A New Health Promotion Model for Lone Workers: Results of the Safety & Health Involvement For Truckers (SHIFT) Pilot Study

A New Health Promotion Model for Lone Workers: Results of the Safety & Health Involvement For Truckers (SHIFT) Pilot Study: "Objective: This study was designed to evaluate the effectiveness of a new health promotion model for lone workers.
Methods: A single group pre- or posttest design was used to evaluate intervention effectiveness for reducing body weight and increasing healthful and safe behaviors. Truck drivers (n = 29) from four companies participated in a 6-month intervention involving a weight loss and safe driving competition, computer-based training, and motivational interviewing.
Results: Objectively measured body weight reduced by 7.8 lbs ([DELTA]SD = 11.5, [DELTA]d = 0.68, P = 0.005), and survey measures showed significant reductions in dietary fat and sugar consumption. An objective measure of safe driving also showed significant improvement, and increases in exercise motivational stage and walking fitness approached significance.
Conclusions: Results suggest that the new intervention model is substantially more engaging and effective with truck drivers than previous education-based tactics.
(C)2009The American College of Occupational and Environmental Medicine

Of Interest due to the techniques used, specifically -

Weight Loss Competitions.
Team weight loss competitions reliably produce two or three times the amount of weight loss observed in the Holmes et al 22 study of truck drivers (as mentioned above), produce very low levels of attrition and are especially effective with male workers. Although the Holmes et al nutrition education intervention produced a mean weight loss of about 4 lbs, team weight loss competitions commonly produce average weight loss ranging from 10 to 18 lbs (see Refs. 24–26). The social and financial incentives in team competitions also produce low study attrition, which is a powerful consideration given high voluntary turnover in trucking and excessive attrition (58%) observed in a previous study of truck drivers.23 For example, attrition averaged only 2.6% (range, 0%–13%) across 10 different weight loss competitions reported Stunkard et al (study 2).26 Team competitions are also especially effective with male workers (see Ref. 25), and 95% of truck drivers are men.27 This enhanced effectiveness may be due in part to increased competitive and aggressive tendencies in men28 and/or to higher historical male participation rates in competitive team sports.29
Behavioral Computer-Based Training.
Behavioral computer-based training is twice as effective as passive training in booklets.30,31 Passive training formats in a previous intervention for truck drivers produced no significant improvements in health knowledge.23 A recent meta-analysis supports replacing passive educational booklets with more engaging training tactics. Burke et al 32reviewed the effectiveness of training tactics that were, by their classification, more or less engaging. Passive methods such as lectures, booklets, and videos were classified as less engaging; computer-based training or programmed instruction were classified as moderately engaging; and behavioral modeling and role playing were considered most engaging. In the studies reviewed, engaging methods were nearly three times more effective than less engaging methods. Although truck drivers cannot easily participate in the most engaging face-to-face training formats, moderately engaging computer-based training is a next-best alternative.
Behavioral Self-Monitoring (BSM).
BSM techniques, where individuals repeatedly observe, evaluate, and record aspects of their own behavior, are widely applied by physicians and psychologists to enhance motivation for change.33–35 BSM is increasingly applied in workplace interventions to enhance worker productivity and safety.33 Evidence suggests that BSM is particularly effective in combination with common intervention tactics such as goal setting, training, and feedback. For example, Olson and Winchester 33 reviewed 24 studies of workplace interventions that included self-monitoring and found that the standardized effect size for 66 intervention phases was large by Cohen's 36 standards (mean weighted d = 2.2; 95% CI = 1.7, 2.7; Cohen's standards are small d = 0.20, medium d = 0.50, and large d = .80), as was the mean effect size for interventions targeting driving and other safety behaviors (d = 1.8). Self-monitoring techniques can be easily administered at the individual level and are therefore well suited for involving isolated workers like truck drivers in health promotion programs.
MI.
MI has emerged as an alternative and more effective approach to health coaching than traditional office-based counseling, which lacks proven effectiveness for promoting exercise and healthy eating.37–39 Originally developed to reduce problem drinking and self-harming behaviors,40,41 MI is described as “a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalence.”42 MI techniques have been operationally defined,43 and examples of techniques include reflective listening, asking open-ended questions, and encouraging change talk. The guiding principles are to express empathy, develop discrepancy, avoid argumentation, roll with resistance, and support self-efficacy.41,42 Burke et al 44 conducted a meta-analysis of 31 controlled clinical trials of MI treatments. Standardized differences between treatment and control group means ranged from d = 0.25 to d = 0.56, with effects on exercise and diet averaging d = 0.53 (95% CI = 0.32, 0.74). MI is a good fit for truck drivers because it can be delivered anywhere a worker can receive cell phone service.

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