Organisational travel plans for improving health New

Abstract

Abstract Background

Dependence on car use has a number of broad health implications, including contributing to physical inactivity, road traffic injury, air pollution and social severance, as well as entrenching lifestyles that require environmentally unsustainable energy use. Travel plans are interventions that aim to reduce single‐occupant car use and increase the use of alternatives such as walking, cycling and public transport, with a variety of behavioural and structural components. This review focuses on organisational travel plans for schools, tertiary institutes and workplaces. These plans are closely aligned in their aims and intervention design, having emerged from a shared theoretical base.

Objectives

To assess the effects of organisational travel plans on health, either directly measured, or through changes in travel mode.

Search methods

We searched the following electronic databases; Transport (1988 to June 2008), MEDLINE (1950 to June 2008), EMBASE (1947 to June 2008), CINAHL (1982 to June 2008), ERIC (1966 to June 2008), PSYCINFO (1806 to June 2008), Sociological Abstracts (1952 to June 2008), BUILD (1989 to 2002), Social Sciences Citation Index (1900 to June 2008), Science Citation Index (1900 to June 2008), Arts & Humanities Index (1975 to June 2008), Cochrane Database of Systematic Reviews (to August 2008), CENTRAL (to August 2008), Cochrane Injuries Group Register (to December 2009), C2‐RIPE (to July 2008), C2‐SPECTR (to July 2008), ProQuest Dissertations & Theses (1861 to June 2008). We also searched the reference lists of relevant articles, conference proceedings and Internet sources. We did not restrict the search by date, language or publication status.

Selection criteria

We included randomised controlled trials and controlled before‐after studies of travel behaviour change programmes conducted in an organisational setting, where the measured outcome was change in travel mode or health. Both positive and negative health effects were included.

Data collection and analysis

Two authors independently assessed eligibility, assessed trial quality and extracted data.

Main results

Seventeen studies were included. Ten were conducted in a school setting, two in universities, and five in workplaces. One study directly measured health outcomes, and all included studies measured travel outcomes. Two cluster randomised controlled trials in the school setting showed either no change in travel mode or mixed results. A randomised controlled trial in the workplace setting, conducted in a pre‐selected group who were already contemplating or preparing for active travel, found improved health‐related quality of life on some sub scales, and increased walking. Two controlled before‐after studies found that school travel interventions increased walking. Other studies were judged to be at high risk of bias. No included studies were conducted in low‐ or middle‐income countries, and no studies measured the social distribution of effects or adverse effects, such as injury.

Authors' conclusions

There is insufficient evidence to determine whether organisational travel plans are effective for improving health or changing travel mode. Organisational travel plans should be considered as complex health promotion interventions, with considerable potential to influence community health outcomes depending on the environmental context in which they are introduced. Given the current lack of evidence, organisational travel plans should be implemented in the context of robustly‐designed research studies, such as well‐designed cluster randomised trials.

Author(s)

Jamie Hosking, Alexandra Macmillan, Jennie Connor, Chris Bullen, Shanthi Ameratunga

Abstract

Plain language summary

Travel plans in organisations (schools, tertiary education institutions and workplaces) for improving health

Travel plans aim to reduce car use and promote more active and sustainable travel such as walking and cycling. This review focuses on travel plans for organisations, such as workplaces or schools. The main reasons for using travel plans are to reduce congestion and to be environmentally friendly, but travel plans are also commonly claimed to improve health. We included 17 studies in this review. One study found that promoting walking in a workplace improved some aspects of health, including mental health, but no other studies directly measured health effects. All 17 studies looked at changes in travel. Although some found that travel plans increased walking, others did not. Overall, there is not enough evidence to know whether travel plans are effective at changing the way people travel, or whether they improve health. Currently, organisational travel plans should be put in place as part of well‐designed research studies.

Author(s)

Jamie Hosking, Alexandra Macmillan, Jennie Connor, Chris Bullen, Shanthi Ameratunga

Reviewer's Conclusions

Authors' conclusions

Implications for practice

Significant emphasis is currently placed on organisational travel plans for changing the dominant mode of travel to work, school and tertiary education, with a number of environmental, social and physical health aims. Despite their considerable potential for influencing health through changing travel behaviour, evidence that organisational travel plans are effective is very limited. There is currently no evidence, outside pre‐selected highly motivated subgroups, that organisational travel plans have any effect on any health outcomes or risk factors that might be expected, such as injury, obesity, physical activity, air quality or social outcomes. Organisational travel plans are implemented in widely varying environmental contexts, which may impact significantly on their effectiveness. For instance, the safety of walking and cycling environments, and the accessibility of public transport are likely to be influential.

In practice, organisational travel plans should be considered complex health promotion interventions. Given lack of evidence for their effectiveness, the implementation of organisational travel plans should currently be in the context of robustly‐designed research studies, such as well‐designed cluster randomised trials.

Implications for research

More robust studies are needed to assess the effectiveness of organisational travel plans for changing travel mode or improving health. In particular, designs that minimise selection bias through randomisation, and that include follow up of individual participants, are needed. More consistent follow up of adequate duration both before and after the intervention would allow secular time trends to be identified and separated from the effect of the intervention itself. In addition, having a longer duration of follow up, with a number of time points for measuring outcomes, would increase our understanding of whether the effects of the intervention are sustained over time, or whether they are cumulative, with increasing effect over time (plausible with an ongoing social intervention such as this).

Cluster randomised controlled trials appear to be a good study design for evaluating these interventions, and should be well designed to minimise the risk of bias. If a controlled before‐after study design is used in future studies, efforts will be needed to ensure intervention and control groups are well matched on baseline characteristics, and to ensure that the risk of bias from incomplete outcome data is minimised.

There is a particular lack of studies in the workplace setting, although additional studies in the school setting are also needed.

Studies included in this review used a range of different methods for measuring travel outcomes. Consistent and robust methods for measuring travel outcomes are needed in future studies. The direct measurement of physical activity, rather than just travel mode, where feasible, would enable more accurate assessment of the health effects of these interventions.

Since increased injury risk is a potential adverse effect from these interventions, it would be useful for future studies to measure injury outcomes. While travel mode shift from car use to walking is likely to increase physical activity and reduce air pollution, whether it will increase or reduce injuries is unclear. Injury outcomes will need to be measured directly, which may require different study designs, including mapping over large areas.

Future studies should include evaluation of the social distribution of effects, e.g. whether the effects of these interventions differ by ethnicity or socioeconomic status, to determine whether different strategies are needed for different population groups. This may include the tailoring of interventions for currently disadvantaged population groups, whose needs may differ in important ways from more privileged social groups (Collins 2005). Additional qualitative research in disadvantaged settings may be needed to inform such tailoring of interventions.

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