Unmet mental health needs in a male-dominated immigrant workforce: Is mobile technology the answer?

Problem

The taxi industry is a male-dominated, predominately immigrant workforce with multiple risk factors for poor mental health. Despite being six times more likely to experience high psychological distress than men in the general community, taxi drivers are no more likely to present to primary care. Low rates of contact with health services, combined with high mental health needs, suggest that taxi drivers are a hard-to-reach population for whom targeted support is urgently needed. Mobile technologies may be a way to provide this support and encourage help-seeking among those who need it.

Approach

This presentation describes the user-centred development and feasibility testing of a smartphone friendly website that aims to reduce psychological symptoms and increasing help-seeking intentions among people working as taxi drivers. Main features of the website included a mental health checklist and over 30 health and wellbeing activities which were presented as videos using real taxi drivers as the actors. Nine drivers participated in two phases of user experience (UX) testing of the website prototype. 46 drivers were recruited to the feasibility trial, and were instructed to use the website any way they liked, for four weeks. Participants completed pre-post measures (DASS-21, Help-Seeking Behaviour, General Help-Seeking questionnaire) and, at follow-up, the User version of the Mobile Application Rating Scale (uMARS). Website use was recorded with Google analytics.

Findings

Results of round 1 of UX testing resulted in modifications to labelling, function and presentation. Round 2 indicated that all problems identified in round 1 had been resolved. No new issues were identified. Forty drivers (87%) in the feasibility trial returned follow-up questionnaire. Results indicated that the website was well-received. Two thirds of participants said they would recommend the website to many people, and some appeared to have already done so, with almost twice as many unique users (n=89) as trial participants. Mental health literacy and help-seeking intentions increased at follow-up, although no change was found in mental health symptoms. Qualitative data indicated that drivers also wanted more content relating to physical health.

Consequences

The Driving to Health website is the world’s first health and wellbeing mobile website for taxi drivers. It is tailored for the large population of immigrant men working in the taxi industry. UX testing indicated strong support for the Driving to Health concept, and resulted in modifications to terminology and interface to increase instinctive usability. The feasibility trial demonstrated that the app is both used by and acceptable to drivers, and improves attitudes towards mental health care. Overall, the findings support further pursuit of the Driving to Health website as an easily distributed and cost-effective option for addressing the substantial need for mental health support in this ‘on the move’ population.