Academic journal article Scandinavian Journal of Work, Environment & Health

Evaluation of an mHealth Intervention Aiming to Improve Health-Related Behavior and Sleep and Reduce Fatigue among Airline Pilots

Academic journal article Scandinavian Journal of Work, Environment & Health

Evaluation of an mHealth Intervention Aiming to Improve Health-Related Behavior and Sleep and Reduce Fatigue among Airline Pilots

Article excerpt

Irregular and long working hours, as well as the cross- ing of time zones are common working conditions of flight crew members, which can lead to a disturbance of the normal sleep/wake pattern and accompanying body functions (1, 2). Short-term effects of these working conditions include digestive problems, fatigue, sleep loss, and an impaired performance capability (3). On the longer term, fatigue and circadian disruption have been associated with a disturbed work-life balance (4), metabolic disturbances (5, 6), cardiovascular diseases (7), gastrointestinal disorders (8), and cancer (9-11).

Fortunately, several studies have shown that cir- cadian disruption can be mitigated by optimizing the timing of exposure to daylight and sleep (2,12). Further- more, the optimal timing of physical activity and intake of specific nutrients can enhance sleep duration and quality, and stimulate alertness or relaxation (12-14). In the aviation industry, attempts have been made to translate this knowledge into educational training pro- grams to help flight crew members cope with their flight schedules and accompanying circadian disruption (15, 16). However, few studies evaluated the effects of such programs. Some of these studies combined their educa- tional interventions with alterations in flight schedules, for which it was impossible to address the measured improvements to the programs alone (17, 18). Other studies found improvement in knowledge, awareness (19), layover sleep, and in-flight alertness among flight crew (20) after short-term application of fatigue man- agement advice, but did not measure the effects on the longer term. Altogether, both the short- and long-term effects of educational programs for flight crew members remain unclear.

Web-based interventions aiming at primary preven- tion have been shown to have positive effects on health knowledge and behavior among adults. The advantage of these types of interventions is that they are able to improve behavior by tailoring information and advice to the specific needs of the individual (21, 22). In recent years, it has become possible to provide such tailored interventions using custom-made mobile applications (apps). In the field of mobile health (mHealth) - the use of mobile devices in healthcare and public health - apps have gradually gained ground due to improvements in technology and an increased usage of smartphones and tablets (23). However, although there are indications that web-based and text messaging interventions can have positive effects on health knowledge and behavior of adults (22, 24), the evidence for such effects of mobile apps is still very limited (25, 26).

Regarding the development of an educational pro- gram for flight crew members to cope with irregular working hours, an app would make it possible to trans- late the relevant information into practical and specific advice, while taking into account the duration and destination of the flight and the number of time zones crossed (16). Moreover, an app would enable the flight crew members to consult personalized advice at any time and place, before, during, and after their flights.

The aim of this study was to investigate the effects of an mHealth intervention among airline pilots consist- ing of tailored advice on exposure to daylight, sleep, physical activity, and nutrition. We hypothesized that, compared to a minimal intervention, the easy obtainable, tailored advice would improve health-related behavior, resulting in a reduction of sleep problems and fatigue and an improvement in health perception.



A two-armed randomized controlled trial (RCT) was performed to evaluate the effectiveness of the MORE Energy mHealth intervention. The intervention strat- egy was developed after focus group interviews with a random sample of 30 pilots, and interviews with key management stakeholders of the airline company. The airline pilots emphasized that they would like to receive advice that was available at any time and place, usable by all types of pilots, dependent on the specific flight schedule, and easy to apply. …

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