Working conditions of commercial drivers: a scoping review of psychosocial work factors, health outcomes, and interventions

Abstract

Background

Psychosocial work factors significantly influence both organisational and worker health. Poor management of these factors can create precarious working conditions, risking drivers’ health. This review maps evidence on the health impact of these factors and health interventions targeting the working conditions and unhealthy habits of commercial drivers.

Method

The search was conducted in four main databases (PubMed, Central, JSTOR and Dimensions Ai) and other sources like Google Scholar. In All, 28,039 articles were retrieved and through a rigorous screening process, 68 records were included in this scoping review.

Results

This review found that drivers work in precarious conditions like long driving hours, low job resources and social support, low job control, poor remuneration, workplace abuse and sexual harassment, work-family conflict, lone driving hour, irregular shift work, lack or insufficient breaks during work hours and difficult access to social protection and sanitation facilities. These precarious working conditions may expose drivers to mental health issues, cardiovascular diseases, HIV/AIDs, stroke, chronic fatigue, kidney and bladder issues and musculoskeletal pains. Most health promotion interventions target behaviour at the individual level, such as the benefits of a healthy diet and exercise, with little effort to improving working conditions.

Conclusion

Employers in the road transport sector need to implement health promotion interventions that focus on drivers’ well-being. Additionally, improving working conditions and enforcing occupational health and safety standards in the road transport sector are essential for creating a safe and healthy workplace for all commercial drivers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-024-20465-1.

Introduction

Road traffic crashes (RTCs) continue to claim the lives of millions of people each year, and a growing body of evidence suggests that these RTCs are not solely due to physical driving conditions, but also heavily influenced by psychosocial work factors [1]. Psychosocial work factors refer to the interaction between job design, the work environment, organisational conditions, and the capabilities of employees, all of which affect behaviour, and health, and safety outcomes [1, 2]. For commercial drivers, these factors can contribute to stress, fatigue, and risky behaviours behind the wheel, increasing the likelihood of RTCs [2]. Unaddressed psychosocial hazards such as long working hours, time pressure, job insecurity, and lack of control over working conditions expose drivers to physical and psychological stressors [1, 3]. These stressors may impair their concentration, decision-making, and reaction time, thus, contributing to RTCs, injuries, and fatalities [3]. When psychosocial factors are poorly managed, they create precarious working conditions that put drivers and other road users at serious risk [1–3], highlighting the need for adequate interventions to ensure safe working environments.

Commercial drivers include truck drivers, bus drivers, taxi drivers, delivery drivers, and other professional drivers who use vehicles for commercial purposes. Evidence shows that commercial drivers have unhealthy psychosocial work factors inherent in their work [4]. Job stress, time constraints, lengthy and unpredictable work schedules, job insecurity, inadequate compensation, rigorous external control by vehicle owners, and a significant lack of job control are some of these issues [2, 4]. Many commercial drivers deal with these psychosocial risk factors regularly, posing serious risks to their health and safety and that of other road users [5]. Additionally, there is evidence to support the idea that unfavourable psychosocial workplace factors, such as time constraints, long driving hours, shift work, monotonous tasks, and ergonomic concerns, increase the likelihood that commercial drivers will engage in risky driving behaviours that result in serious RTCs with injuries and fatalities [3].

The presence of precarious working conditions in the road transport industry makes it difficult to protect the health and safety of commercial drivers, especially vulnerable working populations such as immigrants and female drivers. Nilsson et al. [6] have argued that for countries to attain Sustainable Development Goal (SDG) 8.8, “the protection of labour rights and the promotion of a safe and secure working environment for all employees, including migrant workers, particularly women migrants and individuals in precarious employment by 2030”, then the precarious working conditions under which commercial drivers operate must be given the needed research and policy consideration. Commercial drivers, especially those in developing countries like Ghana, often operate under precarious conditions, which compromise their health and safety [4]. These conditions directly contravene the goals of SDG 8.8, as commercial drivers face inadequate social protections, poor remuneration, and unsafe work environments [1, 6].

Previous reviews attempted to understand the impact of working conditions on the health of commercial drivers [7–9]. However, these reviews focused on truck drivers neglecting other commercial drivers in the road transport industry. Besides, for decades of research on health promotion interventions focused on improving commercial drivers’ health and working conditions, there is a need to synthesise this evidence for recommendations for future systematic reviews, practice and policy. Hence, this study aimed to review the evidence on psychosocial and personal risk factors that make commercial drivers vulnerable to occupational diseases and impaired wellbeing. Furthermore, this study aimed to summarise existing evidence on health promotion interventions essential to improving commercial drivers’ psychosocial working conditions and unhealthy lifestyles. This scoping review will not only identify gaps and inconsistencies in the current research, but also provides valuable insights for policymakers, employers, and practitioners in the transportation industry. The synthesied findings will serve as a crucial resource, informing the development of targeted interventions, including policies aimed at enhancing the psychosocial working conditions and overall health of commercial drivers. Moreover, by pinpointing areas with limited evidence, this review will steer future research endeavours toward filling these gaps and advancing our understanding of this significant yet understudied area, especially in developing countries.

Methods

The guidelines outlined by Arksey and O’Malley [10] were adopted for this scoping review: identifying and stating the research questions, identifying relevant studies, study selection, data collection, summary and synthesis of results and consultation. The reporting of this scoping review also adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. See Additional File (PRISMA-ScR_ Checklist).

Research questions

The research questions for this scoping review included: (1) what psychosocial work factors affect commercial drivers? (2) what are the health outcomes associated with psychosocial work factors affecting commercial drivers? (3) what are the personal risk factors that make commercial drivers prone to poor health outcomes, and (4) what are the health education and promotion interventions, reported by studies, to improve working conditions and unhealthy lifestyles of commercial drivers?

Identifying relevant studies

PubMed, Central, Dimensions, and JSTOR were the main databases searched for literature. Medical Subject Heading (MeSH) terms were generated for the search in PubMed and refined for search in other databases (Central, Dimensions AI and JSTOR). Table 1 presents the search strategy. The keywords in Table 1 were moved to the MeSH. Table 2 presents the search terms and strategy in PubMed. MeSH terms from PubMed guided the search terms for other databases in Table 1. PubMed’s strategy is detailed in Table 2. Google Scholar, Google, and university repositories were also checked for more sources, ensuring a comprehensive search. The last search was done on November 23, 2023.

Table 1.

Search strategy and eligibility criteria

Search strategy item	Search strategy
Databases	PubMed, Central, Dimensions and JSTOR,
Language filter	English Language
Time filter	1990–2023
Keywords	1. “Psychosocial work factors” OR “Precarious working conditions” OR “Working conditions” OR “work environment” OR “psychological working conditions” OR “long driving hours” OR “Job demands” OR “Job Resources” OR “Job control” OR “Organisational factors” OR “Job design” OR “Organisational justice” OR “Time pressures” OR “Shiftwork” OR “Irregular schedule” OR “Operation conditions” OR “Work factors” OR “Work conditions” OR “Job Stress” OR “Occupational stress” OR “Workplace conditions” OR “Lone driving” 2. “Health outcomes” OR “Occupational diseases” OR “Mental health” OR “Psychological distress” OR “Wellbeing” OR “Workplace injuries” OR “Neck Pains” OR “Cardiovascular diseases” OR “Heart disease” OR “Ischemic heart disease” OR “Diabetes” OR “Cancer” OR “Kidney disease” OR “Renal diseases” OR “Hypertension” OR “Obese” OR “Overweight” OR “Negative affect” OR “Musculoskeletal diseases” OR “Low back pain” OR “Knee pain” OR “Body pains” OR “Headache” OR “Depression” OR “Anxiety” OR “Mood changes” OR “Stress” OR “Sleep quality” OR “Chronic fatigue” OR “Daytime sleepiness” OR “Sleep fatigue” OR “Injuries” OR “Disease” OR “Metabolic diseases” OR “ Stroke” OR “Bladder disease” OR “ Myocardia infractions” OR “Elevated blood pressure” OR “Blood pressure” OR “Burnout” OR “Death” OR “Mortality”. 3. “Risk factors” OR “determinants” OR “causes.” 4. “Professional drivers” OR “Commercial drivers” OR “Truck drivers” OR “Taxi drivers” OR “Bus drivers” OR “BRT drivers” OR “Heavy duty vehicle drivers” OR “Haulage drivers” OR “Heavy goods drivers” OR “Transport operator” OR “Motorcycle drivers” OR “Delivery drivers” 5. “Interventions” OR “Policies” OR “Strategy” OR “Protection” OR “Health promotion” OR “Health education”
Inclusion criteria	The paper should be: 1. peer-reviewed or grey literature; 2. a published in 1990 and later; 3. published in the English language; 4. conducted on commercial drivers; and 5. on psychosocial working conditions, risk factors, health education, and promotion interventions for working conditions and unhealthy lifestyle
Exclusion criteria	The paper should be: 1. conducted on non-commercial drivers; 2. a study published online before the year 1990; 3. a report, abstract, minutes, commentary, letter to editors, preprint, 4. outside the variables of interest.

Table 2.

Search strategy in PubMed

Search (#)	Search terms
1	Psychosocial work factors*[MeSH terms] OR Precarious working conditions* OR Working conditions* OR work environment* OR psychological working conditions* OR long driving hours* OR Job demands* OR Job Resources* OR Job control* OR Organisational factors* OR Job design* OR Organisational justice* OR Time pressures* OR Shiftwork* OR Irregular schedule* OR Operational conditions* OR Work factors* OR Work conditions* OR Job Stress* OR Occupational stress* OR Workplace conditions* OR Lone driving*
2	Health outcomes*[MeSH terms] OR Occupational diseases* OR Mental health* OR Psychological distress* OR Wellbeing* OR Workplace injuries* OR Cardiovascular diseases* OR Heart disease* OR Ischemic heart disease* OR Diabetes* OR Cancer* OR Kidney disease* OR Neck pains* OR Renal diseases* OR Hypertension* OR Obese* OR Overweight* OR Negative affect* OR Musculoskeletal diseases* OR Low back pain* OR Knee pain* OR Body pains* OR Headache* OR Depression* OR Anxiety* OR Mood changes* OR Stress* OR Sleep quality* OR Chronic fatigue* OR Daytime sleepiness* OR Sleep fatigue* OR Injuries* OR Disease* OR Metabolic diseases* OR Stroke* OR Bladder disease* OR Myocardia infractions* OR Elevated blood pressure* OR Blood pressure* OR Burnout* OR Death* OR Mortality*.
3	Commercial drivers (MeSH terms] OR Professional drivers* OR Truck drivers* OR Taxi drivers* OR Bus drivers* OR BRT drivers* OR Heavy-duty vehicle drivers* OR Haulage drivers* OR Heavy goods drivers* OR Transport operator* OR Motorcycle drivers* OR Delivery drivers*
4	#1 AND #2 AND #3
5	Risk factors*[MeSH terms] OR OR determinants* OR causes*
6	Intervention*[MeSH term] OR Policies* OR Strategies* OR Protection* OR Health promotion* OR Health education*
7	#5 AND #6 From: 01/01/1990; English language

Study selection

The eligibility criteria that guided screening of the studies is presented in Table 1. The authors examined the records obtained, and duplicates were removed using the Mendeley software. To manage the large number of records obtained, a team of twenty (20) trained graduate researchers and reviewers were involved in the screening process. These researchers were trained and familiarised with the inclusion and exclusion criteria to ensure a consistent understanding and application of the eligibility criteria during the screening process. Regular meetings and discussions were conducted among the team members to address any questions or uncertainties that arose during the screening process. This collaborative approach helped to enhance the reliability and accuracy of the screening outcomes. The 20 trained graduate students screened titles and abstracts for full-text records. Furthermore, reference lists of selected relevant full-text eligible records were checked for additional records. Finally, the screening of eligible full-text records were done independently by MA and JOS and reviewed by EWA to help ensure robustness, accuracy and reliable records.

Data collection/extraction

The papers that met the eligibility criteria were placed in Mendeley software for data extraction. Data extraction form was prepared and piloted using three included studies. Piloting the data extraction form with three included studies allowed for refining and testing its effectiveness. This process helped identify any potential issues or ambiguities in the form before applying it to the entire dataset, ensuring its suitability for accurate and consistent data collection. The data extraction was done independently by MA and JOS and reviewed by EWA. Details that were extracted include authors and year of publication, study design, population, sample size, personal risk factors, psychosocial working conditions and health promotion interventions. Misunderstandings, differences, and inconsistencies during the data extraction process were resolved by all authors during regular meetings.

Data summary, and synthesis of results

All authors extensively familiarised themselves with the collated data to ensure a thorough understanding. Subsequently, a thematic analysis was undertaken, dissecting the data to uncover underlying themes and specific findings. This analysis enabled us to highlight crucial patterns and noteworthy discoveries, which were methodically synthesized and presented in the results section. Additionally, beyond the primary focus of the paper, our exploration through the thematic analysis unearthed unique and valuable insights, enriching the overall depth of the study’s findings.

Consultation

A chartered librarian, Dr. Kwame Kodua-Ntim, at the Sam Jonah Library, University of Cape Coast was consulted during the search and screening process. In addition, he was consulted for the search in university repositories for grey literature. Also, commercial bus and truck drivers and occupational health and safety experts were consulted. They provided valuable real-world insights into the daily working conditions and health challenges faced by drivers. Their contributions helped contextualise the findings, ensuring that the study’s recommendations were grounded in practical occupational experiences and relevant to the industry.

Results

Search results

Search conducted in the four main databases yielded 28,018 records, and additional 21 records were produced from Google, Google scholar and institutional repositories. Thus, 28,039 records were produced from the search conducted. With the help of the Mendeley software, 1,311 duplicate records were removed and the remaining 26,728 records were screened. Abstracts and irrelevant records were removed from further screening leaving 134 full-text records for further assessment. A search through the reference lists of the selected full-text articles produced additional eight, and one record was obtained through consultation with the Digital Librarian (Dr. Kwame Kodua-Ntim). Thus, a total of 143 records were assessed for eligibility. Finally, 75 records were excluded using the eligibility criteria presented in Table 1, whereas 68 records were included in this review. Figure 1 presents the PRISMA flow diagram of the screening process. Most of the excluded studies did not report on psychosocial work factors which made it difficult to be considered in the study though they studied commercial drivers. The exclusion in this study was not based on study appraisal since authors did not appraise the included studies. Language barrier also led to the rejection of two records that could have added to the strength of the evidence reported in this review.

Fig. 1.

PRISMA flow diagram of screening process

Characteristics of reviewed studies

These 68 included studies were conducted in 32 countries across globally (See Fig. 2 for more details). United States leads with 9 studies, followed by Taiwan, 6 and Ethiopia, 4. Other countries, including Brazil, Canada, Mexico, the Netherlands, Spain, and Sweden, each contributed 3 studies. Countries like Australia, China, Colombia, Japan, South Africa, and the United Kingdom each conducted 2 studies, while a large number of countries, such as Argentina, Belgium, Chile, Denmark, Finland, Iran, Israel, Italy, New Zealand, Portugal, Saudi Arabia, Singapore, South Korea, Thailand, Turkey, Zambia, Zimbabwe have just 1 study each. The chart shows that cross-sectional surveys were the most frequently used research design, with 43 studies, followed by qualitative designs with 8 studies. Reviews and longitudinal designs each accounted for 5 studies, while both randomised controlled trials and mixed-method designs had 3 studies. Experimental design was the least common, used in just 1 study. This indicates a preference for observational and descriptive approaches in the reviewed studies (See details in Fig. 3). The studies sampled a total of 32,774 participants, including truck, taxi, bus and general commercial drivers (see supplementary file, Table S1).

Fig. 2.

Countries and continents where included studies were conducted

Fig. 3.

Methods/Designs of included studies

Psychosocial work factors of commercial drivers

The psychosocial work factors are grouped under three thematic areas (job design, organisational or workplace conditions and work environment).

Job design

Job design in the context of commercial drivers refers to the organisation of work tasks, demands, and available resources, balancing the physical and mental requirements of the job (such as long driving hours, time pressure, and workload) with supportive elements (like rest breaks, job control, and access to health resources) to ensure driver safety, well-being, and optimal performance [4]. Reviewed studies suggest that commercial drivers experience high job demands, making them vulnerable to fatigue and burnout [7, 11–19]. Thus, evidence shows that high physical workload [7, 20–23], long daily [9, 12, 22, 24–45], weekly [34, 37, 43, 46–48], driving hours, shift work [49, 50], time pressures [11, 24, 30–32, 51–53], social isolation [7, 8, 22, 39] and role overload [54] were inherent part of commercial drivers’ job that contribute to their poor health and well-being outcomes. Moreover, studies have reported that driving hours of more than 8 and 40 h a day and week, respectively, are harmful to commercial drivers’ health and road safety [9, 12, 25–39]. However, a study conducted on taxi drivers in Thailand reported that long daily driving more than 8 h a day was not associated with elevated haematocrit levels [55].

The argument is that organisations that prioritise health and well-being in designing jobs and make available job resources have the potential to alleviate the negative impacts of high job demands on commercial drivers. Thus, the lack of job resources to cope effectively with job demands may make commercial drivers vulnerable to occupational diseases [16]. For instance, studies have reported that low job control [7, 13–15, 17, 19, 51, 56, 57], work-family conflict [7, 30, 31, 51, 57, 58], poor remuneration [22, 24, 25, 27, 56], effort-reward imbalance [1, 12, 50, 59], lack of social support from co-workers [3, 7, 20, 39, 58] and supervisors [7, 51, 58, 60] and organisation support [51, 54] are markers for poor health, safety and well-being outcomes among commercial drivers. Studies that highlighted job strain, where the demands of the job outweigh the resources available to commercial drivers, also reported a negative impact on the drivers’ health and well-being [1–3, 8, 19, 59, 61, 62].

Organisation conditions

work conditions in the context of commercial drivers refer to the workplace environment and policies that shape their working experience, including job security, management support, safety regulations, working hours, scheduling of rest breaks, and access to essential resources like healthcare, sanitation, and social protection [2]. Evidence suggests that commercial drivers who perceive that their organisations prioritise profit or productivity over their well-being were more likely to report poor health outcomes [31, 51]. In addition, job insecurity in the road transport industry may predispose commercial drivers to occupational challenges [13, 22, 27, 56]. Furthermore, irregular work schedules [30, 31, 51, 52, 60], insufficient or lack of breaks and rest periods during driving hours [22, 26, 27, 34, 35, 42, 49, 57, 60, 63, 64], periodic breaks [65], lack of vacation [60, 65], lack of social protection such as insurance [22, 25] and poor organisational [24] and safety culture [9] may expose commercial drivers to occupational safety and health challenges. Moreover, lack of sanitation and exercise facilities at transport stations or yards may expose commercial drivers, especially those driving on standard routes, to chronic non-communicable diseases such as renal and cardiovascular conditions [7, 39, 52].

Work-environment

The work environment of commercial drivers refers to the physical, social, and operational conditions they encounter while driving, including road conditions, interactions with passengers and other drivers, and the availability of rest areas and supporting facilities [2]. The work environment of commercial drivers is often linked to experiences of hostile behaviours from passengers and other drivers [39, 60]. For instance, a qualitative study conducted among 55 commercial drivers in Chile mentioned confrontations from passengers as the leading cause of stress for drivers [60]. Also, studies have reported that conflict and violence like physical and verbal assault and robberies have exposed drivers to injuries, deaths and mental health challenges, including depression and post-traumatic stress disorder [3, 39, 43, 58].

Psychosocial working conditions and female commercial drivers

Three studies [39, 43, 58] reported on gender differences in exposure to psychosocial work factors among commercial drivers. One study found that working conditions are the same for male and female commercial drivers and, in many situations, that pose greater challenges for female drivers to cope in such a hostile work environment [43]. The other two studies exclusively sampled female commercial drivers from Mexico [39] and Southern Africa [58] and reported that long driving hours, lack of support from co-workers and supervisors, lone driving and work-family conflict expose female drivers to occupational health and safety challenges. Aside from the lack of social support, female commercial drivers experience various forms of abuse and harassment at the workplace, such as verbal assault, threats, homicide and sexual abuse [39, 58]. In addition, female commercial drivers have limited access to breaks and sanitation facilities [39]. These working conditions are precarious for women drivers in the road transport industry.

Psychosocial work factors of truck drivers

Results indicated that psychosocial work factors unique to truck drivers include irregular work schedules, often characterised by long hours, night shifts, and unpredictable working days, which disrupt their sleep patterns and overall health [7, 51, 52]. Additionally, unrealistic work schedules set by employers or clients may compel drivers to meet tight deadlines, increasing stress and fatigue [48]. Work-family conflict is another key factor, as truck drivers spend extended periods away from home, causing strain on personal relationships [30, 51]. Truck drivers often experience an increased need for recovery, as they may face physical and mental exhaustion from prolonged driving without sufficient rest [14, 64]. Additionally, the social isolation that truck drivers often encounter, spending extended hours alone on the road, may contribute to feelings of loneliness and a lack of social support, which can adversely impact their mental health and well-being [7, 8].

Impact of psychosocial work factors on health and well-being

Health implications of poor psychosocial work factors among commercial drivers were grouped into mental health, fatigue and sleep difficulties, musculoskeletal issues and injuries, non-communicable diseases and infectious, and other health issues.

Mental health issues

The link between precarious psychosocial working conditions and poor mental health or psychological distress is well documented [1–3, 8, 9, 24, 27, 31–33, 39, 50, 52, 56, 58]. Specifically, conditions such as depression [7, 8, 15, 22, 37, 47, 56, 57, 66], anxiety [7, 8, 15, 47], stress [7, 30, 60, 61], and PTSD [37] have been identified among commercial drivers who are exposed to job strain and hostile working environments. Lone driving, role overload, work-family conflict and lack of social support may lead to emotional exhaustion among commercial drivers [19, 54].

Fatigue and sleep difficulties

The link between long driving hours, job strain and sleep fatigue and daytime sleepiness has been reported [7–9, 29–32, 35, 37, 48, 49, 56, 58, 60, 67, 68]. In addition, commercial drivers who face high job demands without adequate recovery time are more likely to experience exhaustion and chronic fatigue [1, 7, 17, 26, 47, 61].

Injuries and musculoskeletal disorders

Long driving hours, without adequate breaks and rest periods, are often associated with an increased risk of musculoskeletal disorders, such as lower back pain, neck pain, knee aches, and general body discomfort [7, 11, 18, 22, 25, 27, 28, 33, 34, 42, 43, 50, 51, 56, 58, 61–63]. Furthermore, commercial drivers may be vulnerable to various injuries due to road crashes and ergonomic challenges stemming from prolonged driving [9, 37, 39, 45, 46].

Non-communicable diseases

Cardiovascular health risks [7, 9, 12, 32, 50, 69] and obesity/overweight [7–9, 22, 26, 31, 36, 52, 60, 67] have been observed among commercial drivers who were exposed to poor psychosocial work conditions. For example, long driving hours, job strain, and exhaustion are often associated with increased likelihood of ischemic heart disease [59], hypertension [22, 27, 40, 44, 60, 64], and myocardial infarction [37]. Furthermore, there is evidence suggesting that commercial drivers may be at higher risk for conditions such as cancer [69], diabetes [7, 9, 22, 36, 37, 44, 60], kidney disease [22, 39], bladder disorders [22, 27], digestive issues [50], respiratory disorders [22], stroke [22], and haemorrhoids [50], particularly when working in unsafe environments.

Infectious diseases and other health issues

HIV/AIDs has been found among truck drivers in Southern Africa (Zambia, South Africa and Zimbabwe), especially among drivers who drive long distances and spend most days of the month (more than 20 days/month) on the road [37]. Additionally, poor physical health [12, 25, 38] and well-being [13, 16, 21, 23, 53], hearing loss [31], and headache [7] have been observed among commercial drivers, potentially linked to the hostile and precarious nature of their work environment.

Personal risk factors and poor health outcomes

There is evidence suggesting that drivers who are immigrants [34, 43, 70], female [43], married [13], or have no or low levels of education [14, 48], as well as those who are obese or overweight [4, 22, 44, 64, 70], have high cholesterol [9, 22, 44], or are over 40 years, may experience poor psychosocial work factors and related health outcomes. Additionally, risky behaviours and lifestyles such as alcohol consumption and smoking [4, 8, 9, 18, 20, 22, 32, 37, 48, 55, 60, 64], the use of illicit drugs and caffeine [8, 22, 32, 60], poor dietary habits, including fast food consumption and low fruit intake [9, 22, 43, 60], and lack of physical activity [4, 18, 33, 43, 67, 69] are commonly associated with commercial driving and may contribute to poor occupational health outcomes. Furthermore, drivers without health insurance [67, 70], limited access to healthcare [9, 67], those who rely on over-the-counter medications or self-medication [7, 22, 67], and those who delay seeking healthcare [7] may be more vulnerable to impaired health and well-being.

Health promotion interventions

We grouped health promotion interventions into two themes; interventions focused on improving psychosocial working conditions and those focused on the unhealthy lifestyles of the drivers.

Interventions on improving working conditions

A qualitative study conducted among taxi drivers in Canada has shown that using evaluative, placative and entertaining talk are effective protective strategies for avoiding risky trips and preventing unhealthy behaviours such as smoking during trips among drivers [38]. These strategies help commercial drivers to manage the threat to their health and are also sources of social support that help reduce long driving hours [22]. Also, driver unions used education and advocacy for better working conditions and work environment that helped to improve road transport industry’s occupational health and safety issues in Mexico, especially for female commercial drivers [39]. The use of advocacy by female drivers in Mexico had helped created only female taxi stands [39]. In addition, Garbarino and colleagues [8] have shown that enforcing rest stops or rest breaks regulations, working time or driving hours, occupational health and safety standards, and regular surveillance were fundamental approaches to improving working conditions in the road transport industry. Furthermore, a randomised controlled trial among truck drivers in the United Kingdom has shown that once a week whole day time nature helped reduced chronic and acute fatigue among the drivers [47]. However, it is worth noting that spending time in nature did not significantly reduce the depression and anxiety levels of truck drivers. Legislative support for women drivers, using the technological device to track drivers to adhere to rest breaks, taking breaks between trips by taxi drivers and reducing drivers’ workload and putting two drivers on long trips reduced musculoskeletal issues and emotional exhaustion [7, 22, 39].

Interventions on improving healthy behaviours

A longitudinal study in Australia used health promotion campaigns in healthy eating, drinking and physical activity and supply of free fruits to improve eating and drinking behaviours of truck drivers [71]. Also, truckers in Portugal reported that enforcing exercise during rest days in their organisations helped improve their habit of exercising [51]. Evidence shows that workplace campaigns that encouraged eating and exercising at fixed times, using self-control, replacing snacks with fruits, preventing skipping of meals, promoting the consumption of healthy meals, biking to work, parking far away from truck stops to walk, riding during waiting times helped change their risky lifestyles [52]. Similarly, an experiment conducted in China among bus drivers revealed that adding fresh fruits (apples and bananas) decreased depression levels of bus drivers and improved their eating habits [66]. Moreover, evidence from transport drivers in Chile shown that transport companies that provided access to a gymnasium, complementary health check-ups every six months, and access to a physiotherapist and a nutritionist improved the diet, physical activity and occupational well-being of the drivers [60].

Discussion

Summary of findings

Evidence shows that some commercial drivers across the globe are working in precarious conditions, including long driving hours, high workloads, low job resources like lack of or low level of social support, low control, poor remuneration, work-family conflict, lone driving, irregular shift work and lack or difficult to access social protection and sanitation facilities. These precarious working conditions expose commercial drivers, especially vulnerable groups such as immigrant and female drivers, to varied occupational diseases and safety issues. However, there is hope since the evidence shows that various health promotion interventions are effective in improving working conditions, unhealthy lifestyles and health outcomes of these drivers.

Psychosocial working conditions of commercial drivers

The existing psychosocial work factors, such as long driving hours and days, irregular shift work, lack of breaks, lack of social protections, and difficult access to vacations by commercial drivers across the globe show that more efforts are needed to eliminate precarious work. Occupational health and safety standards known for reducing unsafe psychosocial working conditions have not been prioritised and enforced by governments, mandatory institutions, organisations in road transport industries and driver unions, especially in developing countries [60]. This is because integration of health and safety standards in various industries are in its infant stages or non-existing in most of these countries [60, 72]. The informal nature of road transport activities in most developing countries also makes it difficult to enforce and integrate contemporary occupational health and safety standards into the industry.

Furthermore, a larger percentage of people seeking jobs as drivers are young people with little or no formal education [73]. This situation creates opportunity for exploitation of these job seekers with unrealistic daily or weekly sales targets [74]. The exploitation of these vulnerable working populations by transport companies and owners creates job insecurity that forces drivers to work long hours increasing their risky behaviours on the road, like wrong over-speeding, overloading, etc., to meet employment contract expectations.

Health outcomes and personal risk factors

This review found that commercial drivers may be dealing with many occupational health and safety challenges due to their precarious working conditions. These physical and emotional health issues include musculoskeletal disorders and injuries, respiratory diseases, cardiovascular diseases, overweight and obesity, kidney and bladder diseases, cancer and digestive problems, mental health problems, HIV/AIDS, stroke, fatigue and sleep problems. Hence, when comparing commercial drivers to other working groups and the general population, it is evident that the overall health of commercial drivers is inferior [22]. The high occupational diseases and impaired well-being explain why commercial drivers are among the worker groups of medical care costs, insurance claims and long-term injury compensation claims [9].

Work overload, irregular shift work and working at night are factors associated with heart diseases [32]. For instance, if a commercial driver experiences a sudden cardiovascular episode while operating a vehicle, a collision is likely to happen, endangering the lives of other road users and passengers. There is evidence to suggest that commercial drivers are more likely to experience an abrupt onset of cardiovascular disease, especially when behind the wheel [22]. Surprisingly, these drivers are not getting enough rest to recover after long driving hours. This situation may lead to chronic fatigue [1], which poses high risk of cardiovascular diseases, risky driving behaviours and fatalities on the road [60].

For instance, elevated hematocrit levels of drivers may be a result of long driving hours. Such elevated haematocrit levels can indicate various conditions or factors, including dehydration from inadequate water intake, smoking, and the use of certain medications or substances like performance-enhancing drugs to cope with job demands [55]. Moreover, infectious diseases like HIV/AIDs have been reported among commercial drivers, especially truck drivers who travel long distances. Perhaps, an extended stay away from home increases the propensity for risky sexual behaviours, including taking multiple sexual partners and casual sex that result in increased rate of infections [32, 58]. In addition, the reported frequent abuse of alcohol and illicit drugs use expose long-distance truck drivers to sexual risk behaviours [58]. For instance, drivers who are away from their usual social support networks may experience feelings of loneliness and isolation, which can prompt them to seek companionship and intimacy. These off-the-regular sexual partners offer emotional support and a sense of connection during extended periods away from home [58] and provide a sense of familiarity and stability to these drivers [32]. Unfortunately, such risky sexual behaviours predispose these drivers to many infectious diseases, including HIV/AIDS, gonorrhea and syphilis, among others.

It is worth noting that commercial drivers are among the occupational groups exposed to high levels of mental health issues due to precarious working conditions, including hostile work environments, robberies, and assaults [8]. Drivers abuse alcohol and illicit drugs to compensate for mental distress, anxiety, fatigue, and loneliness [32, 60]. In addition, long days of driving and weekly hours leave little or no time for recreational activities, leading to a sedentary lifestyle. Besides, insufficient breaks and rest periods during driving expose drivers to eating junk food and skipping meals. The time pressures, irregular work schedules, high workload, poor remuneration and lack of social protection like insurance coverage may limit commercial drivers from accessing healthcare, which result in self-medication and the use of over-the-counter medications, that compromise their health and well-being.

Immigrants and female commercial drivers

Immigrants are vulnerable not just to precarious working conditions, but also due to lack of social protections like health insurance and access to healthcare. These situation push immigrants into extreme vulnerabilities to accept jobs that expose them to poor health outcomes. Unfortunately, the harsh working conditions, hostile, abusive work environment, lack of social support from supervisors and colleagues and unavailability of essential facilities like sanitation facilities for women at the workplaces may deter women from pursuing a career as commercial drivers. Moreover, unavailability of favourable sanitation facilities may further prevent women from drinking water and skipping meals at work, visiting the washrooms irregularly, exposing such workers to dehydration and renal problems [39].

Health promotion interventions

Interventions that focus on creating a safe and healthy workplace for all drivers are needed to eliminate precarious working conditions in the road transport industry. Most interventions have concentrated on changing individual behaviours, including healthy diet, and exercise. These interventions failed to address the complicated interactions between the job and driving contexts [32, 75]. Hence, efforts at the individual level are insufficient in creating healthy and safe work values in the transport sector [75, 76]. For instance, if there is insufficient access to nutritious meals on the roads and at truck and bus stops, eating habits may not improve even if employers give their drivers nutritional information. Thus, providing drivers with information on healthy food options and making available such foods at a truck stop may lead to healthy eating habits among the drivers while drivers take time to rest.

Implications for policy and practice

To improve the working conditions and health of commercial drivers, key policy actions need to be taken by international bodies, governments, employers, and driver unions. Integrating occupational health and safety standards into the road transport industry is essential [1]. Regular monitoring of working conditions and health outcomes of drivers are crucial, particularly in developing countries where data is limited [76]. Road safety agencies and transport companies should prioritise these surveillance efforts to inform policy decisions.

Workplace health interventions are needed to address the various causes of poor health outcomes among drivers. Employers should implement system-based interventions that promote health and enforce safety standards [76, 77]. This includes establishing wellness programmes that provide drivers with access to regular health check-ups and resources for stress management and mental health support [9, 77]. Special consideration should be given to the challenges faced by female drivers, who may require policy and legislative support to address sexual harassment and abuse in the workplace [58].

Technology can be leveraged by transport companies to monitor long-distance drivers, ensuring that they adhere to breaks and monitor vital signs of drivers to prevent health complications while on the road [39, 43, 58]. Employers should also focus on driver education and training, particularly on topics like fatigue management, healthy sleep habits, and ergonomic practices [4]. This will empower drivers with the knowledge and tools they need to maintain their health and well-being while fulfilling the demands of their job [9].

For researchers, this study highlights the need for further exploration into the integration of occupational health and safety standards within the transport industry and the impact of wellness programmes on driver health [1, 76]. Future studies should assess the effectiveness of specific interventions in improving both the physical and mental health of drivers. Additionally, there is an opportunity to investigate the use of technology in reducing health risks and promoting safer driving behaviours in the transport sector [43, 58].

Limitations in this review

One notable limitation of this review stems from the predominance of cross-sectional survey studies included. These designs rely heavily on respondents’ subjective perspectives at a single point in time, which limits the ability to capture changes over time or to establish causal relationships between psychosocial work factors and health outcomes of the drivers. While cross-sectional designs are valuable for identifying associations, they do not provide insight into how these associations evolve or progress over time, making it difficult to understand trends in drivers’ health outcomes. Furthermore, the restriction to English-language publications may have led to the exclusion of important studies published in other languages. This potentially narrows the scope of evidence, particularly omitting perspectives from non-English-speaking regions where cultural, social, or workplace factors may differ significantly. As a result, the review may lack insights from regions with distinct working environments and health conditions affecting commercial drivers, which could have enriched our overall analysis. Also, the limited access to databases and studies specific to the Ghanaian context further constrained the review. Local studies often address context-specific issues and conditions that may not be captured in broader, global research. The exclusion of such data could limit the understanding of unique working environments and health outcomes of commercial drivers in developing countries like Ghana. A more comprehensive search strategy, potentially incorporating grey literature and local language sources might provide a comprehensive picture and reduce potential biases in the findings. Despite these limitations, the review enhanced its rigor by incorporating studies from 32 countries and consulting with experts to gather diverse viewpoints and mitigate potential gaps.

Conclusion

This review highlights that commercial drivers work under precarious conditions, including long driving hours, high workloads, low job resources, lack of social support, poor remuneration, work-family conflict, lone driving, and irregular shift work, with limited access to social protection and sanitation facilities. These factors significantly contribute to occupational health risks such as mental health disorders, musculoskeletal injuries, cardiovascular diseases, chronic fatigue, and infectious diseases like HIV/AIDS, particularly affecting vulnerable groups like immigrants and female drivers. Furthermore, extended driving hours without proper recovery time exacerbate chronic fatigue and increase the risk of road accidents and injuries. While some interventions have focused on individual behaviour changes like healthy diets and exercise, there has been little effort to address the underlying psychosocial work conditions contributing to these health issues. Therefore, system-based interventions that integrate workplace health promotion, improve working conditions, and enforce occupational health and safety standards are urgently needed.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

M.A and E.W.A conceptualisation of the design. MA conducted data collection and analysis, thematic analysis, initial write-up and wrote the final manuscript, M.A and J.O.S independently extracted data for evidence synthesis, reviewed by E.W.A. E.W.A examined and oversaw the review process. The final draft of the manuscript was read and authorised for publication by all authors.

Funding

This work received no funding support.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethical approval and consent to participate

Not applicable.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.