The Leeds Cab Drivers Project

EVALUATION REPORT

Karl Witty

Dr Gary Raine

Prof Steve Robertson

November 2013

1

Reader Information

Leeds Metropolitan University were commissioned to undertake the evaluation of the

Leeds Cab Drivers project by Hamara Healthy Living Centre, who themselves received

funding from the Pfizer UK foundation.

This report was prepared by Karl Witty Dr. Gary Raine and Professor Steve Robertson,

Centre for Men’s Health, Institute for Health and Wellbeing, Leeds Metropolitan

University.

The report was produced using data collected by Starr Zaman, Darren O’Donovan and

Shanaz Gul from Hamara Healthy Living Centre.

Report Reference:

Witty, K. Raine, G & Robertson, S. (2013). Leeds Cab Drivers Project: Evaluation

Summary Report. Centre for Men’s Health, Leeds Metropolitan University.

Contact Details:

Karl Witty

Centre for Men’s Health

Institute for Health and Wellbeing

Leeds Metropolitan University

80 Woodhouse Lane

Leeds, LS2 8NU

Phone: 0113 812 1968

Email: K.Witty@leedsmet.ac.uk

2

Acknowledgements

The Centre for Men’s Health would like to thank the following individuals and

organisations for donating their time and supporting the research team throughout

the evaluation project.

Firstly we would like to thank each person who consented to take part in the

evaluation study and supplied us with the data. Secondly, the staff at Hamara for

their considerable support throughout the course of the study. Finally we would like

to thank our colleagues at Leeds Metropolitan University who have supported us

throughout this project.

3

Contents

Reader Information 1

Acknowledgements 2

Contents 3

Background 4

Previous work 6

The Intervention 7

Evaluation Methods 9

Results 11

Discussion 24

Next Steps 25

References 26

4

Background

This publication reports findings from the evaluation of the Leeds Cab Drivers (LCD)

Project, a culturally sensitive health intervention designed to improve the health and

wellbeing of taxi drivers working in Leeds. The intervention was funded by the Pfizer

UK foundation and was delivered by staff from Hamara Healthy Living Centre. The

evaluation was jointly conducted by Hamara and Leeds Metropolitan University.

Taxi drivers, as a group suffer high levels of chronic disease linked to sedentary

lifestyles, poor diet and the stressful nature of their work (McCullagh, 2008). Taxi

drivers can experience difficult working conditions in which they work long, unsociable

hours, take on the financial risk of ownership of capital, low custom; as well as the

increased risk of illness and violent attack (Facey, 2010, McEvoy and Hafeez, 2009).

A recent European review of good practice guidelines for taxi drivers also highlighted

occupational health hazards (including chemical and biological contamination) which

may negatively impact on the health of professional taxi drivers. (EU-OSHA., 2010).

The most recent Joint Strategic Needs Assessment (JSNA) highlighted the strong link

between deprivation and poor health and wellbeing in Leeds (NHS Leeds & Leeds City

Council, 2012). Rates of deprivation in Leeds are high, with 150,000 inhabitants in

the city ranked in the most deprived 10% in England (NHS Leeds & Leeds City

Council, 2012). People in Leeds experience disproportionate levels of ill health and

early mortality compared to England as a whole (Public Health England, 2013). Male

mortality in Leeds is a key concern particularly when taking into account the health

inequalities experienced by men living in the most deprived areas of the city (NHS

Leeds & Leeds City Council, 2012). The average life expectancy for men in Leeds is

77.9 years (82.2 for women) however, in the most deprived areas of the city men can

expect to live just 65.5 years (74.0 years for women) (Leeds City Council, 2012).

Leeds has a large South Asian1 population; including a Pakistani population of over

15,000 and an Indian population of over 12,000. 7.8% of the population of the Inner

South Area of Leeds, in which Hamara Healthy Living Centre is located are of South

Asian heritage (compared to 5.9% of the population of Leeds) (Leeds Observatory,

2012). Whilst heterogeneous in terms of culture and heritage the South Asian

population shares common health issues (NHS Choices, 2012), including a higher risk

of premature death from coronary heart disease compared to the general population

(British Heart Foundation, 2011) and between 5 and 6 times greater likelihood of

being diagnosed with diabetes (British Heart Foundation, 2009).

South Asian pupils consistently perform well below the national average in our schools

and 32% of Pakistanis and 44% of Bangladeshi adults have no recognised

qualifications (national average = 15%). This disparity can be compounded when

English is spoken as a second language. This poor performance in education may

bolster inequitable access to jobs. South Asian men are strongly represented in

transport and communication industries with taxi driving being the predominant

1 The term ‘South Asian’ is, in the context of this report used in reference to anyone with

a Pakistani, Indian, Bangladeshi or Sri Lankan ethnic origin, or decent

5

activity (McEvoy and Hafeez, 2009). With limited access to the labour market, taxi

driving can often be the only viable form of employment for some South Asian men.

One source estimates 25% of Pakistani men are primarily taxi drivers (Equality and

Human Rights Commission, 2013), many of whom will be the sole income earner in

the family.

Current data (Department for Transport, 2013) tells us that 5,807 taxi licenses were

issued in Leeds in 2013, the vast majority of these will be male and a significant

proportion will be of South Asian heritage.

6

Previous work

A rapid review of literature revealed a number of UK projects targeting taxi drivers.

The number of projects with accessible evaluation reports was however limited and on

the whole evaluations lacked rigour.

A project addressing the unmet cardiology needs of taxi drivers in Dundee used a pilot

questionnaire to gauge taxi driver’s interest in cardiovascular health checks, before

inviting groups of drivers to attend health checks in a range of settings. Taxi drivers

were found to have an ASSIGN2 calculated risk of 20% or greater were referred to

their GP for further assessment. Taxi drivers presenting symptoms suggestive of

undiagnosed coronary heart disease were invited to attend a community based

cardiology clinic. Of the drivers receiving health checks 53% (n=83) required further

investigation or management, and four drivers described symptoms which suggested

the presence of cardiac disease (Dryden et al., 2008).

The ‘Colin the Cabbie Programme’ was an NHS Sefton supported project which aimed

to reduce the risk of taxi drivers developing chronic conditions such as diabetes,

cancer and chronic heart disease. Project aims were to be achieved through the

distribution of a lifestyle brochure, stop smoking postcards, free gym passes, launch

of a cooking and nutrition group and provision of a peer mentoring scheme. Reported

outcomes from the project included a 4% increase in the number of men attending

stop smoking services, an increase in rates of exercise, and healthier diets amongst

those engaged with the intervention compared to those who had not (McCullagh,

2008).

‘Taxi!’, was a pilot intervention developed by Walsall Council Creative Development

Team to encourage local taxi drivers to review and make positive changes to their

lifestyle. In order to achieve this, drivers were shown a film illustrating how they

could be active during ‘idle time’. It also involved health messages disseminated

through car accessories, distribution of men’s health manuals and support for taxi

firms to make structural changes which were perceived to benefit the health of their

drivers. Evaluation of project outcomes was sought through semi-structured

interviews with 15 drivers who had watched the film. Drivers reported increased

levels of physical activity, positive changes in diet, but also highlighted existing

barriers to achieve better health within the target population (NSMC, 2009).

The Champions for Achieving Better Health in Sheffield (CABS) project involved

training a core group of South Asian taxi drivers as ‘health champions’ to conduct

health promotion within their community. This included encouraging colleagues to

access cardiovascular disease screening. Monitoring data and semi-structured

interviews were used to assess the impact of the project. Of the 80 health checks

initially administered, 50% were identified as being at risk of cardiovascular disease,

with 35% requiring a follow-up appointment (Willis and Dhoot, 2012)

2 See http://assign-score.com/ for details of the ASSIGN score

7

The Intervention

The LCD Project was designed and delivered by staff at Hamara Healthy Living Centre

in collaboration with Leeds Metropolitan University. Established in 2004, the Hamara

Healthy Living centre is located in Beeston, South Leeds. Hamara seeks to ‘bring

communities together’ tackling social exclusion within what is a multi-ethnic

community. Hamara aims to achieve this through the provision of culturally

appropriate services. (South, 2008). A significant proportion of Hamara’s service

users are from the local South Asian community.

Aims & Objectives: The overarching aim of the LCD Project was to improve the

health and wellbeing of taxi drivers, and their families working within the Leeds area.

Specifically, the intervention sought to:

Improve diet and increase physical activity and thus help to reduce the

likelihood of long term illnesses which particularly affect the health of men

employed as taxi drivers.

Use sports and cultural activities to disseminate health awareness information to

participants.

Develop a multiagency approach to maximise the benefits of the programme

and aid sustainability of the project.

Implement a ‘health champion model’ of health promotion within each firm by

training peer mentors, so they can offer lifestyle advice and information to

fellow taxi drivers.

Primary intervention setting: Hamara Healthy Living Centre, Beeston, Leeds

Intervention length: Each participant was engaged in the intervention for a 12

week period. The project was delivered over a period of approximately one year.

Overview: In order to achieve these aims it was anticipated that the following

activities would be delivered:

Recruitment and training of ‘health champions’ within taxi firms across the

region.

Use of ‘health champions’ to raise awareness of the project and promote the

potential health benefits of joining the project.

Organisation of weekly 5-a-side football matches.

Work with local GP practices to identify people who may benefit from joining the

project.

Distribution of free 12 week gym memberships for one of five gyms in Leeds or

Dewsbury. As part of this membership each driver would receive:

o A personalised gym programme and one-to-one support from a gym

instructor.

8

o Offer of a weekly circuit training class.

Those attending the healthy living centre would receive the following support:

An initial one-to-one health assessment for each participant, followed up at the

end of the 12 weeks. Anybody showing signs of an undiagnosed health concern

would be referred to GP services.

Guidance on healthy eating and physical activity, delivered verbally with

supporting paper resources.

Recruitment of wives and partners of taxi drivers.

o A review of shopping lists and cooking habits.

o Advice and recommendations as to how wives and partners could improve

the families’ diet.

Delivery: The project was designed to be delivered through a multi-agency approach,

with Hamara as the lead agency and support from Leeds Metropolitan University, NHS

Leeds, Local GP Practices and taxi firms.

Fidelity: Budgetary restrictions and reflective learning meant that some aspects of

the intervention were not delivered as initially planned. Specifically, it was

anticipated that intervention participants would be recruited from local GP surgeries,

however, this was not found to be an effective means of engaging the target

population and therefore this strategy was not pursued over the duration of the

project. Promotional events were also scaled back in order to meet the amended

budget.

9

Evaluation Methods

The Institute for Health and Wellbeing at Leeds Metropolitan University were

employed to conduct an evaluation to measure the success of the project in

collaboration with Hamara.

Aims of the study

The primary aim of the study was to identify changes in taxi drivers’ health and

lifestyle over the course of the project.

Secondary aims of the study were to:

Monitor the sharing of information during participation in the intervention.

Examine the extent to which the intervention meets participants’ expectations.

Collate participant feedback

Evaluation design and instrumentation

A non-experimental evaluation, before and after design was employed. The primary

data collection tool was a questionnaire (available on request) administered before

and after each participant had engaged with the intervention. The questionnaire,

collected data on each participants’ perceived health status, levels of physical activity,

diet, lifestyle, support, use of services as well as background information.

Recruitment and sampling

A non-probability sample of service users was sought. No upper or lower limit was on

numbers was set, no other recruitment criteria was imposed.

Recruitment to the evaluation study ran concurrently with recruitment to the

intervention. Each taxi driver choosing to engage in the intervention was presented

with a recruitment pack containing:

A Participant Information sheet

A consent form

A health passport

An evaluation questionnaire

Recruitment of participants to the evaluation study was conducted solely by Hamara

staff.

10

Data collection

The questionnaire was administered by Hamara staff members at baseline (before

participants had engaged in any intervention activities) and 12 weeks later, when

intervention activities had been completed. Hamara staff were able to provide

assistance with translation of questions and answers to any participants who required

support.

Analysis

The data were analysed using the statistical software package SPSS. Percentage

responses were calculated from the total number of valid answers given for each

question. For some questions, additional analytical tests were performed on the data

to investigate whether the change from the start (baseline) to the end of the

programme (follow-up) was statistically significant. A paired t-test was used in

relation to measures of weight, waist circumference, BMI, systolic & diastolic blood

pressure, sitting time and hours worked. A Wilcoxon Paired Signed-Rank Test was

used for the questions related to self-reported health rating, frequency of physical

activity, frequency of fruit & vegetable consumption, social support, GP use and use of

health advice & information services. For all these tests a p value of 0.05 was taken

to be statistically significant. For some analyses a confidence interval is reported. A

confidence interval provides an indication of the range within which the true effect is

likely to be. The width of a confidence interval is affected by the size of the sample,

with smaller samples tending to have larger confidence intervals than bigger ones. A

confidence interval of a mean difference that does not pass through 0 is indicative of

a statistically significant change.

11

Results

This section of the report provides a detailed overview of questionnaire data provided

at baseline and 12 week follow-up. Data in this section is presented both as a

frequency and also a percentage of those providing a legible response to that

question. For clarity the number of responses on which the percentages were

calculated is displayed (n =). In some cases, the percentages may not add up to

exactly 100% due to rounding. Incomplete or illegible responses are not included in

the analysis.

Description of Participants

In total, 66 questionnaires were returned for analysis. All (100%) of the 66

respondents were male. Of those providing information on ethnicity (n=65) the

majority (91%, n=59) were Asian/Asian British Pakistani, and a further 5% (n=3)

Asian/Asian Indian. Three per cent were White British (n=2) and one respondent

(approximately 1%) was Asian/Asian British Bangladeshi.

All but two respondents (97%, n=63) lived with family. One respondent lived alone

and another lived with friends. In total, 99% (n=65) of respondents were taxi

drivers. One person was a family member of a taxi driver. The mean (average)

number of people who were dependent on participants income given was 4 (SD=1.5).

The highest number was 8 and the lowest was 0, with 72% of respondents having

between 3 to 5 people dependent on their income.

The Health of Participants

Self-Reported Health Status

Respondents were asked to describe their own health at the start and the end of the

intervention (baseline n=64, follow-up n=63). As Figure 1 shows the proportion of

respondents who rated their health as `good’ increased from 25% (n=16) at baseline

to 70% (n=44) at follow-up. Conversely, the proportion of individuals stating

`average’ decreased from 70% (n=45) to 27% (n=17) between the stages. The

proportion of respondents rating their health as `poor’ remained similar at both

stages (5%, n=3 at baseline & 3%, n=2 at follow-up stage). Further analysis

revealed that health ratings at follow-up were significantly better than at baseline

(T=2, p<0.001).

12

Figure 1: Self-reported health rating of respondents

Health Problems

Respondents were asked if they considered themselves to have any health problems

(baseline n=66, follow-up stage n=62).

Just over one third of respondents (36%, n=24) indicated that they had a health

problem at baseline compared to 37% (n=23) at the follow-up stage. The health

conditions given at baseline are shown in Table 1.

Table 1: Health problems of respondents at baseline

Frequency

Diabetes 15

High blood pressure 3

Asthma 2

High cholesterol 2

Back problems 2

Arthritis/Osteoarthritis 2

Weight/under weight 2

Other 4

Weight

Respondents were asked to report their weight in kilograms at both stages. The

following results are based on data from the 63 individuals for whom values were

available for both time periods.

4.7

70.3

25

3.2

27

69.8

0

10

20

30

40

50

60

70

80

Poor Average Good

Pe

rce

nta

ge

Health rating

Baseline

Post

13

The mean weight of respondents at baseline was 84.6Kg (SD = 12.01). The

highest weight was 120.7Kg and the lowest was 57.2Kg.

The mean weight of respondents at the follow-up stage was 83.9Kg (SD= 11.8).

The highest weight was 118Kg and the lowest was 58.5Kg3.

The mean change in weight was -0.7Kg (SD= 2.6). The 95% confidence interval

was -0.9Kg to -1.4Kg, which is indicative of a statistically significant change.

This was supported by additional analysis that revealed the weight of

participants at the end of the intervention was significantly lower than at the

start (t=-2.26, df=62, p=0.027).

Weight change ranged from -5.1Kg to +8Kg.

Waist Circumference

Respondents were asked to report their waist circumference in inches at both

stages. The following results are based on data from the 63 individuals for whom

values were available for both time periods.

The mean waist circumference of respondents at baseline was 38.6 inches (SD

=4.4). The largest waist circumference was 48.8 inches and the smallest was 28

inches.

The mean waist circumference of respondents at the follow-up stage was 37.9

inches (SD= 4.2). The largest waist circumference was 50.4 inches and the

smallest was 29 inches.

The mean change in waist circumference was -0.7 inches (SD= 1.6). The 95%

confidence interval was -0.28 inches to -1.1 inches, which is indicative of a

statistically significant change. This is supported by additional analysis that

revealed the waist circumference of participants at the end of the intervention

was significantly lower than at the start (t=-3.34, df=62 p=0.001).

Change in waist circumference ranged from -5 inches to +6.5 inches.

Body Mass Index

Using height and weight data available for participants their BMI at baseline and

the follow-up stage (n=63) was calculated using the formula weight (kg)/height

(m)2.

The mean BMI of respondents at baseline was 28.2 (SD=4.1). The highest BMI

was 38.2 and the lowest was 18.1.

3 Some participants expressed a wish to gain weight.

14

The mean BMI of respondents at the follow-up stage was 28 (SD=4.0). The

highest BMI was 39.2 and the lowest was 18.5.

The mean change in BMI was -0.2 (SD=0.8). The 95% confidence interval was -

0.3 to -0.5 which is indicative of a statistically significant change. This was

supported by additional analysis that revealed the BMI of participants at the end

of the intervention was significantly lower than at the start (t=-2.25 df=62,

p=0.028).

BMI change ranged from -1.9 to +2.7.

Blood Pressure

At each stage respondents had their blood pressure measured by a trained

member of the Hamara team. Sixty-one respondents provided measures at both

stages.

Systolic Blood Pressure

The mean systolic blood pressure of respondents at baseline was 137.3 mmHg

(SD =13.8). The highest systolic blood pressure was 178 mmHg and the lowest

was 114 mmHg.

The mean systolic blood pressure of respondents at the follow-up stage was

135.5 mmHg (SD=14.9). The highest systolic blood pressure was 186 mmHg

and the lowest was 110 mmHg.

The mean change in systolic blood pressure was -1.7 mmHg (SD= 9.3). The

95% confidence interval was 0.7 to -4.1 which is indicative of no significant

change. This is supported by additional analysis that revealed the systolic blood

pressure of participants at the end of the intervention was not significantly

higher or lower than at the start (t=-1.44 df=60, p=0.154).

Change in systolic blood pressure ranged from -32 mmHg to +29 mmHg.

Diastolic Blood Pressure

The mean diastolic blood pressure of respondents at baseline was 84.6 mmHg

(SD =12.9). The highest diastolic blood pressure was 113 mmHg and the

lowest was 45 mmHg.

The mean diastolic blood pressure of respondents at the follow-up stage was

81.2mmHg (SD=10.8). The highest diastolic blood pressure was 104 mmHg

and the lowest was 37 mmHg.

The mean change in diastolic blood pressure was -3.5 mmHg (SD=8.1). The

95% confidence interval was -1.4 mmHg to -5.6 mmHg which is indicative of a

statistically significant change. This is supported by additional analysis that

revealed the diastolic blood pressure of participants at the end of the

intervention was significantly lower than at the start (t=-3.37 df=60, p=0.001).

Change in diastolic blood pressure ranged from -26 mmHg to +22 mmHg.

15

At baseline, 27 participants provided a high blood pressure reading of 140 or above

(systolic) or 90 above (diastolic). At follow-up, there were 16 who had a blood

pressure of 140 or above (systolic) or 90 above (diastolic). Therefore 11 provided

high blood pressure readings at baseline but not follow-up. Conversely, there were

3 who had a blood pressure of less than 140 and less than 90 at baseline, but at

follow-up had a blood pressure of 140 or above or 90 above. i.e. 3 did not have

high blood pressure at baseline but did at follow-up.

Physical Activity

Levels of Physical Activity

Respondents were asked to state the number of days per week they took moderate

physical activity for 30 minutes or more. Sixty-five respondents provided data at

both stages. As Figure 2 shows, at baseline 70% (n=45) of respondents reported

that that they either never engaged in moderate physical activity (31%, n=20) or

took part in moderate physical activity on only 1 day per week (39%, n=25).

However, at follow up this combined proportion (never or 1 day per week) had

declined to just 12% (n=8), with only 2% (n=1) never taking moderate exercise

and 10% (n=7) exercising on 1 day per week. Furthermore, there was a large

increase in the combined proportion reporting moderate physical activity on 2 or 3

days per week from 11% (n=7) at baseline to 65% (n=42) at follow-up.

Individually, the proportions increased from 6% (n=4) to 31% (n=20) for twice a

week, and from 5% (n=3) to 34% (n=22) for 3 times per week. There was also an

increase from 8% (n=5) to 14% (n=9) in the proportion of respondents exercising

4 times per week. However, a small decrease from 12% (n=8) to 9% (n=6) was

revealed in the numbers taking moderate physical activity on 5 or more times per

week.

Overall, the frequency of moderate physical activity per week was significantly

higher at follow up (median=3) than at baseline (median=1), (T=6, p<0.001).

Figure 2: Frequency of moderate physical activity per week

30.8

38.5

6.2 4.6 7.7

12.3

1.5

10.8

30.8

33.8

13.8

9.2

0

5

10

15

20

25

30

35

40

45

Never Once Twice Threetimes

Fourtimes

Fivetimes +

Pe

rce

nta

ge

Frequency per week

Baseline

Post

16

Intention to Increase Levels of Physical Activity

At baseline 91% (n=60) of respondents intended to increase the amount of

physical activity taken compared to 52% (n=34) at the follow-up stage.

Reasons for Not Taking Physical Activity4

Respondents were asked to state what had prevented them from taking part in

physical activity in the past. Table 2 shows that the most common responses at

baseline were ‘work’ and a ‘lack of time’, which were given by 74% and 55% of

individuals respectively. The same two reasons remained by far the most

frequently given at the follow-up stage, although the proportions of respondents

citing each decreased to 65% for work and 46% for lack of time. In addition, there

was a notable decline in the proportion of individuals who lacked interest in

exercising from 19% at baseline to just 3% at the follow up point. Three per cent

of respondents lacked facilities at the follow-up stage compared to 11% at

baseline.

Table 1: Reasons for not taking physical activity

Baseline Follow-up stage

Work 74% (n=48) 65% (n=43)

Lack of time 55% (n=36) 46% (n=30)

Lack of interest 19% (n=12) 3% (n=2)

Lack of money 15% (n=10) 9% (n=6)

Health issues 12% (n=8) 14% (n=9)

Household duties 11% (n=7) 12% (n=8)

Childcare 11% (n=7) 9% (n=6)

Lack of facilities 11% (n=7) 3% (n=2)

Weather 11% (n=7) 8% (n=5)

Other 8% (n=5) 0% (n=0)

Stress 5% (n=3) 8% (n=5)

Partner 2% (n=1) 2% (n=1)

Lack of partner 0% (n=0) 2% (n=1)

Lack of transport 0% (n=0) 0% (n=0)

Social activities 0% (n=0) 0% (n=0)

4 Respondents could tick more than one answer

17

Daily Sitting Time

Respondents were asked to estimate the amount of time they spent sitting,

including the time they spent sitting driving their taxi, each day.

The mean sitting time of respondents at baseline was 526.3 minutes (8hrs 48

mins) (SD=115.2 mins). The longest sitting time was 12hrs 30 mins and the

shortest was 5 hrs.

The mean sitting time of respondents at the follow-up stage was 518.1 minutes

(8hrs 36mins) (SD=113.2 mins). The longest sitting time was 12 hrs and the

shortest was 3 hrs.

The mean change in sitting time was -8.1 mins (SD=64mins). The 95%

confidence interval was 8.5 minutes to -24.8 minutes which is indicative of no

statistically significant change. This was supported by additional analysis that

revealed the sitting time of participants at the end of the intervention was not

significantly longer or shorter than at the start (t=-.977, df=58, p=0.33).

Change in sitting time ranged from -5 hrs to +2 hrs.

Diet

Consumption of Fruit & Vegetables

Respondents were asked how many times each day they ate fruit and vegetables.

Sixty-five respondents provided data at both stages. As Figure 3 reveals at

baseline just under two thirds of respondents (62%, n=40) reported that they

either never ate fruit or vegetables (11%, n=7) or ate fruit and vegetables just

once a day (51%, n=33). At follow up, nobody stated `never’ and just 12% (n=8)

said once a day, which represents a combined decrease of 50%. The proportion of

respondents stating `three times’ increased 21% from 14% (n=9) at baseline to

35% (n=23) after the programme. Similarly, there was a notable increase in the

proportion of respondents who stated ‘4 times’ from 3% (n=2) to 20% (n=13). In

total, 26% (n=17) of respondents ate fruit & vegetables either 4 or 5 times per day

at follow up compared with just 6% (n=4) at baseline.

Overall, the frequency of fruit & vegetable consumption per day was significantly

higher at follow up (median= 1) than at baseline (median=3), (T=3, p <0.001).

18

Figure 3: Frequency of fruit & vegetable consumption per day

Intention to Increase Consumption of Fruit & Vegetables

At baseline 92% of the 66 respondents intended to increase the amount of fruit &

vegetables consumed in the next 6 months, compared to 53% at the follow-up

stage.

Lifestyle

Working Hours

Respondents were asked to state how many hours per week they worked and 63

respondents provided responses at both stages.

The mean number of hours per week respondents worked on average at

baseline was 40.4 hours (SD= 10.7). The highest number of hours was 70 and

the lowest 16.

The mean number of hours per week respondents worked on average at the

follow-up stage was 41.8 hours (SD= 11.5). The highest number of hours was

70 and the lowest 7.

The mean change in number of hours worked was +1.3 hours (SD=6.4). The

95% confidence interval was – 0.3 hours to +2.9 hours which is indicative of no

statistically significant change. This was supported by additional analysis that

revealed the amount of hours worked by participants at the end of the

intervention was not significantly longer or shorter than at the start (t=1.64,

df=62, p=0.106).

Change in number of hours worked ranged from -33 hours to +15hrs.

10.8

50.8

18.5

13.8

3.1 3.1 0

12.3

26.2

35.4

20

6.2

0

10

20

30

40

50

60

Never Once Twice Threetimes

Four times Fivetimes+

Pe

rce

nta

ge

Frequency per day

Baseline

Post

19

Feeling Under Strain

Respondents were asked how often in the last month had they felt under so much

strain that their health was likely to suffer. Sixty-four respondents provided data

at the first stage of data collection and 63 at the second stage. The responses at

both stages were similar. In total, 72% (n=46) at baseline and 73% (n=46) at the

follow-up stage stated `never’. Approximately 22% (n=14) at both stages said

`sometimes’ and 6% (n=4) at baseline and 5% (n=3) at the follow-up point stated

`often’.

Smoking

Respondents were asked whether they were a current smoker, and whether they

intended to reduce or stop smoking. All 66 respondents provided data at both

stages.

At baseline, 9% (n=6) of respondents currently smoked compared to 8% (n=5) at

follow up. Out of the 6 smokers at baseline, 4 said they intended to reduce or stop

smoking in the next 6 months. Similarly, 3 out of the 5 respondents who were still

smoking at the end of the programme said they intended to reduce or stop

smoking in the next 6 months.

Consumption of alcohol

Respondents were asked how much alcohol they consumed each week. All 66

respondents provided data at both stages.

Just 1 respondent reported that they drank any alcohol at baseline which was 1

pint of lager/beer and 1 shot of spirits per week on average. At follow up none of

the respondents indicated they drank alcohol.

Support

People to Rely on in Times of Trouble

Respondents were asked whether they had people to rely on in times of trouble.

All 66 respondents provided data at both stages. As shown in Figure 4 the most

frequent response at both stages was ‘sometimes’ followed by ‘often’. The

proportion of individuals stating `sometimes’ increased from 53% (n=35) at

baseline to 62% (n=41) at the follow-up stage. Similarly, there was also a small

increase from 27% (n=18) to 30% (n=20) in the proportion of respondents stating

`often’ between the 2 stages. In contrast, the proportion of individuals who never

had anyone to rely on decreased over time from 20% (n=13) at baseline to 8%

(n=5) at follow-up. Additional tests found that respondents relied on other people

significantly more frequently at the follow-up stage than at baseline (T =3,

P=0.012).

20

37.9

51.5

10.6

42.4

53

4.5

0

10

20

30

40

50

60

Never Sometimes Often

Pe

rce

nta

ge

Frequency

Baseline

Post

Figure 4: People to rely on in times of trouble

Use of services

Respondents were asked if they visited their GP/family doctor if they had a minor

ailment. All 66 respondents provided data at both stages. As Figure 5 reveals,

there was a decrease over time from 11% (n=7) to 5% (n=3) in the proportion of

respondents stating `often’. The proportions of individuals responding `never’ and

`sometimes’ between baseline and the follow-up stage increased from 38% (n=25)

to 42% (n=28) and from 52% (n=34) to 53% (n= 35) respectively. Respondents

at the follow-up stage did not use the GP for minor ailments significantly more or

less frequently than at baseline (T=4, p=0.07).

Figure 5: Use of the GP/family doctor for minor ailments

19.7

53

27.3

7.6

62.1

30.3

0

10

20

30

40

50

60

70

Never Sometimes Often

Pe

rce

nta

ge

Frequency

Baseline

Post

21

Use of Health Advice & Information Services

Respondents were asked if they made use of health advice and information

services such as NHS direct. All 66 respondents provided data at both stages. As

shown in Figure 6, at baseline 58% (n=38) stated they `never’ used health advice

& information services such as NHS Direct. However, at the follow-up stage the

proportion of individuals giving this answer had decreased to just under a third

(32%, n=21). Conversely, those respondents who answered `sometimes’

increased from 39% (n=26) at baseline to 64% (n=42) at follow-up. Overall,

respondents made use of health advice and information services significantly more

frequently at the follow-up stage than at baseline (T=4, p=0.001).

Figure 6: Use of health advice & information services

Involvement in Any Other Community Health Projects

Respondents were asked if they were involved in other community health projects

at both stages of data collection. Of the 66 respondents providing data at baseline

0 were involved in other community health projects. Three (5%) of the 63

respondents at follow-up had been at the follow-up stage, but no further details

were given.

Project Reach

Sharing of Information from the Project

At follow-up respondents were asked if they had shared information they had

received in the project with anyone else. Fifty-eight respondents provided data for

this question. In total, 31% (n=18) of respondents had shared information they

learnt through the project with someone else. The 18 individuals who answered

positively then indicated with whom they had shared information, and the results

are presented in Table 3.

57.6

39.4

3

31.8

63.6

4.5

0

10

20

30

40

50

60

70

Never Sometimes Often

Pe

rce

nta

ge

Frequency

Baseline

Post

22

Table 3: Individuals with whom respondents had shared learning from the

programme5

Reflections on the project

What Benefits Participants Hoped to Gain From the Project

Respondents were asked at baseline what they hoped to gain from attending the

project, fifty-five provided responses. The responses were grouped into 2 main

categories. The largest number of individuals (n=35) hoped to improve fitness,

and/or become healthier. A similar proportion (n=30) mentioned hoping to lose

weight. Several respondents (n=4) mentioned improvements to specific

conditions: managing diabetes, lowering blood pressure and reducing back pain.

Five individuals saw participation as a way to get back into exercise or training and

1 other saw it as a way to try out the gym. In addition, 4 participants hoped to

gain health advice/information. Other responses included eat healthy, increased

confidence, alertness, and weight gain.

Gains from Attending the Project

At follow up participants were asked what they actually gained if anything from

attending the project, sixty-four respondents provided data. Twenty four

individuals indicated they felt better/ more healthy, or had more energy or

improved health. Slightly less (n=21) said that attendance had improved their

knowledge or awareness of health or specific elements of positive health such as

healthy eating/diet, blood pressure or exercise. Nine indicated they now exercised

more regularly, and 9 also said they now ate healthier or ate more fruit and

vegetables. Eleven individuals specifically mentioned losing weight and 7 said their

blood pressure had decreased. Other benefits included increased confidence,

muscle tone, feeling stronger, desired weight gain, learning how to use the gym

and improved sleep.

5 Respondents could tick more than one answer

Frequency

Friend 12

Wife/partner 9

Other family member 4

Colleague 4

Other 0

23

Improvements to the Project

At follow up respondents were asked to give suggestions about how the

programme could be improved. Thirty-nine respondents provided data for this

question. Eighteen participants thought the programme should be longer, typical

comments included “do project for longer” “longer duration”, “run longer” and

another said “It would have been nice to have the project for a duration of 6

months to see more improvement”. Fourteen participants made general positive

comments such as “brilliant”, “great scheme” “it was very good”. Comments about

the gyms were given by four participants, with two suggesting longer gym opening

hours, and two others a greater number of participating gyms. Three participants

made comments related to the content of the project. One would like to see more

group classes, but conversely another suggested one to one training. ‘A greater

number of sessions’ was suggested by one respondent. Others suggestions made

included: “free gifts” and “get more drivers involved”.

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Discussion

Demographic information on those who participated in the Leeds Cab Drivers

project indicated a good adherence with the target group. Baseline measures of

health and lifestyle showed that participants presented with sedentary lifestyles

and limited consumption of fruit and vegetables. For example, just 12% of

participants engaged in the recommended 150+ minutes of moderate intensity

physical activity per week and just 3% reported consuming the recommended

amount of fruit and vegetables of at least five portions of fruit and vegetables per

week. Thirty-seven per cent (n=23) of participants submitted systolic blood

pressure readings of 140 or over, and 31% (n=19) submitted a diastolic blood

pressure of 90 or above thus presenting with high blood pressure.

With the exception of systolic blood pressure, all measures of participants’ health

showed statistically significant improvements over the course of the intervention.

Improvements were particularly pronounced in participants’ self-reported ratings of

health, waist circumference and diastolic blood pressure. Potentially contributing

to these improvements in health, participants reported significant increases in

physical activity and in the frequency of daily fruit and vegetable consumption.

In common with previous work, evaluation data indicated that there are a number

of barriers to changing the behaviours of taxi drivers. Data showed less profound

change in participants’ lifestyle measures including, no significant change in

participants sitting time, hours worked and limited change in ‘reasons for not

taking physical activity’, unsurprising given the professional demands of being a

taxi driver. However, there was some indication that the intervention may have

affected participants’ use of health advice and information services, as well as their

perceptions of support available to them in times of trouble. Further research

would be required to determine the nature of this relationship and whether the

intervention offers an appropriate and sustainable means of improving the health

of the target population. Specifically, further investigation is needed into how taxi

drivers and taxi firms can improve diet and levels of exercise within the constraints

which the profession presents. Suggestions for improvement provided by

participants such as more flexible hours for accessing services and a greater range

of activities to meet the preferences of individuals could be examined to determine

feasibility.

Data did indicate that several participants shared information which they had

received through the intervention to others, mainly friends and their wife/partner,

thus suggesting that the intervention may provide an effective means of

disseminating health information to the South Asian community. Future work

should aim to determine the most effective and culturally appropriate ways of

engaging the wider South Asian community in health promotion activities, including

‘hard to reach’ groups who do not engage in mainstream health care provision.

Results must however be viewed with caution. Budgetary constraints meant that

the evaluation team were unable to examine the processes involved in delivering

the project as was initially planned. As a result, the evaluation was unable to

examine perceived barriers and facilitators to implementation, delivery and

25

sustainability of the project and the health champion model. The evaluation

questionnaire only provided information on those who fully engaged in the

intervention, and therefore did not provide information on taxi-drivers who did not

complete the intervention. Whilst those completing the intervention provided much

positive feedback about the project, those referred to the project but did not attend

were not followed up therefore the evaluation was not able to provide information

on the barriers to engaging the target group. Furthermore the questionnaire was

administered by a member of Hamara staff, therefore threatening the validity of

the data.

Whilst acknowledging the aforementioned methodological limitations of the study,

data does suggest that intervention activities may contribute to positive change in

taxi driver’s health status.

Next Steps

Further research is needed to examine the potential of the intervention for

engaging other groups presenting sedentary lifestyles and the longer term effect

of participation in the project.

Further research is needed, looking at the broader impact of the intervention,

beyond bio-medical measures of health, on the lives of targeted groups, their

families and the wider community.

Further research is needed around the processes involved in implementing and

delivering the LCD project and the health barriers and facilitators to engaging

with the target group and examining the role of diversity within the target group

in influencing engagement. Routine follow-up of all referrals is required to

determine the specific barriers to engaging hard to reach members of the target

group.

Further investigation should be conducted around the potential for collaboration

with local NHS services.

26

References

BRITISH HEART FOUNDATION 2009. Diabetes and How it Afftects Your Heart. London: British

Heart Foundation.

BRITISH HEART FOUNDATION. 2011. South Asians and Heart Disease [Online]. Available:

https://www.bhf.org.uk/publications/south-asian-publications.aspx [Accessed October, 2013].

DEPARTMENT FOR TRANSPORT. 2013. Taxi and private hire vehicle statistics: England and Wales

2013 [Online]. Available: https://www.gov.uk/government/publications/taxi-and-private-hire-

vehicle-statistics-england-and-wales-2013 [Accessed October, 2013].

DRYDEN, R., HUME, A., PRINGLE, S., BYRES, P., BELCHER, M., DODDY, J., MARTIN, C. &

WILLIAMS, B. 2008. Addressing the cardiology unmet needs of taxi drivers in Dundee - A

'Community Heart' Project. Dundee: University of Dundee.

EQUALITY AND HUMAN RIGHTS COMMISSION. 2013. Employment [Online]. Available:

http://www.equalityhumanrights.com/key-projects/how-fair-is-britain/online-

summary/employment/ [Accessed October, 2013].

EU-OSHA. 2010. Taxi Drivers' Safety and Health: A European Review of Good Practice Guidelines.

Luxembourg.

FACEY, M. 2010. 'Maintaining Talk' among taxi drivers: accomplishing health-protective behaviour in

precarious workplaces. Health Place, 16, 1259-67.

LEEDS CITY COUNCIL 2012. State of the city: Our vision to be the best city in the UK. Leeds: Leeds

City Council.

LEEDS OBSERVATORY. 2012. Area Profile: Inner South Leeds [Online]. Available:

http://westyorkshireobservatory.org/resource/view?resourceId=1465. [Accessed October,

2013].

MCCULLAGH, J. 2008. Men's Health: Driving home a healthy message [Online]. Available:

http://www.personneltoday.com/articles/08/09/2008/46047/mens-health-driving-home-a-

healthy-message.htm [Accessed October, 2013].

MCEVOY, D. & HAFEEZ, K. 2009. Ethnic minority entrepreneurship in Britain. Management &

Marketing, 4, 10.

NHS CHOICES. 2012. South Asian Health Issues [Online]. Available:

http://www.nhs.uk/Livewell/SouthAsianhealth/Pages/Overview.aspx [Accessed October,

2013].

NHS LEEDS & LEEDS CITY COUNCIL 2012. Leeds Joint Strategic Needs Assessment 2012. Leeds.

NSMC. 2009. Taxi! Full case study [Online]. Available:

http://www.thensmc.com/sites/default/files/Taxi!%20FULL%20case%20study.pdf [Accessed

October, 2013].

PUBLIC HEALTH ENGLAND 2013. Leeds Health Profile 2013. Public Health England.

SOUTH, J. 2008. Hamara Health Living Centre: 'Bringing Communities Together'. . Leeds: Leeds

Metropolitan University.

WILLIS, L. & DHOOT, P. 2012. Case study of the CABS project: Champions for Achieving Better

Health in Sheffield [Online]. Available: http://clahrc-sy.nihr.ac.uk/resources-project-

reports.html [Accessed October, 2013].

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