Men’s health: Driving home a healthy message

Taxi driving is a sedentary and solitary occupation with irregular work schedules and minimal contact with colleagues. This often results in social isolation and disruption to home life.


Drivers find it difficult to access medical and leisure services, maintain a healthy diet and engage in regular exercise. All this has a negative impact on their physical and mental wellbeing.


An innovative health promotion pilot scheme in Sefton, Merseyside, tackled this problem by involving the drivers in developing and implementing a programme focused on giving up smoking, healthy eating and exercise. Some of the drivers trained as mentors to support colleagues.


Previous studies identified issues including the threat of physical assault and crime by passengers traffic congestion and conflicts arising from the need to interact with the public in a professional manner while sticking to a schedule.


Taxi driving is found to be stressful and associated with high levels of smoking, a poor diet, inactivity and exposure to vehicle exhaust fumes.


A lifestyle survey of 99 male taxi drivers, aged 22 to 82 years (average age: 44) working in Sefton found:




  • 13.2% of drivers consumed the minimum daily intake of five portions of fruit and vegetables as recommended by the World Health Organisation


  • less than half (43.4%) undertook moderate exercise two or more times a week and one in six (14.1%) never exercised at all


  • more than three quarters (78.4%) of drivers were classified as overweight or obese


  • more than half (56.5%) were smokers


  • a quarter (24.2%) of drivers interviewed were worried about their health and one-third (32.3%) had not visited their GP in the preceding year. Particular areas of concern were being overweight and inactive.

In response to the findings, Sefton Primary Care Trust (PCT) developed the Colin the Cabbie initiative, to help 2,400 taxi drivers to attain a healthier lifestyle. Following national guidance, a consultation took place with 20 local taxi drivers to design the programme via a focus group and one-to-one interviews. Short, structured questionnaires were also devised to evaluate the efficacy of the programme post-implementation, including the written literature, peer mentoring training programme and healthy food demonstrations.


These were completed with 62, eight and 75 drivers respectively.


Male referrals to the local NHS Stop Smoking Service, SUPPORT, and leisure service attendance data from the local authority and leisure club Total Fitness, were monitored.


About 3,000 brochures were distributed to taxi drivers, with information on healthy eating, physical activity, safe sex, sensible drinking, smoking cessation, stress management techniques, testicular cancer and self-examination, prostate cancer and men’s health helplines and websites.


One thousand posters were displayed in the advertising space in the rear seating of 300 Hackney cabs. Four quarterly healthy eating newsletters and 500 sets of healthy recipe cards were distributed to 30 taxi firms in Sefton.


A peer mentoring scheme was developed to offer advice and support to reduce social isolation for drivers, and to increase health awareness among the public.


Eight male drivers trained as peer mentors under the programme.


Each mentor was allocated a training pack and a diary to record the number of people given advice and support on a weekly basis. A structured 20-item questionnaire was distributed to the eight drivers on completion of the mentoring course and the training was well received.


Following the course, participants felt more knowledgeable and confident to discuss healthy lifestyle choices with other drivers and the public and to assess their readiness to change their lifestyle.


The scheme bought 200 passes for drivers to use a local gym free of charge up to 12 times a month, with the option of purchasing an 11-month membership at half price. These were distributed in January to capitalise on people’s New Year resolutions.


An additional 200 passes have been provided by Sefton council, as part of an Active Cabbie scheme, that will enable drivers to continue to use sport and recreational facilities. A total of 75 drivers – 74 men and one woman – have attended nine healthy eating sessions.


The success of the Colin the Cabbie initiative was evaluated after three months via a structured questionnaire with a sample of 62 drivers, comprising 57 men and five women.


While 13,500 information packages were distributed during the pilot, only about half of the survey participants (58.1%) received them, despite the packs being hand-delivered to all 30 taxi firms in Sefton.


Fewer respondents than average had received the If You Quit, I Quit packs, which may reflect their non-smoking status. The disappointing allocation of the information packs may be attributed to competing work commitments or drivers’ shift patterns.


Almost all of the drivers who had received the packs had read the information provided and the majority rated it as either useful or very useful.


Each mentor gave information to an average of 77 people a week (the range was 30-150), with 26,419 contacts made over the 49-week pilot period.


Daily fruit and vegetable intake was also significantly greater among drivers who had participated in the initiative compared with those who had not. On average, programme participants consumed three portions of fruit and vegetables a day while non-participants ate only two portions. Six times more of those involved in the programme than those who were not, consumed the minimum daily intake of five portions of fruit and vegetables.


Data from the gyms operating the free pass scheme shows that between January and December 2007, more than half of the 200 passes (51.5%) were redeemed by taxi drivers and used for 1,053 individual visits (an average of 10 times with a range of 6 to 12). Sixty of these drivers (58.3%) went on to buy continued gym membership after the free pass expired.


The If You Quit I Quit stop smoking information packs boosted service access rates. Demographic analysis of referrals to the local NHS SUPPORT service in the three months following the campaign, revealed that the number of men using the service and setting themselves a quit date increased by 4.3% (37% to 41.3%) compared with the previous year.


The Colin the Cabbie programme targeted men in the 21-65 age range, across 30 occupations. This illustrated the potential for transferring this initiative to other workplaces, geographical areas and socially disadvantaged population groups that underuse healthcare services.


The peer mentoring scheme has been adapted by the Queen’s Nursing Institute to develop its Number One intervention, which aims to encourage its community nurses to eat more healthily, increase their physical activity levels, quit smoking and drink sensibly.


The programme also demonstrated the advantages of multi-sector collaboration, forging a successful working partnership between the PCT, the local authority, smoking cessation services, the business sector and taxi drivers.


Another key success was the active involvement of the taxi drivers in designing, delivering and evaluating all programme components. This demonstrated the value of client participation in the development of such initiatives. The peer mentoring programme helped local drivers undertake a health-promoting role and enabled them to reach the wider population.


Key points




  • Client participation is pivotal to the development and evaluation of health improvement schemes


  • Health care delivery should not be constrained within four walls. Health agencies should use innovative methods of delivering health improvement messages to men


  • Peer mentoring training can successfully equip community champions with the skills and knowledge to disseminate healthy lifestyle messages to a wide audience


  • Collaborative working can benefit men in their working environment.

By Jo McCullagh, BSc Hons, MPhil, is a health promotion specialist at Sefton Primary Care Trust


Table 1: Daily consumption of fruit and vegetables


Number of                Participated in Colin the Cabbie
portions                    programme


                                 % Yes (n=33)           % No (n=24)


0                               3.0                            8.3
1                               0.0                            16.7
2                               24.2                          16.7
3                               30.3                          29.2
4                               15.2                          25.0
5+                             27.3                          4.2


 


Table 2: Efficacy of the mentoring skills course


Outcome                                                                                        Median score/5*
                                                                                                      (25,75 percentile)


Greater understanding of healthy lifestyle choices                             5 (4.75,5)
Knowledge of healthier eating, exercise messages and stop              5 (5)
smoking advice has increased
Gained an understanding of the stages of behaviour change and        4.5 (4,5)
can use it to assess people’s readiness to change their lifestyle
More confident about discussing healthy lifestyles with other people 4.5 (4,5)


*Score ranged from 1 (not at all) to 5 (definitely)


Table 3: Knowledge and behavioural intention of participants


Outcome                                                              Number of            Median score/5*
                                                                            participants           (25,75 percentiles)


Greater understanding of healthy lifestyle choices          35                         4 (3,5)
Knowledge of healthier eating, exercise messages         35                         4 (3,5)
and stop smoking advice has increased 
Exercise more                                                              35                         4 (3,5)
Eat more fruit and vegetables                                        35                         5 (4,5)
Reduce the amount of saturated fat in diet                     35                         5 (4,5)
Consider quitting smoking                                            13                          5 (2,5)


*Score ranged from 1 (not at all) to 5 (definitely) ^ Current smokers only


Acknowledgements


The programme was jointly funded by an Innovation and Creative Practice Award from the Queen’s Nursing Institute and Sefton PCT.


References




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