poor driving performance in a simulation test. ²⁷

Finally, in the dimension of the strategic approach, it is recommended that health promotion in professional drivers should include changes at the policy, environment and systems levels, especially at the governmental level. ²⁰ Another study adds centralization in action planning and coping planning, ²¹⁾ and industry-oriented reforms; ²²⁾ as such considerations at the strategic level will enable a culture of health promotion to be established in the target community.

It is highlighted as a challenge to continue building knowledge associated with health promotion interventions in professional drivers. Although several results were identified, there are problems not covered by the interventions identified, such as those related to musculoskeletal pain. In that line, a high prevalence has been seen in professional drivers, being the lumbar area reported in the study of Joseph L, et al, ²⁸ as the most affected, whose risk factors can be mitigated through stretching programs, together with road safety education. ²⁹

The limitations of the present study are limited to the databases consulted and, consequently, to the sample identified. In addition, in terms of strengths, the present review is the first known to provide a variety of interventions including different levels of health management, from health care and environmental aspects to strategic approaches. Moreover, the findings identified may complement other reviews that have not identified specific occupational interventions targeted at older HGV drivers in the categories of health, safety, well-being, and other occupational factors, ³⁰ and may provide new insights that have not been considered.

As considerations for future studies, it is recommended to generate new interventions associated with the identified gaps and their consideration in professional drivers.

Conclusions

The present study was able to respond to the objective of identifying, in the available state of the art, which interventions promote the health of professional drivers. Several interventions were identified, which were grouped into 5 dimensions: technology, counseling and motivational interviewing, environmental control, sexual health and strategic approach. It is recommended that these interventions be considered by the health area, as this approach is essential for professional drivers.

There is important evidence of the positive effect of health promotion programs in workplaces. The study subjects vary according to the objectives of the researchers, with a scarce scientific production in professional bus drivers. There is a challenge in the permanence and adherence of the study subjects to perform or integrate the interventions.