Background South Asian (SA) taxi drivers potentially possess a double epidemiologic risk for cardiovascular disease (CVD) due to their ethnicity and occupation. This study investigates SA taxi drivers’ knowledge, attitudes, beliefs about general health, CVD and approaches to reduce CVD risk. Method Five focus groups were conducted with 31 SA taxi drivers in the participants’ primary language (Bengali, Hindi, Urdu or Punjabi). Audio-recordings of the sessions were transcribed, translated and entered into ATLAS.ti 6.2 for coding and analysis. Results SA drivers in an urban setting perceive themselves to be at high risk for CVD because of high work-related stress, physical inactivity, poor diet and poor health care access. Participants attributed their occupation to increasing risk for heart disease; none believed that being SA increased their risk. Discussion Interventions to lower CVD risk among SA taxi drivers should be multi-level and involve the individual drivers and the taxi industry.

There is considerable evidence demonstrating the positive impact of pedometers and walking programs for increasing physical activity and reducing risk for cardiovascular disease among diverse populations. However, no interventions have been targeted towards South Asian taxi drivers, a population that may be at high risk for developing cardiovascular disease. Supporting South Asian Taxi Drivers to Exercise through Pedometers (SSTEP) was a 12-week pilot study among South Asian taxi drivers to increase their daily step counts. SSTEP assessed the feasibility, acceptability, and potential impact of an exercise intervention employing pedometers, a step diary, written materials, and telephone follow-up to initiate or increase physical activity in this at-risk occupational group. Seventy-four drivers were recruited to participate at sites frequented by South Asian taxi drivers. Participant inclusion criteria were: (1) age 18 or over; (2) birthplace in India, Pakistan, or Bangladesh; (3) fluent in English, Hindi, Urdu, Punjabi, or Bengali; and (4) intention to remain in New York City for the 3-month study period. Comprehensive intake and exit questionnaires were administered to participants in their preferred languages. Intake and exit health screenings, including blood pressure, cholesterol, and glucose were completed. Daily step counts were obtained 4 days after recruitment, and at the 4-, 8-, and 12-week mark via phone calls. To measure the impact of the intervention, step counts, blood pressure, cholesterol, and body mass index were compared at intake and exit. Participants in SSTEP were sedentary at baseline. The SSTEP intervention resulted in a small increase in step counts among participants overall, and in a significant increase (92,000 steps) among a subset ("Bigsteppers"). Drivers with higher baseline glucose values had significantly greater improvements in their step counts. Focused lifestyle interventions for drivers at high risk for cardiovascular disease may be particularly impactful.

BackgroundLow- and middle-income countries (LMICs) are developing novel approaches to healthcare that may be relevant to high-income countries (HICs). These include products, services, organizational processes, or policies that improve access, cost, or efficiency of healthcare. However, given the challenge of replication, it is difficult to identify innovations that could be successfully adapted to high-income settings. We present a set of criteria for evaluating the potential impact of LMIC innovations in HIC settings.MethodsAn initial framework was drafted based on a literature review, and revised iteratively by applying it to LMIC examples from the Center for Health Market Innovations (CHMI) program database. The resulting criteria were then reviewed using a modified Delphi process by the Reverse Innovation Working Group, consisting of 31 experts in medicine, engineering, management and political science, as well as representatives from industry and government, all with an expressed interest in reverse innovation.ResultsThe resulting 8 criteria are divided into two steps with a simple scoring system. First, innovations are assessed according to their success within the LMIC context according to metrics of improving accessibility, cost-effectiveness, scalability, and overall effectiveness. Next, they are scored for their potential for spread to HICs, according to their ability to address an HIC healthcare challenge, compatibility with infrastructure and regulatory requirements, degree of novelty, and degree of current collaboration with HICs. We use examples to illustrate where programs which appear initially promising may be unlikely to succeed in a HIC setting due to feasibility concerns.ConclusionsThis study presents a framework for identifying reverse innovations that may be useful to policymakers and funding agencies interested in identifying novel approaches to addressing cost and access to care in HICs. We solicited expert feedback and consensus on an empirically-derived set of criteria to create a practical tool for funders that can be used directly and tested prospectively using current databases of LMIC programs.

This study provides encouraging results about the potential impact of an easy-to-deliver, easily scalable workplace intervention with a large, vulnerable population.