Using action research to improve health and the work environment for 3500 municipal bus drivers

During the past five decades occupational researchers have documented that bus drivers' health is worse than in almost any other profession. The authors suggest that the reason there has not been any successful attempt to change this situation is because the focus until now on removing statistically associated external risk factors has been too narrow. The article describes a project whose purpose was to improve the health and well-being of 3500 Copenhagen bus drivers. At the end, more than 200 interventions were implemented. The authors adopted a new approach of combining epidemiological results and qualitative methodologies, creating a broader explanatory foundation for action, linked by repetitive processes of critical reflection, which was central to defining problems, explaining causes, developing sufficiently effective interventions and measuring effects. The project revealed the importance of several new and potentially preventable factors involving such issues as lifestyle, private stressors and inappropriate management. During the project period an evaluative framework was developed to explore and measure the complex effects of multiple interventions. Three years after the interventions were launched, follow-ups revealed remarkable improvements such as reductions in stress and body pains, an increase in satisfaction, and improvements in management and the drivers' cabin. This article is the story of a methodological journey, from classical epidemiology to an approach combining the strengths of survey (broad coverage), qualitative methods (in-depth focus) followed by critical reflections and ending with action research.